Left Alone

For every patient lying alone in a hospital room somewhere, there was usually a spouse and an entire family left behind at home, adrift and sick with worry and, often, bereft of its rock of support.

Rabbi T., a longtime rebbi in a Lakewood yeshivah who spent 12 days in a local hospital on a ventilator, says that after being removed from the machine, he looked at his phone and realized he’d just missed nearly two weeks of his life.

“So I called my wife — it was one thirty in the morning — and I said, ‘These past two weeks — who took care of you and the family?’ And I’ll never forget her response. She said, ‘There were many malachim, many tzaddikim, and foremost among them were Yehudah Kazsirer, his assistant P.D. Lapidus, and the whole Bikur Cholim family.’ ”

The Sunday night before Pesach, Rabbi T.’s situation became critical, and the doctors wanted to put him on a trach. “My wife was very upset about this, feeling strongly that it would make my process of recovery much more difficult,” the rabbi says. “She conveyed her feelings very sharply to Rabbi Kazsirer, and he just listened very calmly. And then, as the conversation was ending, he asked her, ‘Tell me, what are your Pesach plans? I know your mother and mother-in-law are sending you food for Yom Tov, but I want you to know that Bikur Cholim will be sending you the entire Pesach, from the ke’arah and the matzos down to the last dish.’ And they didn’t stop there — late on Erev Pesach afternoon, Kuny Tress, a Bikur Cholim volunteer, came running over with his arms full of extras like desserts and treats for the kids.”

Rabbi T. wasn’t really surprised. He says this is something Bikur Cholim does as a matter of course. “I have a friend who unfortunately suffered an aneurysm a while back, causing him to lose his short-term memory, and he’s now in a rehab facility. His family still gets supper every single evening from Bikur Cholim of Lakewood.”

In the package for Rabbi T.’s family were included a few servings of applesauce, something he would be able to swallow in the highly unlikely event he’d be able to go home on Yom Tov. And b’chasdei Hashem he did, even though just days earlier, his condition had been critical, and even on Erev Pesach, his physician, Dr. Kadosh, said he’d need to be in the hospital for another week.

But the very next day, in a rapid turnaround, his numbers reverted to being completely normal. The doctor called Mrs. T. to tell her, “Take him home, he doesn’t need to be here. He’s weak, but he’ll be fine.” Bikur Cholim arranged for a non-Jew to transport him home and set things up in his home for his return. And when he got there, his wife told him, “These people fought for your life like you were their brother.” Despite the grim prognosis just days before, he was able to lead the second Seder from his seat at the head of the family table.

Rabbi T. notes the irony. “Baruch Hashem, many people were able to be home for the Seder, myself included. But there are two people I know of who didn’t have a Pesach Seder at home this year, and they were Rabbi Kazsirer and P.D. Lapidus. Their simchas Yom Tov was how much they could help another Yid, that’s all that mattered to them and all they did.”

Home Stretch

Although Bikur Cholim invested heroic efforts to sustain the lives of scores of hospitalized patients like Rabbi T., the team realized early on that the best strategy of all was to keep coronavirus victims out of the hospitals in the first place. The 40 percent survival rate for Lakewood-based patients on ventilators was far better than the national rate of 10 to 15 percent, but with hospital staff and resources stretched way beyond capacity and personnel simply incapable of providing the care and attention they normally would, the automatic assumption that the best place for an ill patient is in the hospital no longer held true.

And so, Bikur Cholim began buying concentrators, which provide oxygen without a tank, thus enabling patients to keep their oxygen levels elevated while staying out of the hospital. A successful fundraising campaign in Lakewood enabled Bikur Cholim’s stock of concentrators to go from 14 to 200 within just two weeks.

For patients who’d already been admitted, the biggest challenge Bikur Cholim’s in-hospital advocates faced was convincing these patients to maintain their oxygen levels using oxygen masks. Most of those who did, made it through, while those who didn’t, and had to be intubated, often had a different, tragic outcome.

Reb Yehudah speaks with barely concealed emotion as he recalls coaching patients lying in their hospital beds, begging them to hold on to dear life. “I’d speak with patients at three and four in the morning who were begging to take off their oxygen masks. We spoke with them, we cried together with them. I vividly recall a Friday night phone call from a Yid in the hospital in tears. ‘Ich macht shoin nisht ois [I can’t take it any longer]. I need to take off the mask and if they have to intubate me, so they’ll intubate me,’ he cried. They weren’t bringing him water and he was completely dehydrated, making the mask unbearable. I spent a half hour with him on the phone, crying with him, pleading with him not to remove the mask.”

