In 2014 Atul Gawande wrote Being Mortal: Medicine and What Matters in the End addressing end-of-life care, hospice care, and his reflections and personal stories. It is one of those paradigm busting must reads.
Being Mortal is a meditation on how people can better live with age-related frailty, serious illness, and approaching death. Gawande calls for a change in the way that medical professionals treat patients approaching their ends. He recommends that instead of focusing on survival, practitioners should work to improve quality of life and enable well-being. Gawande shares personal stories of his patients’ and his own relatives’ experiences, the realities of old age which involve broken hips and dementia, overwhelmed families and expensive geriatric care, and loneliness and loss of independence.
I got to thinking about this in the context of reading Chukat, this week’s Torah portion. There the Israelite people are instructed to bring a red heifer without blemish, in which there is no defect and on which no yoke has been laid to sacrifice. The critical ritual involved the ash from this perfect cow. There we read:
Another party who is pure shall take hyssop, dip it in the water, and sprinkle on the tent and on all the vessels and people who were there, or on the one who touched the bones or the person who was killed or died naturally or the grave. The pure person shall sprinkle it upon the impure person on the third day and on the seventh day, thus purifying that person by the seventh day. [The one being purified] shall then wash those clothes and bathe in water—and at nightfall shall be pure. If any party who has become impure fails to undergo purification, that person shall be cut off from the congregation for having defiled God’s sanctuary. The water of lustration was not dashed on that person, who is impure.
Numbers 19:18-20
While Israelite society was much more at home with death than our own, there is an interesting notion that there is no room for death in God’s house. Just as Gawande points out, there is a taboo of death that we are struggling to make sense of in their lives.
Gawande also points out how this dynamic impacts how generations deal with each other. This comes into focus when we think about the exceptional and rare case of actually finding a perfect red cow as we learn about in our Torah portion. In the Gemara we learn an amazing story about Dama ben Nesina. There we learn:
Rav Yehuda says that Shmuel says: They asked Rabbi Eliezer: How far must one go to fulfill the mitzva of honoring one’s father and mother? Rabbi Eliezer said to them: Go and see what one gentile did for his father in Ashkelon, and the name of the son was Dama ben Netina. Once the Sages wished to purchase precious stones from him for the ephod of the High Priest for six hundred thousand gold dinars’ profit, and Rav Kahana taught that it was eight hundred thousand gold dinars’ profit. And the key to the chest holding the jewels was placed under his father’s head, and he would not disturb him. The next year the Holy One, Blessed be God, gave Dama ben Netina his reward, as a red heifer was born in his herd, and the Jews needed it. When the Sages of Israel came to him he said to them: I know, concerning you, that if I were to ask for all the money in the world you would give it to me.
Kidushin 31a
Gawande offers us a lens to see our distance from death and an older generation. Like Being Mortal, the ritual of the Red Heifer gives us a window into how we might reconnect with our own mortality and morality.
Other posts on Gawande:
Said to Myself 