Rabbi Weiner describes the heartbreak of patients dying alone, yet he says that for the Jewish patients, there is usually a chaplain standing by the door for the yetzias haneshamah.

“Many times the patient is aware of our presence, and it’s a unique privilege to provide even that small measure of support,” he says. “We say Tehillim from our posts to benefit the neshamah on its journey, and we direct some brave nurses who are willing to enter these rooms and carry out the post-mortem minhagim that are usually done by us.”

Rabbi Weiner says that today, most of his work entails providing phone support to families, and acting as liaison between them and hospital staff. “Staff on the front lines are also anxious and afraid, and we’ve created various programs and support meetings for them too,” Rabbi Weiner explains. “While we pray for the return to our pre-COVID daily routines, for now we’re trying our best to nimbly adjust to the needs of those around us in this trying time.”

Anxiety over illness is a common human experience crossing all religious lines, and a chaplain doing his or her job by being a sensitive, nonjudgmental listener can be an asset to a patient of any religion.

On his very first day on the job, Rabbi Yerachmiel Rothberger, who for the past ten years has been the Jewish community liaison at New York City’s Calvary Hospital for palliative care, was asked by a nun to see the family of a Catholic patient who had just died. He asked the nun what would be spiritually meaningful for them, and she replied that Psalms work for everybody. “She was right, and the family was very grateful. I learned then that you can find common ground with all people.”

Now, however, as chaplain visits are limited or not allowed at all in his facilities, supportive phone calls are increasingly important and impactful. “I recently received a heartbreaking call from a woman who described how she said goodbye to her father right there on the street, unsure if it would be their last time seeing each other. She told me it was the hardest thing she’d ever done,” Rabbi Rothberg relates. “With coronavirus everywhere, her father’s transfer from hospital to nursing home was an excruciating move — it turns out that his unit indeed has many confirmed cases of corona.”

Although patient visits have been truncated, Rabbi Rothberger has unfortunately been busier than ever. In addition to supportive phone conversations, much of his time is spent arranging kevurahs. “What’s usually done in minutes can take hours or even days,” he says. “Every component of the system is overwhelmed — funeral home directors, cemetery offices, and the chevra kaddisha are difficult to reach due to the surge in volume. In normal times, hurdles often come up that cause delays, such as obtaining funds for a burial to prevent a cremation, transferring a niftar to another location, and myriad other scenarios, but there are organizations that help sort it out with the snap of a finger. With the well-oiled machine in serious disrepair, families are sometimes waiting days for kevurah. On our end, we’re working doggedly to speed things up.”

Quiet Moments

Experienced chaplains appreciate that silence is sometimes more powerful than the most polished words. While words can come across as minimizing an experience, silence demonstrates an understanding of the depth of pain.

Rabbi Tsvi G. Schur, a chaplain with 45 years of experience who for the past 12 years,has been with Johns Hopkins Hospital in Baltimore, once visited a girl who was in terrible shape after a car accident — her head was wrapped in bandages, her legs casted and suspended. “I tried to give her chizuk by pointing out that she had her whole life ahead of her. She looked me in the eye and said, ‘What could be worse than killing your own mother?’ The only response to something like that is deep silence. I ended the encounter with, ‘G-d should be with you and give you strength.’ Nothing more would have been appropriate.”

That said, people respond most openly to those who can understand them best. And that’s why Mrs. Miriam Schwartz, an active volunteer for the NY State Chaplain Task Force, says that when a call comes in, she drops what she’s doing and drives anywhere in the city to see a patient.

“Frum women, specifically, feel much more comfortable speaking with another woman,” she says. “Many abused women end up in the emergency room or psych unit, all alone. No man can truly understand the fears of a pregnant woman in her eighth month who’s landed in the psych unit. In this vulnerable state, when a caring, frum, female chaplain bound by HIPAA privacy laws comes around, a woman might open up for the first time and begin to get help.”

A frum woman in her forties was dying of cancer, and her biggest fear was being alone. Mrs. Schwartz spent a week holding her hand, hugging her, and playing her favorite music. They didn’t talk much, but her caring presence offered more comfort than any words. “An interesting postscript to the story,” she relates. “One morning the woman looked at me — she was intubated at that point and couldn’t speak — and I realized she wanted me to leave. I told her I’d be back at two. She died at one forty-five, alone with her husband, as I believe she wanted.”

