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AUGUST 1996 EDITION


The Art of Visiting the Sick

by Rabbi Myer Schecter

Reprinted with permission from THE JEWISH OBSERVER
Agudath Israel of America, New York, October 1992

As a hospital chaplain, I often get calls from people interested in visiting the sick, "Can you please give me a list of the patients in your care? I really would like to get involved in a visiting program."

The chaplain usually tries to accommodate these well-meaning people, but most hospitals have a strict confidentiality code that prohibits distribution of patient lists. In addition, some patients simply do not want it known that they have been hospitalized. This is their privilege and right. But working within the guidelines of confidentiality, the chaplain and volunteer department can prepare a list for the friendly visitor to enable him to see certain patients--especially those who need such visits the most.

Visiting the sick is one of the commandments whose performance is limitless, that is, it is of such significance, that even a visit of short duration can tremendous value. On the one hand, the Talmud records that after Rabbi Akiva had visited an ailing student and cared for his basic needs, the young man told him, "Rebbe, you restored me to life!" On the other hand, Rabbi Akiva said, "He who does not visit the sick is as one who sheds blood"
(Talmud, Nedarim 40a).

In many cases, the patients are elderly people, and there is an additional commandment of giving honor to elders, as well as numerous other mitzvahs that emphasize responsibilities to parents, teachers, and those older than us.... "Respect for our elders is tied to the fear of G-d Himself' (Talmud Kiddushin 32b).

THE DROP-OUT TENDENCY

Actually, few of us have to be convinced of the importance of visiting the sick, and yet many people who decide to visit the sick on a regular basis tend to drop their commitment after a couple of visits. In trying to understand the reasons for this drop-out tendency, we need not saddle ourselves with all the blame. Ours is a different world from that of our sages. Our society emphasizes privacy; in fact, we hardly know our neighbors. We don't like to intrude on others, and we become upset if others intrude on our privacy. How, then, do we approach the patient we have never met before? "Rabbi, what do I say? How can I tell if he is receptive? What if he rejects me?" This awkward feeling is only natural. And because of these fears, we tend to visit only those who are close to us, family or friends. This, too, only reinforces the privacy ethic, defeating the whole purpose of the reach-out element in helping others.

There are other underlying causes to our laxity towards assuming this commandment (mitzvah) as a routine. The average patient in an "acute-care hospital" is in the late seventies, and very often he (or she) is there immediately before or after surgery. A visit during such times of anxiety and physical weakness may not be appreciated. And then, in a long-term-care setting, patients may be stroke victims, suffering from chronic heart ailments, struck with Alzheimer's, incontinent, or just very ill; visiting here can be quite delicate and uncomfortable for both visitor and patient.

There is also an internal mechanism of denial that affects all of us. We become uncomfortable with older people who are ill. We prefer to belong to that group of young (or recently-young) people who are vibrant and alive. We wonder, without actually asking ourselves, "Am I ever going to be like that sick 'old lady'? If so, who wants to live so long? What kind of quality of life is that?"

Or when contemplating a visit to younger patients that are suffering from chronic illnesses or debilitating diseases, we tend to shun confrontation with such tragic circumstances: "Could the same thing happen to me?"

Although these feelings come naturally, they run counter to basic Jewish attitudes--from the concept of respect for every human being as bearing the Divine image, to the requirement to bear a burden with our fellow, no matter how heavy or uncomfortable it proves to be. The plan to visit should over rule the impulse to stay home.

When preparing to visit hospital patients, I strengthen my resolve by recalling a thought I once heard from Rabbi Avrohom Pam, Dean of Yeshiva Torah Vodaath:
The Midrash relates that when our matriarch Sara conceived a child at the age of eighty-nine, barren women the world-over also became pregnant, people were cured from illnesses, and a sense of joy pervaded the world. Rabbi Pam asked, 'Why was it necessary for the whole world to be filled with joy, just because Sara became with child?" He answered, "Sara would not have felt true joy if the salvation were hers alone. In making certain to please her, G-d saw to it that all other barren women would also conceive. Only then was Sara able to sense the joy.

The message is indeed profound, but it is not new in Jewish life. By way of contrast, people frequently complain about the impersonality of contemporary society, and bemoan the fact that people just "don't care any more." These arguments and discussions have been pursued ad nauseam, to the effect that we have become desensitized to the alienation that pervades today. The very essence and 'raison d’ętre' of groups visiting the sick is to negate this tendency and to inspire some personalized caring in this cold, fragmented world of ours.

ENTERING THE PATIENT'S WORLD

Before visiting the sick, we should develop our understanding of the patient's world.

