by Nina Ackerman Indig
The Jewish Hospoce Helps the Terminally Ill Live Life to the Fullest
Chaim Bergman’s* (* A pseudonym) cancer was spreading rapidly. Ravaged by illness, his body was reduced to a mere shell of its former self — but his spirit hung on. Mr. Bergman’s grandson was getting married in a few months, and Zaide was determined to be there.
His doctors gave him six weeks to live. To their amazement, and to that of his family and friends, Mr. Bergman did not succumb. He continued to live at home, where his physical and spiritual needs were met. As the months passed, the upcoming wedding was always on his mind.
A few days before the big event, Mr. Bergman took a sudden turn for the worse. He was admitted to a health care facility, where he slipped into a coma.
The day of the wedding arrived, and Mr. Bergman suddenly opened his eyes. “What day is it?” he asked urgently. Upon learning that it was his grandson’s wedding day, he asked for the intravenous tube to be removed and his tuxedo to be readied; after all, he had a chasunah to attend!
Mr. Bergman’s son gathered his father’s formal attire and returned to the facility to help him dress. When Mr. Bergman pointed out that his dress socks were missing, one of the nurses hurried to a local store to purchase a pair for her determined patient. Finally, wearing his tuxedo (now several sizes too large for his emaciated frame and hastily pinned up to fit), Mr. Bergman was transported to the wedding hall. He mingled with family and friends, and, as he had hoped and prayed for all along, he blessed his grandchildren, wishing them a long and happy life together.
What makes Mr. Bergman’s story particularly notable is that it occurred while he was receiving services from The Jewish Hospice of Greater New York. From the time he received the inaccurate prognosis that he was at the cusp of death until his passing shortly after his grandson’s wedding, Mr. Bergman remained under the care of the doctors, nurses, social workers, and rabbis who participate in this remarkable program.
In accordance with the hospice’s philosophy, this care was administered at Mr. Bergman’s home for as long as possible. When the sudden deterioration took place, Mr. Bergman was transferred to the hospice’s in-patient facility. It was from there that he traveled to the wedding.
The four-year-old Jewish Hospice is a program of the Metropolitan Jewish Health System, which first established the Brooklyn Hospice (now called the Metropolitan Hospice of Greater New York) nineteen years ago with the goal of improving the quality of life for individuals with life-limiting illnesses. Although this philosophy transcends religion and ethnicity, and the hospice program was headquartered in Borough Park, Brooklyn, Orthodox Jews did not generally avail themselves of the hospice’s services. The religious community had the false perception that the philosophy of hospice care is inconsistent with Jewish law.
 Rabbi Yosef Stern, the chaplain of the Jewish Hospice |
A dialogue between the hospice management and Orthodox rabbis and leaders ensued. The outcome was The Jewish Hospice of Greater New York, where end-of-life issues are dealt with according to halachic guidelines. When a patient’s physician, working with the patient’s rabbi, decides that aggressive treatment, such as chemotherapy or radiation, is no longer a viable option, and when the patient’s prognosis is for less than six months of life, he or she may be eligible for the hospice program. Under its provisions, the patient generally remains at home, receiving palliative care in familiar surroundings. Health professionals monitor his condition on a regular basis.
A terminally ill patient entering The Jewish Hospice program is given the choice of signing a halachically valid living will. In this document he designates a rabbi who is to be consulted regarding end-of-life issues. In addition, the hospice retains two rabbis on its staff. In this way the patient’s spiritual needs are addressed along with his physical ones.
Rabbi Meyer Scheinberg, Rav of Kehillas Orach Chaim in Flatbush, Brooklyn, serves as the hospice’s posek, or halachic authority, regarding issues such as resuscitation, hydration, nutrition, and medication. These are determined on a case-by-case basis. He visits the in-patient unit and is available to consult with doctors, patients, and family members. Rabbi Scheinberg meets regularly with the hospice staff members to answer their queries regarding specific cases and incidents, and to sensitize them to halachic issues. These include kashrus, prayer, modesty in dress, and Shabbos and yom tov matters.
Rabbi Yosef Stern, Rav of Congregation Agudath Achim in Midwood, Brooklyn, is the hospice’s chaplain. He visits patients and is available to talk and listen to them. After being there for both patient and family during the patient’s last days or weeks, he offers bereavement counseling for the grieving family.
Rabbi Stern’s approach is the essence of bikur cholim, the mitzvah to visit the sick. If the patient is able to talk, Rabbi Stern establishes a rapport, discussing the “old days” — the patient’s life and experiences. He tries to instill hope, but not false hope, thereby focusing on the concept of chayei sha’ah, or short-term life. This reinforces a central hospice theme: that every day is important and there are things that can be done in even a short time.
While the health care workers focus on alleviating the patient’s physical pain, the chaplain addresses the spiritual quality of life. At the appropriate time, Rabbi Stern emphasizes the importance of helping a dying person recite Viduy (a ritual confession of sins and request for forgiveness) and Shaimos (verses stating belief in G-d’s divinity).