Another boon to the effort to care for patients at home was an already-existing program called Health at Home, which sends Bikur Cholim volunteers to patients’ homes to draw blood and provide IVs and other services. Until COVID-19 hit, this service was used mainly for cancer patients, but once the hospitals started closing their doors due to the COVID overload, Bikur Cholim marshaled a team of 40 nurses and paramedics to provide care to patients with a whole range of non-virus-related medical needs, which they continue to provide.

Keeping patients at home and out of hospitals required specialized medical equipment, and within hours, Bikur Cholim acquired everything needed for the dozens of these patients.

“They became a kind of medical logistics SWAT team,” says Dr. Lebowitz, “procuring the equipment, assembling and deploying the equipment, with a volunteer spending all day every day calling every patient using the oxygen concentrators to make sure they were working and that hospitalization wasn’t necessary.”

Two months ago, Bikur Cholim received emergency clearance from the Lakewood Township to erect a state-of-the-art storage facility behind its present quarters on Prospect Street for its large and growing medical equipment gemach, which previously operated out of 15 trailers on-site.

Dr. Lebowitz also highlights the organization’s role in the well-known plasma initiative, through which thousands of frum people were tested for antibodies and many hundreds of doses of plasma have been donated. “Behind the scenes,” he says, “they were the plasma people, responsible for setting up the initiative. The things that happened here were extraordinary: Yehudah Kazsirer chartered a private plane to fly samples to the Mayo Clinic for antibody testing. And when the local hospitals ran out of a certain medication, I made a call to Rabbi Kazsirer, who placed a call to his contact and we were able to replenish the hospital pharmacies with that drug. He has a huge network of great resource people who want to give, and who trust him to do the right thing.”

The Time Has Come

Perhaps that integrity and trust is a reflection of Rabbi Kazsirer’s previous profession: In the years he was with Bikur Cholim on a part-time basis, he was also a third-grade rebbi at a local cheder. The choice to volunteer with the organization came naturally, as chesed was an integral, day-to-day part of growing up in his warm, heimish Flatbush home. His mother, Mrs. Suri Kazsirer, is a one-person engine of giving, single-handedly preparing Shabbos packages for people on the communal margins whom most others had forgotten about. And on Shabbos afternoons, Yehudah was part of a group of kids that brought good cheer to nursing home residents, led by the late chesed legend Moishe Binik.

The Kazsirers were close with the Novominsker Rebbe ztz”l, and Yehudah attended Boro Park’s Novominsker yeshivah for high school, where, with the Rebbe’s encouragement, the boys would regularly visit the residents of the nearby Mishkon home for the developmentally disabled. Six years ago, when he consulted the Rebbe for direction after being involved in Bikur Cholim part-time for a decade, the Rebbe told him, “higi’a hazeman” — it was time to make the move from chinuch to full-time communal activism.

In the years since, it has certainly become a family affair, too — it’s not uncommon for Reb Yehudah to take a doctor’s emergency call right at the Shabbos table. Like many things in life, Rabbi Kazsirer says, one never knows where he’ll end up and what he’ll be doing. And although his wife, Rivki, certainly didn’t imagine how things would end up for her husband, he has her full support in all he does.

He admits that there’s been a lot of learning on the job. Over the years he says, “We’ve gotten to know the medical system very well and a lot of things have gotten much, much better. We developed a program of patient advocacy long before it was widely popular, first going to one hospital and getting ourselves recognized as official patient advocates, and then doing the same in the next hospital. So slowly, we got to know the doctors, the administrators, the staffs. We got to know the protocols and how the system works. The beauty of our approach is that we work with the system, we don’t try to buck the system.”

For that, says Rabbi Kazsirer, having preexisting relationships is a must. “We try to have an open relationship with them — that means that if a hospital staff member is going through rough times or if the hospital itself is experiencing a difficult period, we listen and try to be there for them.”

When coronavirus struck, those relationships created over time became invaluable. Bikur Cholim spent over $120,000 to feed the overworked, overloaded staffs at hospitals within a 50-mile radius of Lakewood. “Takeout and calzone and chicken wings, you name it — all to express our understanding that they are so overextended that they can’t even get out to get lunch and supper. We also sent food deliveries to the homes of frum nurses in order to ease their burden of feeding their own families,” Rabbi Kazsirer relates. “And we saw how the food really made a difference in the patient care — we had full access to every hospital in which we had patients.”

Two-Way Trust

Part of this approach to advocacy is making sure that the hospitals see the relationship with the frum community as a two-way street. It’s not just about making special requests on behalf of patients, but looking out sincerely for the hospitals’ needs as well. For example, when Rabbi Kazsirer learned that hospitals were running short on respirators, he approached 20 potential donors in Lakewood, asking each to sponsor a respirator for $15,000, and they came through.

