Rabbi Yehuda (Leonard) Blank MS, BCC
Vice President of Professional Development and External Affairs
Rabbinical Alliance of America/Igud HaRabbonim
**** Thursday March 23, 2023, Rosh Chodesh Nisan 1, 5783 ****
The need for empathy for patients who are unable to eat or drink at the Seder,
How a healthcare and a hospice chaplain make a difference for Pesach.
The importance of collaboration between the chaplain, social worker, dietician team members and also the family Rabbi with the permission of the authorized caregivers.
Hashgacha Pratis and how a dermatologist saved the life of a Rabbi.
The following is purely to share my experiences with some of my patients. For patients who for decades looked forward to and did fulfill the various mitzvos at the Seder, not being able partake of drinking ,eating of matzah, karpas and maror can be heartbreaking. After discussing each patient’s needs, I would speak to a dietician, rabbi, family members and ultimately the patient him or herself, if able to participate in discussions. Through the years I have come across family members who were knowledgeable of their relatives condition, yet would feel it important to give a sip of grape juice and small pieces of matzah or even matzah meal knowing it would be dangerous for the patient. After the Shabbos services in the skilled nursing facility that I worked in, we had a kiddush. The CNA and I had a copy of each patient’s diet, listing what foods and beverages each resident was permitted , which thickener had to be added to certain beverages and which patients needed to be fed. I remember a certain wife who attended the Shabbos services and would give her husband a certain food item that he used to enjoy eating, but was dangerous for him to have. I encouraged a meeting together with the spouse and dietician to explain what foods and beverages are appropriate and safe and why certain items were dangerous to eat or liquids to drink without thickeners. I would spend time with family members and patients who were able to participate in discussions about these and other concerns. It was always important to listen to the desires and concerns of patients, family members or care givers and not to dismiss or make light of any issue or thoughts of why certain things were important to them. Eating is an important aspect of life and very important to patients. There are also certain foods that are given just for pleasure.
According to his wife, one of my elderly male hospice patients was devastated that he would not be able to have any of the traditional foods and wine or grape juice at the Seder. I spent a lot of time listening to the patient, discussing the different laws and customs of Pesach. He and his wife shared their thoughts about participating at the Seder and partaking of the traditional foods and drinking the four cups of wine and what that meant to them. The wife tried to calm her husband down and remind that he cannot eat or drink many of the traditional items. When they asked for my opinion, I gave them an opportunity to share their concerns. I acknowledged both of their legitimate concerns and desires. I told them not to worry about how they are going to observe Pesach including how to prepare their apartment. I suggested holding off on any further discussions until my next visit, where I hoped to give them meaning solutions that will please them both. They agreed and thanked me for sharing kind and thoughtful words of happiness filled with the love they have for each other. They only wanted to please each other as they had done for many years.
I shared my ideas with the hospice team. With the permission of the patient and his wife I contacted their rabbi to ensue my ideas were feasible and appropriate. When all of my thoughts were discussed with the team and the rabbi, I then spoke to the wife giving her the confidence that we were there for her too. Her daughter also contacted me. One of the main concerns of the patient was that he will someday have to answer to the Heavenly court. He was afraid he would be asked why he was no longer able to fulfill certain mitzvos, like participating in the Seder and not having been able to eat the matzah, karpas, maror and drink the arba kosos. He felt his time was coming close and this would be the last major Jewish holiday that he could keep properly. We would spend time talking about Pesach, the various tefilos, customs and what we usually do at the Seder. We discussed which parts of the Haggadah he could recite and the songs he could sing with his wife. He was concerned about the food and the drinking of the grape juice. I suggested having his wife dip a cloth napkin into the grape juice to suck four times representing the four cups of wine, to wash his hands as required during the seder, he would then lick the matzah and continued the same scenario with the karpas, maror/lettuce and the Hillel sandwich. It will then be considered as if he had fulfilled the various traditions of the Seder. With tears in their eyes, his wife and daughter shared with the social worker how pleased the patient was having had a meaningful Seder. He was grateful to me for my support and encouragement bringing him closer to the Holy One and helping him fulfill the many mitzvos of Pesach.
It is always important to give hope, to give love and understanding, to be empathetic, and be in the present with the patients and the family members and or caregivers. It is always important to be compassionate and have lots of patience and to let them know how I could be their advocate. It was also important to participate in family meetings with respective team members.
