Generations ago, the end of life was a part of life. At a time when people died at home, when several generations of a single family lived together, and when, unfortunately, disease was both more common and more dangerous, being present for the final days and weeks of someone’s life was an experience that most people had been through several times. While it was surely never routine, there would have been a certain rhythm to it, a sense that it was time to put one’s affairs in order, for family to gather around, and for final words to be said. The end of life was a sacred time.
Today, by contrast, our experience with the end of life is usually much different. For one thing, many people pass away in hospitals or other kinds of medical facilities, lending an institutional feel to the final period of time. Our modern medications and treatments have also profoundly changed the experience. Even as they provide the tremendous gift of relieving pain and anxiety, these medications usually leave their beneficiary unable to think clearly or communicate in the days or even weeks before passing away. And, thankfully, death is something many of us simply experience less often.
As a result, however, we have a much harder time thinking about the end of life as anything more than a period of waiting for the inevitable. We have a hard time seeing it as a chance for spending time together, for saying important things, for leaving last instructions, or as a time for ruchni’us (spirituality). The truth is, though, that the end of life can be all of these things. The idea of a healthy person preparing mentally and spiritually for that experience might be reserved only for a select few. But it is worth trying to bring back a sense of the possibilities that exist.
The first two articles in this series discussed how to approach the complex and difficult decisions that face us at the end of life. We know by now that we must expect the unexpected. At the same time, one of the benefits of making decisions ahead of time is that it creates the potential for days and weeks that are calm, meaningful, and spiritual. “Ein shilton leyom hamaves – There is no control over the day of death.” But we can hope to merit some time with our loved one that is a source of strength and even inspiration.
What follows in this article are some thoughts about making the end of life meaningful. To our modern ears, that might seem impossible, but the idea should not seem so foreign to us. There are many sources in the Torah that talk about the unique spiritual qualities of this time, of which we will discuss just a few. Rav Shlomo Wolbe, in his Alei Shur, a guide to personal growth, devotes a chapter to thinking about and preparing for the day of the ultimate journey. Whether we are considering our own experience or that of a parent or loved one, it behooves us at least to understand what might be a part of it.
Leaving a Legacy
The most obvious examples of an end-of-life experience in the Torah involve tzadikim leaving a verbal legacy to their descendants or to the nation. As Yaakov Avinu realizes that he is near death, he calls his sons together to give each his individual bracha. On his final day, Moshe Rabbeinu does the same to each of the shevatim (tribes), while also teaching Ha’azinu, the song that encompasses all of Jewish history. Dovid Hamelech leaves his son Shlomo with detailed instructions of tasks to carry out after he becomes king. And we find the same of various Tanna’im, whose final instructions to their students are recorded in the Gemara.
Broadly, the final words of our tzadikim fall into one of two categories. The first category is bracha: Yaakov Avinu and Moshe Rabbeinu pronounce their brachos for the future of klal Yisrael. Each bracha is tailored to its specific recipient, serving as a guide to the unique strengths and destiny of each shevet. The second category is spiritual instruction for the future: Yaakov, Moshe, Yehoshua, and Shmuel all used speeches at the end of their lives to provide guidance for the future, to warn of spiritual challenges that would lie ahead, and to encourage klal Yisrael to continue in the path they had been taught. Some of the Tanna’im gave their students specific principles to follow.
Unless a person has ru’ach hakodesh, he is unlikely to replicate the brachos of Yaakov Avinu. However, there are many ways in which we can help a dying loved one leave a legacy for generations to learn from and follow. Traditionally, it has long been the practice of some to write a so-called ethical will in addition to a financial one. An ethical will talks about particular values that are important to its author, gives direction to the author’s family and students about tasks they should focus on carrying out, and generally offers advice on living in the way of the Torah. Some of the ethical wills of great tzadikim have been published.
But there are many other, less formal, ways for someone to leave a legacy behind, especially at a point when composing a written missive has become difficult. Making a video or audio recording is a powerful way to preserve thoughts or feelings. On occasion, in my work with hospice, I encounter traditional Jews who are disappointed that their own descendants do not seem to appreciate Judaism as much as they do. I encourage them to leave a recording about their feelings about Yiddishkeit. It may be the most powerful gift they can leave behind. Even if that is not our concern, leaving a record of ideas, principles, advice, or encouragement is an equally powerful legacy to leave for future generations. This memorializes both lessons for life and the individual’s personality and spiritual qualities.
It is also incredibly valuable to record family history and traditions, especially when those stories risk being lost forever. Often, people always intended to write these things down or to interview their parents about generations past, but the right time never seemed to present itself. Facing the possibility of the end of life brings out these stories and memories. In my own family, a relative who had served in World War II was always reluctant to talk about his experiences. Soon after receiving a difficult diagnosis of what turned out to be a terminal illness, he shared an incredible story with me that has since become part of family lore. Even in the absence of a formal interview, be aware of those stories that might emerge and encourage them. It is a unique opportunity.