And sometimes the moment just calls for a song. The chaplain playlist includes such across-the-board favorites as “Adon Olam,” “Yigdal,” “Esa Einai,” and “Oseh Shalom.”

But in this era of coronavirus, the personal touch sometimes falls through the cracks. “Our staff has been so focused on monitoring the physical condition of our residents, while minimizing ‘social visits’ to reduce infection spread, that less time is spent on their emotional needs,” shares Rabbi Akiva Feinstein, director of spiritual care at Vinney Hospice and Palliative Care of Montefiore in Beachwood, Ohio, where he’s been a chaplain for 25 years. “Yet those needs are greater than ever. Residents are unable to leave their rooms or have visitors, all activities are banned, and even we chaplains must enter their rooms in full protective gear while maintaining a distance. The isolation is taking a tough toll. Sensing this, we chaplains have pivoted from primarily spiritual care to a broader focus of reducing anxiety and depression among our residents. We even polled our residents about what they miss most from the outside world, and the most popular response was soda. Even though soda is usually taboo here, we’ve been loading up on it in light of the times. We’re seeing firsthand how improved spirits positively impact physical health.”

Unforgettable Moments

Some moments strike such a deep chord that they remain in a category of their own.

Rabbi Weiner tells of a yeshivah boy from Israel who abandoned Yiddishkeit, moved to L.A., and lived a degenerate life of drugs, tattoos, the works. He came into the hospital with liver failure due to alcoholism, where he met Rabbi Weiner and told him his story. He hadn’t spoken to his family since he left home, two years earlier. He soon went into irreversible organ failure, and was sedated and intubated. His parents were called and told that he was dying, and, in shock, they immediately flew out to say goodbye.

“The parents desperately wanted to reconcile with their son. The doctors told them that if they extubate and awaken him, he’d die within two or three days, but if they left him on the ventilator, he’d probably live another two to three months in an induced coma. Their choices were to say goodbye and hasten his death, or let him die gradually without making amends.

“They asked me to ask a sh’eilah for them, and the psak was not to extubate. The next day they called and told me they just couldn’t let him die without reconciling, and they had him extubated. They spent the entire day holding hands, expressing their love for each other, laughing together, and forgiving past wrongs. He died that night.

“That last day together brought the parents comfort and closure, but they felt guilty about what they had done. While I certainly didn’t agree with their decision, their son was gone and I sensed that my job now was to be nonjudgmental and supportive, so I called back the posek and asked him. He told me, amid tears, that bedieved what they had done could be justified. I went back to the family and quoted to them a Meiri that says that one can be mechallel Shabbos to prolong life by even just a few hours in order for a person to do teshuvah, and drew a parallel to their own situation. But deep inside I wasn’t sure I was right, so I called back the posek and asked him. He told me, amid tears, that bedieved what they had done could be justified.”

Rabbi Feinstein recounts the time a patient came into hospice at age 95, alone in the world, having grown up in a local Jewish orphanage and never having created a family of his own. “Rabbi, I’m always going to be alone, it’s the theme of my life,” he told Rabbi Feinstein. The thought of dying alone greatly distressed him.

“I told him, ‘Abe, tell G-d what you want, you never know.’ He was skeptical, never having prayed in his life, but he agreed to try it,” Rabbi Feinstein says. “A short while later, $50,000 came his way. But he wanted people, not money, so I convinced him to use the money to pay for a caregiver, someone who could be devoted to him in his final days. A 25-year-old guy applied for the job, and we were all surprised to discover that they grew up in the same orphanage, under very similar circumstances. They became very close, and he took care of Abe with extraordinary patience and caring — he was exactly what Abe needed. After 95 years, he no longer felt alone. ‘For the first time in my life, I spoke to G-d, and He listened,’ Abe told me. He died with his caregiver at his side.”

An incident that Mrs. Schwartz says she’ll never forget involved a Jewish man in his forties whom she worked with professionally. His only living relative, a sister, dropped dead while walking her dog in the park a few days earlier, and now he himself was admitted to the hospital with unexplainable symptoms.

