Dear Dr. Weisbord,
I am struggling with the decline of my favorite aunt and wonder if you can give me some clarity. What is the correct Torah hashkafa about visiting or being involved with a person with dementia who does not seem to recognize you or appreciate your coming to see her? Sometimes I think that it is useless to visit my aunt. Moreover, I feel certain, knowing that, if she had a choice, she herself would not want others to see her in her diminished state. As I try to interact with my aunt and get no meaningful response, I wonder if I should just follow the advice of an acquaintance, who told me that she had not seen her good friend for the 10 years before she died because the friend did not recognize her.
On the other hand, not visiting someone you respected and were close to just because she is now old and sick does not seem like the right thing to do, even though I do not know what the purpose of the visits would be. Do we have an obligation to visit, or is our job just to make sure that our relative is well taken care of physically and is comfortable, safe, and fed.
I hope you will give me the proper Jewish perspective on this dilemma.
Conflicted
Dear Conflicted,
While every illness is painful for the choleh and the family, Alzheimer’s disease is way at the top of the list. Watching someone you truly care about “disappear,” losing memory and logic and the ability to communicate, is excruciating, and dealing with the course of the disease over a period of years makes it that much more difficult. I commend you for taking into account your aunt’s dignity and her wishes as you think about whether or not to visit her.
In his book In the Splendor of the Maggid, Rabbi Paysach Krohn brings a powerful lesson about the mitzvah of bikur cholim that I believe applies to your question: As a young man, Rabbi Yaakov Bender studied with Rabbi Shlomo Heiman, zt”l. When Rabbi Heiman was hospitalized with a very serious illness, Rabbi Bender stayed in the hospital with him. One day, the doctor gave Rabbi Bender strict orders that absolutely no one could be allowed to visit because Rabbi Heiman was too weak. The next visitor was Reb Moshe – the great talmid chacham and Gadol Hador, Rabbi Moshe Feinstein.
Rabbi Bender was most uncomfortable telling Reb Moshe the doctor’s orders, but Reb Moshe just smiled and said, “If that’s the case, then the mitzva of bikur cholim today is not to visit.” (He added that the second part of bikur cholim is to daven for the patient, so he stood outside of the hospital room and said some tehilim – and then he left.)
It’s in the Jewish DNA to fulfill the mitzva of bikur cholim, and so many times we run to do it. Reb Moshe Feinstein’s hanhaga (conduct) reminds us that we need to think before we do. Someone who does not have a deep connection with an individual who suffers from Alzheimer’s might very well be doing a bigger mitzva by not visiting, not putting the person on display, and certainly not talking about how “she didn’t even know where she was.” If you think there’s a possibility that the individual with Alzheimer’s actually might appreciate a visit, check with a family member first.
In your case, the person with Alzheimer’s is a favorite and beloved aunt. While she might not be able to recall your name or even your exact relationship, she will view you as someone about whom she has positive feelings – and that’s enough to say yes for a visit. You can expect to have a cauldron of emotions swirling within you. You might feel a sense of joy that you are able to bring some pleasure to this individual while simultaneously feeling a deep sadness because the aunt you knew is no longer here. This is a different person. Please keep reminding yourself that a person is more than her memory or her ability to do things: She is the sum total of her life and all the loving attention she gave you is still part of both of you.
In some ways, it’s easier not to visit and to bypass the pain – and fear – that come with a visit. It’s easier to picture your aunt as she used to be, vibrant and full of life and a loving fixture of your childhood. I can’t argue with the acquaintance who avoided visiting her good friend for 10 years. I will, however, argue with her reason: “because the friend did not recognize her.” There are deep connections between people, connections that transcend the names and even the shared memories. It sounds to me that you can bring some small measure of joy to your aunt’s life, some sense of feeling loved, cherished, and remembered. And isn’t that what bikur cholim is all about?