But words are not the only way to leave a legacy. In hospice, the term “legacy” often refers to some sort of artistic project that can be created as a memento. This can be a song, a piece of jewelry, an art project involving a loved one’s handprint, or any sort of creation that is an expression of love and connection. One patient had a read-out of her heartbeat printed and framed, as a way of representing her heart. On occasion, someone will buy cards for a wedding or the birth of a child and fill them out, to be given in honor of an anticipated simcha many years in the future at which they do not expect to be present.
To accomplish these things, of course, requires the person to be aware of his or her condition and physically and mentally healthy enough to participate. The image of someone being aware and alert at the end of life might seem strange to us, and it is often not possible. But when it is, it creates special opportunities.
Recently, I was talking with a family whose mother had made her own decision to stop any aggressive treatment and transfer to hospice. It became clear that, because the mother was fully aware and conversant, it was harder, not easier, for the children to come to terms what was happening. I reminded them of the image of Yaakov Avinu at the end of his life: fully aware, understanding what was happening, and using the unique opportunity it provided. It seems unfamiliar to us, but it does not have to be.
There is another reason, aside from leaving a legacy, why people engage in recalling memories and family history at this part of life. It is also a way of achieving a sense of closure. It is often pointed out that the special kaddish that is said at the cemetery after someone is buried is the same kaddish that one says at a siyum. A life is a complete book; it is not just a series of days but a full creation. In a book, all the tension and suspense is resolved in the last chapter. We are not always lucky enough to perceive our whole story in this world. But we do gain a certain perspective in our later years on our life’s journey. Hopefully, we can appreciate our successes and come to terms with our disappointments.
For that reason, looking back is one way for people to gain a final perspective on their life’s path. Certainly, doing teshuva at the end of life, as Chazal discuss, is ideal and very important, even if it is not always easy to raise the suggestion. But looking back at memories, getting a sense of a life well lived, or even thinking through regrets or disappointments and trying to come to terms with them, are all valuable and meaningful. This might mean that old experiences, sometimes painful, come to the fore. But seeing life as a journey that is nearing completion, not just a random series of events, is very much in keeping with what the Torah teaches.
The Gemara indicates that when a talmid chacham leaves this world, he is greeted by the tzadikim whose Torah he spent time learning. There are stories of talmidei chachamim experiencing this even in our own time. When Rav Moshe Shapiro, zt”l, was very ill at the end of his life, he was often convinced that it was Shabbos, no matter what day it actually was, and it was very difficult to convince him otherwise. This speaks to a sense of having reached a conclusion, as Shabbos concludes the work of Creation. On our own levels, we should all hope to come to Shamayim with a sense of having completed some of our life’s work.
It is also quite common for people who are very ill to sense the presence of relatives who have already passed away. In particular, people often relate having a vision or feeling the presence of their mother. This is common enough to be noted by secular hospice professionals, although I do not know of any scientific explanation. While this may sound frightening to us, it is usually a source of great comfort to those who experience it; it gives them a sense of going home and having someone to take care of them. There are mystical sources about spiritual changes that take place when someone is near the end of his life, as well as sources about reuniting with relatives in Shamayim after someone passes away. These are obviously not things that most of us understand. However, we should know that they are a natural and even comforting part of this process.
Another important medium for enhancing the end of life is song. There is an entire field, known as music therapy, dedicated to using music to provide comfort to people who are ill and to help their loved ones share meaningful moments with them in ways they cannot achieve just by conversing. In my work with hospice patients, this has been one of my most surprising discoveries. Music therapists regularly report playing music and singing with a patient who has not spoken in weeks, only to have them perk up and sing along with the music. Something about music touches us in ways that words alone cannot.
For frum Jews, of course, a nigun creates more than just positive feelings or happy memories. A nigun can also speak of kedusha. It reminds us of Shabbos, of Yamim Tovim, of our connection to Hashem. We turn to song intuitively when words seem inadequate. This makes song a powerful way to connect and express what cannot be said. If anyone is interested in volunteering to sing Jewish songs for hospice patients, I would be happy to help them through the process and would love to have them as an asset for the community.
Telling the Patient
Any or all of the above approaches can be used to bring meaning to the end-of-life journey. It should be stressed, however, that deciding what, how, and when to tell a sick person about his or her condition is complicated. Halacha takes seriously the concern that knowing the truth about a prognosis might be so frightening that it exacerbates one’s illness. There is a great deal of debate about how to approach this issue, and it should always be considered carefully, in consultation with a rav and those who know the patient best. There is also a difference between volunteering information to someone who is sick and responding to his or her questions or suspicions. In general, the goal is always the same: to allow the person who is sick to be in the best emotional state. The difference in opinion centers on how best to achieve this. But if we have decided to tell a person something about his or her condition, we should remember the sacred opportunities that this stage of life can create.
To be continued…
Rabbi Daniel Rose is the rabbi for Jewish Hospice Services for Seasons Hospice and Palliative Care. He is also the Assistant Rabbi at Congregation Bnai Jacob Shaarei Zion.