“I came to visit, and he made me promise he wouldn’t die alone. He didn’t seem anywhere near death, so I breezily said, ‘Of course I’ll be here.’ Less than a week later he went into cardiac arrest while in the middle of a CT scan, and was put on a ventilator. Now he really was dying, and I spent a few days at his bedside, bound to my promise. One night I had a simchah I couldn’t miss, so I arranged for another frum chaplain to stay with him just in case his time came. I also told a frum doctor at the hospital of my promise, and asked him to be with him as well if the worst happened. In the car on the way to the simchah, we set up a video call and he mouthed a thank-you to me. I was zocheh to keep my promise: This secular Jewish man with no family died that night with a frum doctor holding his hand, and a rabbi in the room saying Tehillim for him.”

Family Moments

Medical crises have a way of opening fault lines in families. Weighty decisions, differing opinions, and emotional strain can combine to create a noxious brew whose bitter aftertaste may never go away.

“I implore people to tell their children what kind of care they’ll want in the future,” says Rabbi Schur. He explains that both Agudath Israel and the Rabbinical Council of America (RCA) have excellent advanced directives documents, which also assign a health-care proxy and designate a rabbi who will be consulted for the halachic and hashkafic aspects of care — all ways of reducing conflict down the road.

Rabbi Rothberger once witnessed two brothers outside their mother’s room, shouting at each other and on the verge of blows. The doctors tried unsuccessfully to break it up, and security needed to be called. He later heard that one brother cut himself off from the rest of the family because he believed the medical care should have gone in a different direction. “The more a family decides in advance, the less room there is for disagreement later,” he says.

Rabbi Feinstein says that the hardest moments of his job are when he sees family members unwilling to forgive each other, even when time is running out. As a neutral person in the room, a chaplain can sometimes help reduce tension and can help family members reconnect. One way, he says, is by asking questions about the family history, which can help bring them back to better days. Most people soften when facing a death, but sometimes a person is so entrenched in his anger toward a dying relative that he won’t budge an inch.

“I try to explain that there’s only a brief window to bridge the gap, and if it doesn’t happen, coming to terms with the relationship after the relative dies will be much, much harder. Even if forgiveness is impossible, a small conciliatory step like saying, ‘I wish things could have been different,’ can have a big impact on how the relationship is processed afterward.

“There was an 85-year-old woman in our facility who was dying, and her son, after decades of not seeing her, flew in only because ‘it was the right thing to do.’ But he was still full of anger — he felt his mother had always put her own needs ahead of his, and nothing I said penetrated. ‘I appreciate what you’re saying, but you don’t understand how hard she made it for me to have a normal life,’ he told me. I had no choice but to close the book on this case, while knowing that his rigidity would only hurt himself.”

Illness of a loved one can bring out the best, or the worst, among siblings. When one sibling spends more time at a parent’s bedside than another, they often begin to compete and come to resent each other, Rabbi Weiner says. In other families, however, the stress softens people, and they let go of old grudges and come together for the sake of the patient. This happens most readily when there’s a strong leader in the family who is able to unite the family in its time of need.

“A few years ago, a frum 60-year-old woman was dying of heart failure, alive only with the assistance of an ECMO machine [which pumps a patient’s blood outside of the body],” Rabbi Weiner relates. “Most of the family felt they were just prolonging their mother’s suffering and should let her go, but one daughter was adamant about keeping her alive. I met with the family a number of times and we talked it out. The siblings saw how dedicated their sister was, and made a joint decision to support her despite their strong disagreement. This so impressed the medical team that they accepted the family’s decision to prolong life in hope of a miraculous recovery. Against all odds, she recovered and is doing well today. The profound unity this family achieved actually saved their mother’s life.”

Questioning Moments

Chaplains can’t choose their cases, but they do want to stay aligned with their religious principles — and the sh’eilos that come up stretch the mind: Can a Jew who donated his brain to science have a taharah and kevuras Yisrael? Can the Megillah be read with a brachah on Taanis Esther after plag haMinchah, if a patient can’t stay up late to hear the Megillah at the right time? Can one officiate at a funeral if the deceased is being cremated? If the deceased is not Jewish? Can a person be buried in a metal casket if it was already purchased? Can one have a Jewish burial if he refuses to have a taharah done? And the borderline absurd: What day of the week is best for an assisted suicide? Can the family exhume their relative and have another funeral since they weren’t happy with the first one?