From The Grandeur of the Maggid by Rabbi Paysach J. Krohn Artscoll Series Mesorah Publications Ltd. Pages 125-130 “Operation: Mistaken Identity” “Every morning, among our blessings giving thanks to H, we praise Him as Hameichin Mitzadei Gaver, the One Who organizes the steps of man. This beracha is based on the pasuk Mei Mitzadei Gaver, [It is] from H that man’s steps are established (Tehillim 37:23).
Rashi (ibid.) notes that the word gaver (lit., strong person) is referring to the individual who is firm in his belief in H. Perhaps then the pasuk can be understood to mean that those who study in their faith in H realize that though they may have been sure where and when they had to be in a particular place, it is ultimately by design of H that they end up where they were meant to be.
In this remarkable story, first told to me by Dovid and Ayelet Feldstein, we witness this phenomenon. They introduced me to the people involved in the episode, who each told me what happened from his own perspective.
Rabbi Melech Kushner* began his story by telling me, “I am still astonished how these events could have transpired together. It is so obvious that the Ribono shel Olam runs this world, He never tires of retelling this narrative, and who can blame him?
Rabbi Kushner is an exceptional man. He runs a large tzedakah fund in Israel that supports hundreds of widows and their families over the Yamin Tovim throughout the year, and he is the Rosh Yeshiva in Dimona* at a snif (branch) of Yeshiva Shaarei Binah* of Haifa. Rav Henoch Segal* is the Rosh Yeshiva in Haifa and Rav Kushner refers to him reverently as a malach Elokim (an angel of H).
Rav Kushner told me, “ I would come to America every so often to raise funds for both the widows and the Shaarei Binah snif, but only during bein hazmanim (between semesters), which means that I came during the summers, or before Pesach or Succos, when the yeshiva was closed.
“A number of years ago, Rav Segal called me the day after Shavuous and told me I must travel to America immediately.
“Is there an emergency?’ I asked him.
‘It’s the middle of the zman and I give shirurim a few times a week.’
“You must go now,’ he said.” There is now a big financial strain on the yeshiva, and there are endless bills to pay, and while you’re there you’ll collect for your tzedakos and for the yeshiva.”
Rav Kushner was surprised. “It was unusual for Rav Segal to worry about the finances and even stranger that he insisted that I go at once, but as I told you, I regard him as a malach Elokim, so I didn’t argue. I called the various hosts with whom I usually stayed in those cities and told them that I would be arriving shortly.”
Rav Kushner had been in America just a few weeks earlier, just before Pesach, and so he could not approach his usual donors. He had to obtain new names, people from whom he had never solicited before. One of the names he was given, and from whom he hoped to get a substantial contribution, was Berish Fuchs, a prominent baal tzedakah. Rabbi Kushner, who speaks only Hebrew and Yiddish, wrote the name in his notepad as Fei kuf samech.
Upon arrival in New York, he settled at his hosts, the Feldsteins, and summoned his regular driver, Yair,* who chauffeured him wherever he needed to go. Yair read the name of Fei kuf samech and drove him to the home of Josh Fox.
It was already late in the evening, but Josh welcomed him in and apologized that he was on an emergency phone call. However, in the meantime, Rabbi Kushner could chat with Josh’s father, Rabbi Samuel Fox, who had been a rav in Dayton, Ohio, for fifty years. The two chattered amicably for close to twenty minutes. During the conversation, Rabbi Fox mentioned that his son was a doctor. Rabbi Kushner was surprised. Doctor Fox? No one had told him that he was going to a doctor’s house. Was Berish Fuchs a doctor? It suddenly dawned on Rabbi Kushner that maybe he was in the wrong house. And if he was, it would be too late afterward to visit the noted baal tzedakah, Mr. Fuchs. What a waste of precious time this was.
Finally, Josh came in and once again apologized that he had been detained.
“There was a medical emergency and I had to be on the phone all this time; please excuse me,” he said respectfully.
(Josh later told me that Rabbi Kushner looked prominent and dignified and he wished to show him the respect he deserved.)
“I’ve enjoyed talking with your father,” Rav Kushner said. “His rabbinical experiences are fascinating.”
In the subsequent conversation, Rabbi Kushner tried cleverly to find out Dr. Fox’s first name.
“My first name is Melech,” he said pleasantly. “And what is yours?”
“People call me Josh,” came the smiling reply.,” but I was named Yehoshua.”
What am I doing here? Rabbi Kushner wondered, but he continued talking about the reasons for his trip. After a while, over a cup of hot tea, the Rav asked, “By the way, what type of doctor are you?”
“I am rofei ore, a dermatologist, a skin doctor, “Josh said.
Rabbi Kushner lost his breath. He could not believe what he was hearing. Maybe this why H sent me here, he thought quickly. “May I ask you a medical question?” he asked.
