There’s a brief story near the end of the book of Genesis in the Torah which I have always found touching. Joseph becomes the Pharaoh’s right hand man in Egypt, and brings his entire family down from the land of Canaan because of a severe famine. Joseph brings his elderly father Jacob to meet the mighty Pharaoh. Here is how the story is told:
“And Jacob blessed Pharaoh, and Pharaoh said to Jacob, how many are the days of the years of your life? Jacob answered: The days of the years of my sojournings are 130 years. Few and evil have been the days of the years of my life, and I have not attained the days of the years of my fathers in their days of sojourning. And Jacob blessed Pharaoh, and went out from his presence.”
How many are the days of the years of your life? The Pharaoh’s question seems on the face of it to be just an odd, old-fashioned way of asking How old are you, old man? But we can hear in Jacob’s answer that he is responding to a deeper question. Jacob’s brief answer is drenched in pain, and self-knowledge. Life has not gone well for Jacob. “Few and evil have been the days of the years of my life,” he says. His many years have been filled with suffering, often as a result of his own actions. So he responds not just about the number of years in relation to how long his father and grandfather lived, but also about the quality of those years.
How many are the days of the years of your life? How would each of us answer the Pharaoh’s question? Like Jacob, we should hear the question as being not just about the number of our years, but also about their quality.
Yom Kippur intentionally confronts us with our mortality. No food. Minimizing physical comforts. White clothing like shrouds. And of course the liturgy itself. Yom Kippur confronts us with one of the ultimate questions worth asking: Given that we are going to die, how shall we live?
Or put another way: What do we value in life? What makes life worth living, even as we face death? What are the reasons we wish to be alive?
Last year I read Dr. Atul Gawande’s book Being Mortal. The sub-title of the book is “Medicine and What Matters in the End.” I wrote about it in the temple newsletter last year. I find that I am still talking about it a year later. I just re-read it recently with a group of friends who range in age from 40s through 80s.
Dr. Gawande is a surgeon at Brigham and Women’s and a professor at Harvard Medical School. His message is both simple and profound. He writes, “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.”
Among the many practical points Gawande makes in his book is that there are a few important questions that doctors should be helping us to ask ourselves and our loved ones when we are facing catastrophic situations. Questions that doctors are not accustomed to asking. Questions that spark conversation about what we value most in life. Questions that seek clarity about what makes our lives worth living. Questions that put us, and not the medical system, in the driver’s seat.
Two of the questions are particularly relevant to Yom Kippur’s question of How shall we live? These questions are:
1. What are your fears and what are your hopes? and
2. What are the trade-offs you are willing to make and not willing to make?
The more I think about it, the more I think that these questions are vital for us to get in the habit of asking ourselves and one another now. Get in the habit of asking them for less consequential situations, so that they become a part of our repertoire before a catastrophe arises. Because it will.
This summer I spent many hours in conversation with a friend, accompanying him as he wrote his advance health care directive (also known as a medical directive). As some of you may know, this is the document which specifies how we wish to be cared for at the end of our lives. I wrote my own directive a couple of years ago, and while my friend admired what I wrote, he felt that it did not address several issues that were of concern to him; he wanted to write his own. Many of the questions raised by a health care directive are addressed in Jewish law, so we sat together to consider both the personal and the Jewish implications of a variety of end-of-life scenarios.
I understand that this might not be everyone’s idea of a fun summer vacation, but for me it was perhaps the deepest experience of the year. (and btw, he gave me permission to talk about it)
For my mother Leila, like for many others, creating a medical directive meant checking off one of three choices on a form provided by her attorney. Simple medical directive forms are also available from health care providers or the Commonwealth of Massachusetts, along with health care proxy forms to name who you want to make medical decisions for you if you cannot. The process that my friend and I went through takes all of this a step further. Like pondering Dr. Gawande’s questions, writing our own health care directive puts us face-to-face with our hopes and fears. It puts us face-to-face with the tradeoffs we are willing to make and not willing to make. It puts us face-to-face with what is ultimately important to us. It puts us face-to-face with the quality of “the days of the years of our lives,” not the quantity.
For example, one of the primary values that arose for my friend in our conversations was that of the capacity to share love. He therefore wrote in his directive: “Loving is a main reason for being alive… if I can’t share loving with others under some future medical scenario then it argues for withholding or discontinuing treatment.”
For my friend, it comes down to love. For a retired professor featured in Dr. Gawande’s book, it came down to something very different. His daughter told Gawande about a pre-surgery talk she’d had with her elderly father: “We had this quite agonizing conversation where he said – and this totally shocked me – ‘Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.’ I would never have expected him to say that,” the daughter said. “I mean, he’s a professor emeritus. He’s never watched a football game in my conscious memory.”
But the conversation proved critical. When faced with the need to make a rapid decision about emergency surgery following the initial procedure, a decision that put her between a rock and a hard place with only a few minutes to think, she knew what to ask. She asked the surgeons whether, if her father survived, he would still be able to eat chocolate ice cream and watch football on TV. Yes, they said. She gave the okay to take him back to the operating room. The decision, she realized, was not hers to make. Her father had already made the decision.
Having clarity about what makes life worth living helps us gain clarity regarding what degree of suffering and risk we are willing to endure. We each have to answer those questions for ourselves, and it helps to talk them through with a trusted friend or family member.
Another Torah story: Isaac’s wife Rivkah is pregnant with twins (Jacob and Esau). They are struggling with one another in her womb, and she is in agony. She cries out to God: im kain, lama zeh anochi? Which can be translated as: If this be so, why do I exist? Or put another way: If this is what my life has become, what’s the point of living?
Many of us have known someone who cried out in agony like Rivkah; many of us will have this same cry ourselves one day, if we haven’t already. This primal question underlies the motivation for writing an advance health care directive – if we become unable to make our own decisions, we want it known what our values are. We want it known what makes life worth living for us.
If we haven’t articulated those values yet, Yom Kippur reminds us that now is a good time to do it. Now is a good time to envision what we would like to be able to say when someone asks us, “how many are the days of the years of your life?”
As we enter into Yom Kippur, may the days of the years of our lives – however many there are – be filled with love, joy, human connection, chocolate ice cream and football, and whatever else makes life worth living for each of us.