Patients Don't Know When Care is Futile
This makes my blood boil!
A new study of cancer patients found that 60-80% of those given palliative radiation treatment thought it was
going to cure their cancer, when in fact their cancer was fatal and the radiation was just to maybe make their tumor shrink
a little, make the cancer progress a little more slowly.
"How can we bridge this communication gap?," ponder
the researchers. "We don't even know if it's a problem with how the doctor speaks or how the patient listens."
the answer: The problem is that no one brought in spiritual care!
A chaplain would have known that the patient misunderstood,
and would have called a meeting between patient, their family and the doctor to hold everyone's feet to the fire until
the point was made and absorbed.
Do we all know that we are talking about how this patient's last days should be
Hospice Business Takes a Hit
The cure for anger: Parashat Emor
Life is not easy. In fact, at times it’s downright infuriating. Our natural tendency is to want to blame someone, and
the easiest target is God. We may carry anger at HaShem for our entire lives. As a result, we miss out on decades of spiritual
connectedness and comfort.
There is another way, and the Ishbitzer Rebbe (Rabbi Mordechai Yosef Leiner) uses this
week’s Torah reading, Emor (Lev. 21-24) as the answer. It contains a list of five kinds of negative thinking, in the
form of rules for the high priest, matched with a framework for redirecting our thoughts when they arise, in the form of
We can’t choose what pain we will experience day to day. We can, however, choose not to let
ourselves feel alienated from the Holy One as a result, freeing us to remain open to God’s loving presence in our
lives. The Ishbitzer shows us how.
First, the priest is told to avoid funerals, saying it will contaminate him.
He cannot grieve in community, even for his own parents. How infuriating for him! For the Ishbitzer, this suggests existential
frustration — the hopeless feeling that the world is a shattered place and we can’t fix a thing. We
rage at God: “Why don’t You put things right?”
The cure is Passover. Its core message is
that God takes us out of Egypt, the narrow place, with a mighty hand and an outstretched arm. We need never doubt that God
will deliver us from our circumstances, and that the world is moving toward a time of Messianic perfection. Pesach tells
us to have faith. Change can and will come.
Second, the priest must be unblemished: without disability or disease,
injury or scar. This corresponds to the humiliation we feel about our own weaknesses and broken places. We wish we were
more beautiful, more admired, more accomplished.
Shavuot is the remedy for this line of thought, the holiday when
we commemorate receiving the Torah. Torah, it is said, heals all wounds and perfects all imperfections, because they don’t
matter to God. A life of prayer and study, of spiritual attainment, helps us to let go of shallow understanding and to be
who we are truly meant to be. Shavuot tells us we are perfect just the way we are.
Third, a priest must rigorously
guard his ritual purity, such as by marrying only a virgin. How infuriating for him to be so close to service and then to
be made impure by his sexual relationships. This is the sadness of addictions and distractions. We are drawn to the things
that seem to bring us relief from the anxiety of life. They may tamp down our loneliness and disappointments, but they push
away God and truth in the process. We are left feeling numb, sick and spiritually dead.
The cure is Rosh
Hashanah. When the shofar is blown, the world starts over again afresh. The Book of Life opens before us, ready to receive
the good news of our readiness to change our ways. Rosh Hashanah reminds us of our neshamah taharah, our eternally
Fourth, Emor speaks of ways in which the sacrifices themselves can be unworthy of ritual use. The
owners of these offerings might cry out to God, asking why their hard-earned possessions should be judged inadequate. It’s
so easy to fall into the self-righteousness of deprivation. “We deserve better!”
Yom Kippur comes to
hand us a feeling of infinite riches. By abandoning our worldly pleasures and benefits for a day and focusing solely on
God, we see our meager belongings take on a new, perfected light. Yom Kippur says, “I have plenty.”
finally, the Ishbitzer sees the command for the Kohen to eat the thanksgiving offering “on that day” to point
out our tendency to fret about what was or will be, rather than rejoice in what we have right now. We go through our days,
flooded by memories and worries. Our thoughts convince us that they alone will bring relief, but they never do. Only by
letting go and standing in awe and fear of the Holy One of Blessing can we bring our lives into focus.
is the teaching of Sukkot, z’man simchateinu, the time of our joy. This moment, this breath, is as flimsy
as a leaf-covered hut. But it is God’s promise to protect and surround us, to give us joy and never to abandon us.
Sukkot is presence.
As we continue our counting of the Omer toward Shavuot, may the Ishbitzer’s Emor
mindfulness practice give us the tools we need to release suffering, and to refine ourselves, like a silversmith pounding
shiny bits together to form a whole, holy vessel for receiving Torah.
[Originally appeared in the LA Jewish Journal, April 24, 2013.]
The Kalsman Institute's Jewish Wisdom & Wellness Week is fantastic! To see a picture of me demonstrating
chair poses as part of a group demonstration of Jewish yoga, follow this link.