Common scenario: Mr. Weiss is dying, and his secular family has decided it’s time to relieve him of suffering. They’ll request a rabbi to pray with them before “the event.” The chaplain knows that the machines will be turned off shortly after he’s finished praying with them, meaning that he is, in effect, determining the time of death. May he go?

In an interesting precedent from a past century — a Jew about to be put to death requested a visit from Rav Chaim Brisker as his final wish. Rav Chaim refused to go, because his visit would influence the time of death.

“The posek I asked this question to, gave me his psak with a story,” Rabbi Weiner relates. “A paraplegic teenager once asked this rav for a heter to remove his tracheal tube, wanting to end his life. The rav told him he couldn’t do it, and the boy responded, ‘Will you daven for my neshamah if I do it anyway?’ The rav was stuck: He’d sound cruel if he said no, and sound like he was sanctioning it if he said yes. He ultimately responded with, ‘I hope you won’t do it, but, yes, I will daven for you.’ This boy is still alive five years later, and the rav believes it was the compassion that saved him.

“This rav told me that I, too, can potentially affect the outcome, and therefore I should go,” Rabbi Weiner continues. “If the family expresses any hesitation to me about pulling the plug, I gently ask questions that may lead them to rethink their decision. If they are committed to doing it, I can still improve the situation in other ways. For example, if they’re planning on cremating — in California, about 50 percent of Jews are cremated — I’ll ask them why. Most of the time the reason is simply that it’s cheaper than a burial, and I tell them I can get them a burial for even less than a cremation. Very often, they end up opting for a Jewish burial.”

In fact, preventing cremations and ensuring kevuras Yisrael is most commonly cited by chaplains as one of the most gratifying parts of the job.

Orthodox families usually turn to their own rav with sh’eilos, but often don’t have the presence of mind during a crisis to understand the medical nuances and/or relay them accurately. “For example,” says Rabbi Rothberger, “if a patient has esophageal or stomach cancer, food can literally feed the tumor, so the doctor might order ‘no food, IV only.’ What the family hears is ‘they’re starving Mom to death.’ The chaplain, there on the ground with the doctor, can be better equipped to explain the medical situation to the rav. It’s a resource that can be invaluable to rabbamin and poskim.”

Final Moments

Death and dying are the sad companions of chaplaincy, but this final phase of living is one that contains great potential for positivity and affirmation. Chaplains are there to help that happen.

“A young woman in her thirties was dying of cancer and was extremely depressed,” Rabbi Weiner remembers. “When I spoke with her, it became clear that the main source of her depression was that her two-year-old daughter would never know her mother. I suggested she make an ethical will imparting the ten most important lessons she had learned in her life, along with a video, to give her daughter a sense of who her mother was. She became animated about this mission to create a legacy, and spent her last few weeks of life with meaning and purpose.”

Leaving the world with no discernible footprint is a common fear. Rabbi Feinstein remembers a used-car salesman who, estranged from his children, was very concerned that no one would remember him after he’d die. Rabbi Feinstein suggested he record stories of his life for his children. The man claimed they wouldn’t be interested — they never were — but he did it anyway, sharing a time he was courageous, a time he was honest despite great difficulty, how he went out of his way to help Jewish customers, and more. “He wrote it all down and recorded it. His children were so grateful for it, which was extremely validating for him — it meant his life actually mattered. After he died, his children shared the stories during shivah, which was healing for them as well.”

A surprisingly common concern for dying patients is how their funeral will play out. How many people will show up? What will be said about me? People find comfort in sharing with the chaplain what they’d like said at their funeral.

These days though, funerals are difficult, almost surreal. “With just a few people in attendance and the cemetery workers not allowed to approach the grave until the family has left, there is no way to cover the coffin with earth other than a few ceremonial shovelfuls,” says Rabbi Feinstein. “There is a sad sense of incompletion for the family, and I suggest to them that we meet for a proper memorial as soon as we’re able to. Lacking the comfort of a proper shivah, I recommend that family members gather stories of the niftar, write them up and share them with each other, as a way of finding comfort even while alone.”

