Heart and Soul

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One Sunday more than a decade ago, I lay in a curtained-off cubicle adjacent to a hospital’s emergency room, my chest bared and awaiting the sort of wired paddles that make still, supine bodies on medical dramas jump like chopped onions in a hot, oiled frying pan.

The procedure I was about to undergo, though, was relatively routine and quite safe; it had been scheduled weeks earlier in response to my heart’s march for several years to the beat of a different drummer. One means of discouraging such nonconformance is to teach the offending muscles a good, swift lesson with a well-placed jolt of electricity. Same principle as a cattle prod.

No private room had been available at the hospital for so minor a chastisement as a cardioversion (or “conversion” in medical parlance; I warned the men of the frocks that they stood little chance of successfully “converting an Orthodox rabbi,” but from the rolled eyes I realized I hadn’t been the first bearded, beyarmulked patient to make the comment). Thus my decidedly unprivate, if off-the beaten-path, digs.

As I lay there, head propped on a pillow, awaiting the arrival of the anesthesiologist and the executioner, I watched a parade of patients being chaperoned from the emergency room through the hub of activity just beyond the half-parted curtain. A bloodied head here, a broken limb there, a macabre march, the yield of a sleepy city and its mistakes (or worse) on the sober morning after a Saturday night.

And then, in the middle of the procession, I saw her, and the look in her eyes.

A blanket covered all but her hoary head and one skeletal, desperate arm reaching for something that wasn’t there. Her eyes, though, deeply sunken in a wizened, trembling face, were an irresistible force; they seized my own eyes and simply would not let go, not for the eternity of that fleeting moment. What I saw in those eyes was unfiltered, raw fear.

Maybe the fact that my heart was about to be stopped by a machine had oversensitized me. But something else weighed on me too, 3000 years of religious tradition.

For Judaism values life to an awesome degree. One moment on this earth is cherished beyond imagining in the Torah’s eyes. “Tomorrow,” asserts the Talmud – the next world – is for our ultimate reward; only “today,” though, “is for doing.”

The contemporary world values an assortment of talents and skills but none so intensely as Judaism treasures the ability to confront one’s life, to face reality, to wield free will, to choose, resolve, repent. And even immobilized and ailing in a hospital bed, a man or woman can do those most meaningful things a human being can possibly do. A Talmudic teaching has it that some “acquire their portion” in heaven through the efforts of many years, others “in a mere hour.”

Even the comatose may well be functioning beyond our assumptions. Electroencephalographs measure electrical activity in the brain but nothing more. Who can possibly know what might be happening in the soul of a living human being?

While my condition was benign and medically treatable, the imminent procedure was disconcerting. A lightning-quick thought of the coming anesthesia and what might follow stabbed at my brain. What if my heart protested the punishment (its owner, after all, tends toward overreaction) and decided to stop beating altogether? What, I wondered, was the hospital’s policy about patients who suddenly need the proverbial “heroic measures”? Old or diseased patients, I knew, can have a “DNR” – a “Do Not Resuscitate” – order attached to their charts. They, or their relatives, or a doctor – depending on circumstances – can direct medical personnel to allow a patient in extremis to die, rather than interfere to postpone the final event. (Agudath Israel makes available for the asking “Halachic Living Wills” designed to ensure that health care decisions in the event of incapacity are made according to Jewish religious law.) I was pretty sure that a relatively healthy middle-aged adult like me would be rescued if things went awry.

But should there really be any difference, I mulled there on the gurney, between young and old, sick or healthy, clearly moribund or only subtly so like the rest of us? If a moment of human life is invaluable, is it not so for everyone?

Which thought made the coda to the apparition so striking, fixing it forever in my mind.

For just as the eyes, arm and blanket all disappeared to the left of my line of sight, a nurse’s face entered stage right for the briefest of moments. It was a speaking part, but she had only one line.

“That’s a DNR,” the nurse called out with startling nonchalance. Even before the voltage came, a frisson washed over my bones.

When the electroshock came, it did nothing but burn my chest. My morning in the hospital left my heart unaffected.

Its rhythm, anyway.

© 2009 AM ECHAD RESOURCES

[Rabbi Shafran is director of public affairs for Agudath Israel of America.]

All Am Echad Resources essays are offered without charge for personal use and sharing, and for publication with permission, provided the above copyright notice is appended. The essay above, in slightly different form, was first shared in 1999.

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2 Responses

  1. Noam says:

    With all due respect, I think that Rabbi Shafran has oversimplified a complex issue and charged it with an emotion that is not really necessary nor helpful. Of course every moment in life is precious, and the gemara in Avodah Zara notes that some buy their ticket to the world to come in one hour. However, that does not mean that every single medical procedure should be done on every single person, and that people with terminal illnesses are halachically obligated to undergo painful procedures that do not have lasting effect. This is a widely accepted halachic concept.

    Of course we would hope and expect that the nurse and all personnel would treated every human with dignity and respect, and not just refer to them with a label. However, that does not mean that the person did not recieve appropriate care, nor that she was neglected. Since it appeared that it was quite the busy emergency room, it is possible to judge the nurse on the side of merit, and posit that she was trying to take care of as many people as expeditiously as possible, and the woman in question did not require care at that particular time. From the description, it appears that what she most needed was a smile and a comforting presence.

    It is also true that those who deal with the injured and dying on a regular basis can become used to patients with terminal conditions, and display more nonchalance than the regular public is used to seeing or would want to see. That does not necessarily mean they care less or have less respect for the patients. It does mean that they have developed coping mechanisms that allow them to care for patients in these conditions without becoming emotionally overwhelmed by the human tragedy that faces them on a daily basis. Of course there is a compassionate balance that needs to be struck between an unfeeling coldness and an immobilizing sense of disaster, but each care provider has to find that for themselves, or they will not be able to function. Some wind up seeming to be more uncaring, some burn out from the emotion. Either way, I think it is unfair for Rabbi Shafran to judge based on the one interaction and with absolutely no data on the circumstances.

  2. One Christian's perspective says:

    “And then, in the middle of the procession, I saw her, and the look in her eyes.

    A blanket covered all but her hoary head and one skeletal, desperate arm reaching for something that wasn’t there. Her eyes, though, deeply sunken in a wizened, trembling face, were an irresistible force; they seized my own eyes and simply would not let go, not for the eternity of that fleeting moment. What I saw in those eyes was unfiltered, raw fear. ….. I was pretty sure that a relatively healthy middle-aged adult like me would be rescued if things went awry.

    But should there really be any difference, I mulled there on the gurney, between young and old, sick or healthy, clearly moribund or only subtly so like the rest of us? If a moment of human life is invaluable, is it not so for everyone?

    Which thought made the coda to the apparition so striking, fixing it forever in my mind.” ” – Filed by Avi Shafran

    Rabbi Shafran, every moment of human life is valuable…if not in the eyes of man, certainly in the eyes of God, our Creator.

    Your narrative of an event experienced years ago, will stay for quite a while in my mind. One cannot imagine what that woman was going through. Was she alone ? Did she have family ? Did she know God ? Who was there to comfort and love her ? Does a DNR make a person less in the eyes of man that they cannot be comforted ?

    From your many narratives, you paint a picture of yourself as someone who is sensitive and caring and who loves God. Perhaps, God placed you in that ER for a time when that woman needed to see His face in yours.