Rabbi Avivah Interviewed
was interviewed by the organizers of Jewish Wisdom & Wellness: A Week of Learning, (April 21-27) because I will be involved
with several of the week’s programs. Below are links to the clips now posted from those talks.
will be a panelist for the talk Is Yoga Kosher? Why These Jews Stand on Their Heads (Monday,
April 22, 2013, 6:00 pm, at Temple Emanuel of Beverly Hills, 8844 Burton Way, Beverly Hills, CA, 90211). We will talk about
how we found yoga to be a path to our own Jewish souls. For myself, yoga was central to my coming to the rabbinate, and finding
the boundary between Judaism and Yoga was the goal of my masters thesis. The panel will be moderated by Rabbi Anne Brener,
and panelists in addition to myself will include Jewish yoga teachers Ida Unger, Michelle Azar and Zack Lodmer.
I am also involved with the newly forming Jewish Burial Society of Los Angeles, this city’s
first community-wide Liberal Jewish chevra kaddisha. Trainings will be taking place throughout the week, in both Los Angeles
and Orange counties. It is our hope that trainees will become volunteers for the society, which will make available to anyone
who wishes them, the traditional Jewish practices of ritually guarding, washing and dressing the deceased for burial.
A blessed Passover, Easter and Spring season to us all.
Peace Starts At Home
Patients I visit in my chaplaincy work often ask me if the term “Jewish chaplain” is an oxymoron. Doesn’t
“chaplain” mean Christian? Am I not really a rabbi? And is what I’m doing, sharing spiritual presence
and nondenominational prayer with people of all backgrounds, not really Jewish?
The idea that Jews need to steer clear
of non-Jews in prayer is deeply rooted in our texts. In this week’s Torah reading, Mishpatim, for example, the Israelites
are told that that they will need to “smash the pillars to bits”, demolishing the holy places and objects of
the foreign religions they will encounter when they overtake the land that will be Israel.
As a professional interfaith
chaplain as well as a rabbi, I have come to feel that assertions such as this in our texts have been misunderstood by many
Jews, and that this has led to needless parochialism and fear. Interfaith work is not only okay, I see it as a pure expression
of Jewish teachings, and the reason why I am drawn to it.
At the same time our tradition teaches the importance of
avoiding the practices of other faiths, we are taught to take care of all people. Rabbi Hillel addressed this balance: “If
I am not for myself, who will be for me? If I am only for myself, what am I? And if not now, when?” We wish to live
in a world of mutual trust and honoring of difference – where no one would wish to deprive us of our own, personal
relationship with the Holy One, and we need to afford others the same respect. I am privileged to be able to model this
through my work.
Jewish chaplains need not say the “foreign” words of other traditions. I was once asked
to perform an “Anointing of the Sick” (it used to be called “Last Rites”) for a dying Catholic when
no priest or Christian chaplain was available. I got the booklet of prayers and divided them up; I read the 23rd
Psalm while family members read the prayers with Christian doctrine and verbiage in them. As I held the spiritual space,
a family otherwise too distressed by the moment was able to relax into the eternity of this opportunity, to bring blessing
to their loved one as they transitioned away from this world. They were very grateful for the opportunity.
the pillars of other faiths in place is very Jewish indeed. By understanding the Parsha’s teaching differently, we
can see the message in a new light: as a command to reject values that undermine human connection and understanding. Smash
obstacles to mutuality. Hate “hate,” and love “love.”
Hardship and rebirth
In these dark, cold days of winter, it’s so easy to lose hope. Add to this the hardships of loss, with which life
seems intent on liberally sprinkling our lives, and we get something akin to paralysis. We may feel like a tree in winter,
shorn of its leaves, standing still like death. Will spring ever come, and will we survive until it does?
of the Talmud knew this place of emptiness and sought to ritualize the experience of awakening from winter’s fearful
sleep with a message of new growth by pointing to the rising sap and first fruit buds in our orchards. This Shabbat we celebrate
the 15th (written with the Hebrew letters “TU”) of the month of Shevat, Tu B’Shevat, the New Year of the
Trees, as well as Shabbat Shirah, the return in our Torah reading of the Song of the Sea, with which the Israelites expressed
their gratitude to HaShem for their escape from Egypt.
In our Torah reading this Shabbat, Beshalach (Exodus 13:17-17:16),
we find not God or Moses being credited with the exodus from Egypt, but Pharaoh — the ruler who refused to free the
Israelite slaves through 10 plagues that destroyed his own economy and brought tragedy to every household. God then leads
the Israelite people through 40 years of war and regrouping in the desert, saying this is what we need to shape us into a
people ready to enter the Promised Land.
Can obstacles, hardship and trauma actually contain the buds of our
“What does not kill me makes me stronger,” wrote Friedrich Nietzsche, a German philosopher
in the late 1800s. An article in Current Directions in Psychological Science says, yes, hardship is good for us. Loss allows
us to develop the ability to cope through gratitude for what we still have.