Dr. Fox replied, “Of course.”
“I have these growths on my neck and on my hands. The doctors in Israel that I’ve gone to tell me they are not dangerous, but they have not been able to help me. The growths embarrass me. Can they be removed?”
Dr. Fox examined them closely; after a few minutes, he said,” To me they don’t seem like anything dangerous. Come to my office tomorrow; I believe they can be removed by laser and you will be fine.”
They made the appointment and Dr. Fox assumed the Rabbi that he would see him despite his busy schedule. He gave Rabbi Kushner a check for the yeshiva and the next day they met at his office. Indeed, the spots and marks were only cosmetic issue; using laser technology, Dr. Fox was able to remove the blemishes that had made Rabbi Kushner so uncomfortable for so many years. Rabbi Kushner then asked Dr. Fox if he could see his abdomen. At that point, as a conscientious doctor Dr. Fox insisted that he do a full body examination.
When Dr. Fox examined the rabbi’s back, he saw a suspicious growth that alarmed him. He had decades of experience and he was the coordinator for skin cancer prevention for the American Academy of Dermatology. He realized it was malignant melanoma. It was cancerous.
With a nurse in attendance, Dr. Fox removed the growth and said,” I have to send this for a biopsy. Please call me in a few days and I will have the results.”
Rabbi Kushner was upset. The word biopsy is frightening in itself; to hear it six thousand miles from home was even worse. He was flying to Toronto that evening, but all he could think about was the possible results of the upcoming tests.
As soon as the biopsy results were known, Dr. Fox called Rabbi Kushner in Toronto. “I am sorry to tell you this on the phone, but the growth on your back is malignant; thus, the remaining cells with a one-centimeter margin around the growth must be removed before the cancer spreads.”
Rabbi Kushner called his rav in Eretz Yisrael, who suggested that he return to Dr. Fox and let him do the procedure, as Chazal teach, megalglin zechus al yedei zakai, Benefit is imparted through one who is meritorious (Shabbos 32a), and he had been the one to find the cancerous growth.
Dr. Fox told Rabbi Kushner that the expense of coming back to New York from Toronto and then going back to Toronto to fly to Eretz Yisrael was unnecessary. A surgeon in Israel who would be given the biopsy reports could take care of it.
Rabbi Kushner canceled all his appointments and flew back to Eretz Yisrael, where he consulted with Rabbi Avraham Elimelech Firer, founder and president of Ezra LeMarpeh. Rabbi Firer is a world-renowned expert on medical conditions and the best doctors and hospitals to treat them.
Within days, Rav Kushner was operated on and his doctors told him that he was fortunate that the cancerous growth had been completely removed in time. The malignancy had not spread to any other part of the body and no chemotherapy or other treatments were necessary except for regular follow-up visits.
In telling me this story, Dr. Fox strongly stressed the importance of annual skin exams, which would save hundreds of lives a year! This, he said, is especially so for men, for their cancerous growths are on the back and are not readily visible, unlike women, whose skin growths are more visible as the growths usually are found on their extremities.
Looking back, Rav Kushner who is as healthy and as strong as ever, says. “ I thought I was going at the wrong time and going to the wrong place. Turns out I had to be where the Ribono shel Olam directed me that saved my life.
P.S. Since that episode, he did meet Berish Fuchs, and he has the correct spelling of the name.”
It is important to acknowledge when a congregant shares with his rabbi or rebbetzin how he/she is feeling or concerned about or how embarrassing a few warts or pimples on the hand might be. As we see in the story above, one thing led to another, and the dermatologist found something that was serious. Had it not been addressed it could have been life threatening.
To one and all, please be on the lookout for someone who would appreciate an invitation to a Seder not just for one night, but for both nights. Look out for someone who needs help shopping for Pesach, or someone who might not have the means of purchasing adequate items for Pesach. Look out for someone who might need help getting their kitchen or other rooms ready for Pesach. Perhaps there is someone who might not ask but would appreciate some home cooked meal. Those who are younger might not appreciate the challenges of the elderly, or someone who is homebound and unable to accept an invitation but would appreciate assistance. There might be someone who wants to sell their chametz, but unable to meet with the rabbi. There might be someone who is unable to get to the location to burn their chametz erev Pesach. Pesach is a time for family and friends and those who would appreciate a welcoming phone call and or a friendly visit.
We are mispallel for a kosher and meaningful Pesach and for Eliyahu HaNavi to herald in the coming of Mashiach speedily in our days.
Sincerely, Rabbi Yehuda Blank