Two nights before Pesach, in one hospital alone there were 70 frum patients on respirators, and the hospital had maxed out on its capacity. Four of those families received calls from the hospital ethics unit saying that based on a review of the charts, their loved ones had little prospect for recovery and urged them to begin exploring options like hospice. The families contacted Bikur Cholim in a panic, and following consultation with major poskim, a high-level conference of rabbanim, doctors, and hospital administrators took place.

“We told them Dr. Lebowitz was ready to accept them in his Long-Term Acute Care (LTAC) unit,” Rabbi Kazsirer explains, “but they said it would take a couple of days for that transfer to take place and meanwhile they needed the beds for other patients with a better chance of survival. We asked what the community could do for the hospital and they responded, ‘To be honest, we’ve maxed out on respirators and the next shipment isn’t arriving until next week.’ We offered them 10 respirators, which they were shocked to learn we could provide. The next morning, we delivered not 10, but 14 respirators to them and the very next day our patients were transferred to the LTAC.”

To underscore the significance of what that meeting accomplished, Rabbi Kazsirer plays a video of the emotional July homecoming of a middle-aged Lakewood woman — one of those four patients on whom the hospital had given up.

With 4,000 meals going weekly to patients both in and out of hospitals, Lakewood’s Bikur Cholim has been a major provider of kosher food to medical centers for many years, as well as stocking 18 food pantries in hospitals and Friendship House hospitality suites around the country. But the recent crisis posed a unique challenge: Not only did it encompass Pesach, with its strict kashrus requirements, but the hospitals, beleaguered and overloaded, were wary of what providing kosher food would entail.

Recognizing this, Rabbi Kazsirer’s team assured the hospitals that it would be their sole responsibility, and promised to deliver all the food when, where, and how the medical facilities would dictate. Then they went out and bought a thousand portable, camping-style hot and cold bags in which to store everything needed for making two Sedorim.

And then there were the special requests, like the one Rabbi Kazsirer got on the second day of Yom Tov from the food director at a major hospital: “We just removed five Orthodox patients from respirators,” the director told him. “They need to eat, but the food must be pureed, and our supplier can’t provide kosher-for-Passover pureed meals. Can you do it for us?” Reb Yehudah didn’t hesitate. “Give me an hour and you’ll have it.”

He called one of his non-Jewish kitchen workers and told him to pick him up and head for the Bikur Cholim kitchen, where he said, “Today, we’re going to do things just the opposite of the usual. Today, you turn on the fire and I cook….” And with that, Rabbi Kazsirer spent the next hour cooking up 20 portions of brisket, gefilte fish, and applesauce and, using a hand blender, turned them into an edible liquid.

With Broad Strokes

Only Hashem knows what the future holds, but at least for the time being, the worst of the tempest has subsided. With life seeming to be slowly returning to at least some of its normal rhythms, Rabbi Kazsirer reflects on lessons learned and wisdom gained during this crazy, trying time: “You just keep remembering that the Ribbono shel Olam put you here and there’s no situation He can’t get you out of. But we have an obligation to do our hishtadlus, and in that regard, the bottom line is that what you have is what you have. Your only resources are the ones you’ve already prepared — you couldn’t manufacture stuff during coronavirus, you couldn’t buy stuff during coronavirus, you couldn’t even get hold of stuff during coronavirus.

“Nevertheless, you could scale your existing resources. Thus, we took our telemarketers who usually make fundraising calls and we told them to solicit blood donations. We took the drivers and vehicles that usually transport patients and families to and from hospitals, which had stopped, and we used them to transport more medical equipment.”

The other big takeaway, he says, is the absolute necessity of solid local connections with hospital administrations and staffs who understand you and understand the needs of the community and will work with you. No one likes getting directives. If it’s the law, they have to listen, but if it’s from anyone else, they’ll automatically feel a need to push back. But when you explain what your community needs and you also listen to what they need, you can work to make it mutually beneficial.”

As for the possibility of a second coronavirus wave, “We hope, of course, that if it comes, it will be much more manageable. Yet we saw how quickly the first one descended upon us. It came quicker than anyone could have imagined, in under half a week. We’re experiencing a quiet period now, baruch Hashem, but we have to be vigilant and know that it can return at any time.”

As someone who fought the good fight alongside Rabbi Kazsirer and his “SWAT” team throughout a period of unforeseen tragedy and travail, Dr. Lebowitz lists the essential ingredients that turned it into a Lakewood chesed powerhouse. “First, they define their mission broadly: From bringing Shabbos meals to a local hospital to helicoptering a specialized ventilator from Albany for a patient in Boro Park’s Maimonides Medical Center, it’s all part of what they do. Second, the word ‘impossible’ is not in their lexicon.”

That’s because, as Rabbi Kazsirer learned so many years ago, when you step out of your comfort zone, anything’s possible.

(Originally featured in Mishpacha, Issue 828)