As patients enter a hospital, they are subjected to a process of depersonalization and humiliation. Starting in the admitting area, patients are given identity tags, a hospital card and an information book which tells of the patients' rights and responsibilities. They are then brought to an unfamiliar room, often with very ill roommates, told to remove their clothes, and to put on an ill-fitting gown. Next, they are confronted by a nurse and intern who dole out instructions and information in language not distinguished for its clarity. Older patients frequently find themselves helpless, at the mercy of nurses and orderlies who are often overworked, sometimes less than compassionate. Some patients have to be assisted in eating, going to the bathroom, getting in and out of bed, even to manage a drink of water. This whole process brings a loss of autonomy, creates feelings of dependence and lack of self-worth that are difficult for the patient to accept.

It is precisely at this point that visiting the sick is essential, and becomes something of an art form. It is not only the importance of the visit per se, but how we make use of the visit: how we talk to the patients, our tone of voice, how we touch the patient, fix a pillow and encourage him or her. It's how we listen to their problems, how we give them the self-esteem they sorely need, and how we just make them feel human again. If one may, one could describe the Jewish commandment of visiting the sick as being "beyond measure" simply as referring to what the visitor gives over to the patient. We cannot measure, in any terms, the significance of your promise to pray for them, your listening to their problems and pains, the value of your smile and your sense of humor, which gives them such a lift. And what can equal the value of the handshake you receive in return, or the gratitude and blessing the patient may shower upon you as you leave? They are beyond measure.

SOME PRACTICAL GUIDELINES

To ease the way for those who are considering the formation of visiting the sick groups, I would like to offer a few suggestions. Many of my points may strike the reader as ordinary common sense, but they bear review, for they have been very useful to me. Eventually, of course, every visitor of the sick will develop his or her personal approach.

1. Advise the chaplain and volunteer department of the group you are forming--they may have invaluable suggestions. Ask for names and room numbers for the patients you should visit. Names are very important for introductory purposes: they immediately make visits more personal. Entering the room, you might say, "Is this the room of Jack Schwartz? My name is Joe Levy from a visiting-the-sick group. Is it all right if we visit with you?" Addressing the patient by name gives him a personal sense of worth.

2. At first, don't go alone. Go in pairs, or try to form a group of four or six, so you can share experiences and support each other. Before entering the room, gently knock on the door and wait for a positive response. The patient may be indisposed or in an uncomfortable position. He may be tired and not in the mood for visitors. He may ask you to return another time. Don't feel rejected. The patient's feelings are quite normal. We all have times when we need to be left alone.

3. Find a chair and sit down. Eye-to-eye contact is important; try not to stand, peering from above. Explain to the patient that he is just one of many you are visiting. If the patient is elderly, try to offer some thing concrete: "Can I get you something?" or "Can I raise or lower the bed?" In the event the patient has visitors, don't feel you are intruding. Your stay should be brief and serve primarily to introduce yourself to everybody.

4. Always come into the room with a smile. No matter how ill a patient is, he appreciates a smile. Try to get the patient to talk about the "good old days." You don't have to do the talking; it is far better to listen and reinforce his sense of self worth. "You must have been an exceptional man . . . ," " . . . a very giving mother, and character doesn't change." If there are other patients in the room, they should of course be acknowledged, not ignored.

5. If possible, bring something with you to give the patients: a few cookies (if the patient is not diabetic), or a flower for a lady. On Friday, before Shabbos begins, I usually bring challos (traditional Shabbos bread loaves) and grape juice (wine is forbidden because of the medications patients take). It's a gesture that is always appreciated. Some friendly visitors in our hospital take long-term-care patients out for an occasional drive. Others belong to groups that sponsor Shabbos get-togethers, Purim and Chanukah parties, and other such entertainment. This latter approach can usually be arranged through special geriatric therapy departments or social services.

6. Try to keep your visits on a steady basis. This is especially applicable in the chronic-care sector, where the patient looks forward to your regular visit. After a visit or two, don't be afraid to hold a patient's hand, fix a pillow or even give him a hug. This is what patients need most, a little warmth and friendship. A telephone call during the day is also most appropriate. It shows the patient you're thinking of him.

7. If you see the patient is seeking reassurance with regard to his health, you can tell him that although you're not a doctor, you believe that the medical team is trying their very best. Usually, this is all the patient wants to hear, not any false answers that are patently unrealistic. Never suggest the use of second or third opinions. This often causes confusion, disruption and has all-around negative effects. The patient, family and doctor are responsible for what must be done.

A VERY DELICATE ART

The art of visiting the sick then, is very delicate indeed. Besides the greatness of the commandment , it offers the visitor deep feelings of satisfaction. It offers a sense of wholeness in that you shared something of yourself with someone in need. It offers growth, both to the patient's self esteem and to your own. One final thought. The Sages taught, "be as careful in the observance of a smaller Jewish commandment as in a greater one" (Ethics of Our Fathers II,1). The commentaries tell us there are many components to a Jewish law that cannot be measured. Two of these are the true significance of the Jewish commandment and the way in which we do the commandment. In visiting the sick, we may just grasp a little understanding of these components . . . the greatness of its impact and how it may be developed into an art of loving care.



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