The decision to suggest the recitation of Viduy is not a simple one. A patient who is encouraged to do so may become alarmed that death is near, which itself can hasten his demise. Rabbi Stern takes great care to gauge each patient’s emotional state.
Many poignant moments have marked Rabbi Stern’s visits. One patient was an alumna of the Bais Yaakov in Poland and an Auschwitz survivor. Legally blind and deaf, she wanted to recite Shaimos. Since she could neither hear the words nor read from a regular siddur, Rabbi Stern wrote out the prayers in large letters on cue cards. She yelled out the words from her bed.
Then there was the patient, ravaged by cancer and Parkinson’s Disease, whose daughter asked the rabbi to encourage him to sing. The patient sang the classic liturgical songs “Lecha Dodi” and “Adon Olam” with profound feeling, and was briefly able to overcome the intensity of his suffering. Rabbi Stern recalls a Russian patient whose husband, a man totally estranged from his heritage, was a descendant and namesake of Rabbi Yisrael Salanter, the founder of the Mussar movement. After the wife’s passing, Rabbi Stern maintained a relationship with the bereaved husband, giving him information about his illustrious forebear, thus helping him build pride in his personal bond with Yiddishkeit.
Moshe Borowski, who serves as a community liaison and social worker for The Jewish Hospice, emphasizes that even seemingly small actions must be carefully considered. “People sometimes have a tendency to speak about patients as if they’re not there. But they are there! We stress that families should speak soothingly to patients, touching and stroking them often as a form of comfort and support.”
Religious rituals can also comfort hospice patients. “I remember a Russian patient who wanted to light Chanukah candles,” says Borowski. “Other than fasting on Yom Kippur, this was probably the only ritual he had performed in the past fifty years. He kept talking about how Purim had been celebrated in his shtetl as a young boy. I gently reminded him that it was now Chanukah time, but he continued to adamantly reminisce about Purim. The patient ended up passing away about six weeks later, right after Purim. It’s amazing how some people seem to have an intuitive sense that the time that Hashem has allotted them is near its end.”
And there was the time Rabbi Stern visited the bereaved parents of a young man who had passed away six months earlier due to a brain tumor. The parents were distraught, seeking meaning in the tragedy. “What can we do in memory of your son?” Rabbi Stern wondered aloud. “Perhaps you would consider putting on tefillin every day.” The father replied, “I don’t know how to, and besides, I don’t have any.” The rabbi approached a friend who makes battim (tefillin boxes) and had expressed a desire to give a pair of tefillin to a bar mitzvah boy who couldn’t afford them. Rabbi Stern arranged to have the tefillin donated to this older man instead. The rabbi taught the man how to wear them; now, months later, the mourning father’s outlook has improved somewhat.
Although the hospice is a home-care program, The Jewish Hospice of Greater New York also has a fourteen-bed in-patient unit. Patients are admitted when their pain becomes unmanageable at home. After the pain is brought under control at the unit, the patients return home. Patients may also be admitted if family caregivers need a brief respite from the intensive daily assistance they provide.
Decorated in soothing tones of gray and teal, with carpeted rooms and hallways, the in-patient unit strives to achieve a homelike ambience. There is a lounge for visitors and patients, with a television, two microwave ovens, pictures and flowers, plants, and brightly colored pillows. A small outdoor terrace leads off the lounge. Families are encouraged to visit, and even to sleep over. A glatt kosher kitchen serves the patients, but relatives are encouraged to bring favorite foods for patients who are able to eat.
Alex Moses, a veteran nurse in the in-patient unit, prefers to call the people under his care “residents” rather than “patients.”
“I must please the family without hurting the resident,” is how he codifies his philosophy. “The last things to go are hearing and touch. Sometimes visitors stand around a bed and talk about a patient who seems comatose. I gently pull them out of earshot. Sometimes I’ll put the bed rails down and put the relative’s hand into the patient’s hand. ‘Talk to him,’ I say. ‘He hears you. Tell him you’ll see him again. Tell him you love him.’ It’s important to effect a degree of closure.” Maxine Hochhauser, an Executive Vice-President of the Metropolitan Jewish Health System, says that often a patient is not referred to The Jewish Hospice early enough. “A person does not have to be in the final stage of life to be admitted,” she says. “If a person with life-limiting illness is referred earlier, there’s more that we can do regarding intervention.”
Abby Gordon, Administrator of The Jewish Hospice, adds: “Hospice is a service nobody wants to need, but it’s important to know about it. End of life becomes such a crisis. Many people don’t know that they have this option to meet medical, physical, and spiritual needs. We believe in a philosophy of entitlement: at the end of life, a person is entitled to the best care possible.”
For additional information about The Jewish Hospice, call 718-921-7900.
Nina Ackerman Indig is a free-lance editor and writer living in Bayswater, NY. Her articles have appeared in various magazines, including Jewish Action and Country Yossi.