Regrets over past mistakes, particularly regarding parenting, are another frequent source of angst for dying patients. “If a person regrets having been too focused on his work at the expense of his kids,” says Rabbi Feinstein, “I might tell them, ‘G-d created you with this tendency, He never expected perfection, and He will credit all the improvements you made in this area.’ All failures should be plugged into this model. I also tell people that even if it’s too late to fix things, just wishing they were different — a form of teshuvah — mitigates the failure in G-d’s Eyes. This is an unfamiliar concept to most secular Jews.”

And Jews who never cared about Judaism suddenly express how meaningful it is for them to end their lives surrounded by Jewish people, he says. They have a vague sense that there’s comfort in the Next World, and they intuit that Judaism connects them to that. If they ask about the afterlife, Rabbi Feinstein might tell them, “Why would G-d put us through life and its challenges if this is all there was?” For those who accept it, it’s an emotional lifeline.

When it comes to young children facing the imminent death of a parent, chaplains can provide a framework that will have a profound impact on how they view their loss. Rabbi Rothberger was once asked to explain to a six-year-old what would happen when his mother died. “Hashem whispered the answer in my ear as I told the boy, ‘Think of a princess wearing a special white dress. Your mother will be treated like a princess, cleaned and clothed in her special white dress. And what do we do when we have a treasure we want to keep safe?’ I asked him. He said we bury it. ‘Exactly, we’re going to bury your mother for safekeeping, until one day we get our buried treasure back.’ ”

What constitutes a “good death”?

For some, it means the patient dies at peace and free of pain. For others, it means that the family knows everything possible was done to help their loved one. For observant Jews, a good death is when a patient and family have complete confidence in advance that everything will be done according to halachah, there will be no red tape, the funeral will happen quickly, and the niftar will be treated as halachah and minhag dictate.

“When families feel taken care of because there is a chaplain they trust to make that happen, they can go through the process with peace of mind,” says Rabbi Rothberger.

This can mean facilitating emergency passports so family can escort a niftar to Israel, getting death certificates in the shortest time possible, personally overseeing the transfer of the niftar from bed to funeral home, and pulling well-cultivated strings when necessary.

“Last year, an autistic man in his fifties was deathly ill,” Rabbi Rothberger says. “His parents, both Holocaust survivors, weren’t well either — he had cancer, she had Alzheimer’s — so the man’s care fell to a brother. The brother had spent a few days unsuccessfully looking for a burial plot that met his criteria. At 7:20 Monday morning I got a call the patient had died. By 8:45 I had procured a spot in the cemetery the brother wanted, right near the road because they were Kohanim, and by three o’clock that afternoon he was buried. Having the ability to ensure that kevuras Yisrael is done in the best way possible is one of the most gratifying parts of my job.”

In the moments before death, families often request a prayer, and chaplains each have their preferences. “I usually say Bircas Kohanim, and then tell them it’s their turn for a prayer, whatever is on their minds,” Rabbi Weiner says. “Many people don’t realize they can talk to G-d, and I give them permission to do that for the first time. They get very emotional, and powerful things come out that they’ve never shared with anyone.

“I explain to them about Vidui, how it’s a chance to clean the slate, and what a huge merit it is to say it. I usually say it for them and they listen. Vidui can be said any time there’s danger of death, and sometimes I’ll suggest it to a very ill patient who isn’t necessarily on the brink of dying, in order to give them the opportunity should they end up needing it. It sounds frightening, so I reassure them that it doesn’t mean anything specific about their medical situation. There was an old tradition among German Jews that anyone hospitalized for at least three days would say Vidui — this was instituted so that people wouldn’t be afraid of saying it. Rav Herschel Schachter has said publicly that his father said Vidui on nine different occasions.”

Most Jewish chaplains will at some point be asked to perform last rites for a dying Christian. “I explain to whoever has asked that it’s much more authentic to the family if it’s done by someone of their own faith, and then I try to find that someone for them,” Rabbi Weiner says.

Be it Jew or non-Jew, how do these spiritual emissaries face the raw pain of death every single day?

Many years ago, Rabbi Schur went to Rav Shach ztz”l, feeling unsure about how much longer he could keep at it.

“Rav Shach asked me, ‘Are you a ben Torah?’ I said that I try to be. ‘Do you believe in Hashem?’ I answered, ‘Of course.’ He then banged his hand on the desk and told me, ‘You are doing Hashem’s work, don’t stop.’ Somehow I continue to find the strength, 30 years later,” he says.