Psychology Today, on the other
hand, ran an article saying that what doesn’t kill us makes us weaker. It says the connection between hardship and
strength building is a coincidence, like a chicken that pecks the same spot before random food drops in, hoping to re-create
the chain of events. It’s not the calamity that hardens us, it says. If you’re stronger after, it’s despite
— not because of — the trauma. Trauma exposure leads only to vulnerability and mental disorders down the road.
Only tender love and care build character and adaptability, it says.
So the jury is out as to whether the
school of hard knocks provides a useful education.
But there is a difference between hardship and suffering.
According to Buddhist teaching, dukka, suffering, is not having bad things happen in your life. It is letting your
mind dwell on them — being filled with worries, stresses, plans and panics. What matters is how we process our grief.
I visited a woman in the county jail with drug problems. She told me that since I last saw her, she had been released,
hospitalized for an illness, prescribed a painkiller, and made the mistake of telling the nurses she wanted more. And here
she was again, in jail, meeting me, just like before, except for one thing: She felt incredibly grateful. She could so easily
have slipped back into her old addictive habits, but God had sent her a mighty hand in the form of further incarceration.
She felt chastised for the good, and ready to see what else God had in store for her.
The benefit of hardship,
according to psychologist Polly Young-Eisendrath, is not having had it, but the confidence gained from knowing you survived
it and, perhaps, that you are part of something that cares about your survival. Similarly, Carl Jung wrote that the difference
between suffering in vain and suffering productively is being able to give things a spiritual context. If we can find hope
in the midst of darkness, if we can believe fervently that this time will pass and that there will be a meaning for it,
we can get through it and become new on the other side.
Sometimes it is this process of letting go of who
we were and becoming someone we don’t know that is the hardest part of spiritual growth. As the great mystic Rabbi
Isaac Luria wrote in the 1500s, by being shown the truth and the splendor of spirituality, the soul rudely awakens to the
triviality of all the things the body convinced it to be important in this world. This realization of the shallowness of
the physical world is more painful than any pain that can be experienced in it. Yet, it is what the righteous strive for:
to allow their old, frightened selves to die, so that they may live fully in the truth of spirit.
This is the message
Chaplaincy from a Doctor's Perspective
A great summary of healthcare chaplaincy recently appeared in a blog in the Washington Post. A quote from it:
"Professional chaplains are trained and board certified (like the rest of us in health care)
to meet the needs of people from any faith or no faith. They help to identify and call on sources of strength to cope with
a life changing health situation. Professional chaplains are active listeners. They clarify and address concerns, and facilitate
communication between the patient, family, and the health care team. They aim to help the care plan integrate the beliefs,
values and practices that are important to the patient and family."
The author goes on to advocate for a systemization
of the chaplain's toolkit, known as our interventions. That was my goal in my previous post titled "Putting Chaplaincy
I have now re-edited that post to incorporate both the original list and my modifications. It represents
an evolving effort to compile a complete list of all the services, skills, talents and kindnesses that a professional chaplain
can offer in a healthcare environment. It can be found here.
Happy New Year!
Having 'The Conversation'
How do you want your medical affairs to be handled when you can no longer say? Would a life without walking or talking
or eating or thinking still be a worthwhile life, by your definition? And do your family and friends know your wishes?
According to this story by ABC News, when we know our loved one's wishes and preferences ahead of time, we experience dramatically less trauma
following that inevitable loss. Rather than being torn by thoughts of "what would he/she want?", we will know exactly
their wishes and concerns, and can be confident that our decisions will be in full accordance with how they would want things
Having "The Conversation", for ourselves or for someone we care for, can be one of the hardest
things we do, and one of the most important. If this does not sound like something your family can handle alone, consider
adding a healthcare chaplain to the mix. Guiding families to make informed, comfortable decisions is exactly what we are
trained to do. We can help put all parties at ease, prepare them ahead of time, guide the conversation to ensure that it is
calm and complete, and fill out an Advanced Directive for Healthcare to record the wishes expressed.
A beautiful season
of light to all.
What Chaplains Do
Putting Chaplaincy Into Words
Patient-centered, professional spiritual care (as opposed to religion-centered proselytization)
as part of an effective medical interdisciplinary medical team is so new, professionals in the field are only now starting
to try to capture in words what it is we do, and why it’s unique and essential. I was invited to write an article for PlainViews, an online journal that presents the cutting edge of research into the efficacy of chaplaincy in a healthcare setting
– or as they put it, “spirit-centered palliative care,” in the issue that came out today.
What I wrote is a set of suggestions for expanding on a list of 54 “interventions” (things
chaplains can do to help) that appeared in the previous issue. The original list’s author, Chaplain Brent Peery,
DMin, BCC, had invited comment on his work. My response added the perspective I could bring, as …
A rabbi –
there were items that only made sense if you were familiar with Christian theological language;
A chaplain with experience beyond hospitals
– it lacked references to cover hospice, extended care and other circumstances; and
A former newspaper editor – I
also made suggestions to consolidate and clarify the wording of the piece.
With the permission of the publication, I have uploaded the article I wrote and
the two-part article by Peery that it expands on, below.
Peery List of Interventions
Erlick Expansion on Peery