But burnout is very real among chaplains, and regular exercise, learning sedorim both before and after work, and time with family are potent antidotes they say make a big difference. Rereading gratitude notes sent from families over the years can also give renewed energy to a weary chaplain.

Transcending Moments

Working with those bound for the Next World affords a certain Divine encounter; being physically and spiritually present taps a chaplain as G-d’s partner in the closing scene of a life in This World. Sometimes it’s even tangible.

“Mr. Green was a concentration camp survivor, in a hospital room with a crucifix on the wall that couldn’t be removed,” Rabbi Rothberger relates. “I got word he was being transferred to our facility, and so I made sure to remove the crucifix on our wall before he arrived. He was admitted at 3 p.m., and by 7 p.m. he was already out the door with the chevra kaddisha. The son told me that his father clearly had to pass through our facility so that he could die without a cross in the room.”

Rabbi Rothberger shares how shortly after the previous Siyum HaShas, he mentioned to a patient’s son that he’d just started learning daf yomi. The son said he also goes to a daf yomi class, and the rabbi offered that they learn the daf together. They sat at his father’s bedside that night and learned the daf; the next morning the patient passed away. Rabbi Rothberger’s rebbi later told him that hearing those words of Gemara likely was the final zechus this man needed before arriving at the Olam HaEmes.

Sometimes chaplains are agents of influence even for souls who’ve already passed on. “Just a few weeks ago, I went to visit a dying woman,” Rabbi Rothberger says. “She was married to a non-Jew, and her deceased son had been cremated, but she wanted a Jewish burial. I said Vidui with her, and explained to the family how a Jewish levayah works. She died two days later. At the cemetery we were four Jews — just two men — so there was no chance of Kaddish. And then out of nowhere a frum family approached me: They had gotten up from shivah that morning and wanted to say Kaddish at their father’s kever, but they were only nine men — could I join them for a minyan? In the end, both niftarim were zocheh to Kaddish with a minyan. Who knows what zechusim they’d accrued in life in order for this to happen?”

Moments of Resolution

Patients often bring up existential questions, such as, “What does Judaism say happens after death?” and, “Why do bad things happen to good people?”

“These questions often stem from a concern they have about their own future, and I gently probe to discover what it is,” Rabbi Weiner says. “Very often, people think their illness is a punishment from G-d. And because they see the chaplain as representing G-d, if the chaplain is really compassionate toward them, they’re reassured that G-d is also compassionate, and maybe they’re not being punished by Him after all. Of course, if someone insists on answers, I explain to them some Torah views on sickness, death, and Olam Haba.”

While the role of a chaplain is not to preach his own religious values, at the end of the day, an Orthodox Jewish chaplain is the presenting face of Judaism. Rabbi Rothberger speaks to Yeshiva University semichah students, where he impresses upon them the need for Orthodox rabbis to go into the chaplaincy — because for so many Jews, a hospital chaplain is their only exposure to Yiddishkeit.

Religion can be a volatile subject, and if someone had a negative experience with Judaism, even in childhood, they can hold on to it their whole life. Rabbi Feinstein tells of an elderly woman whose parents were immigrants, unable to afford tuition, so the local Hebrew school hadn’t accepted her as a child. “She resented Judaism ever since. I brought her a bagel and lox and some music she told me she liked, showed her an abundance of caring and respect. Slowly her attitude toward Judaism changed — and we never even spoke about religion. This kind of healing brings a tikkun to the neshamah before it’s too late.”

And on the front lines of coronavirus, where chaplains have had to change — hopefully not for much longer — their long-successful modes of communication and bringing solace, they are privileged to glimpse the constancy of Jewish spirit even as family members suffer. Rabbi Rothberger tells of a 60-something man who lost his rosh kollel on a Thursday, and his wife the very next day.

“We spoke by phone and he wanted to know: Does his state of aninus apply while lighting Shabbos candles for his family? Should he light with or without a brachah? This family suffered yet another blow when they arrived at the cemetery. Only the husband, two sons, the rabbi, and the chevra kaddisha representative were allowed in, while the other 5 children stood helplessly behind the locked gate. ‘This is the will of Hashem, and we have to be strong,’ he told me. His strength, and that of many others, fuels me as I navigate each new crisis. Mi k’amcha Yisrael.”

(Originally featured in Mishpacha, Issue 808)