Sensitivity and Visiting the Sick

Understanding Aggada
Yeshivat Har Etzion

Shiur #17: Sensitivity and Visiting the Sick

By Rav Yitzchak Blau

Rav Chelbo fell ill, so Rav Kahana went out and announced: "Rav Chelbo is very sick." Still, no one came. 

[Rav Kahana] said to them: "Did not the following story happen with a student of Rabbi Akiva?  He was sick and no one came to visit him, so Rabbi Akiva came in to visit the student; because the floor of the sick fellow was swept and washed, that fellow recovered.

"He said: 'Rabbi, you have revived me.'

"Rabbi Akiva then went out and taught: 'Whoever does not visit the sick is as if he sheds blood.'"

When Rav Dimi came (from Israel) he said: "Whoever visits a sick person causes him to live; whoever does not visit a sick person causes him to die."  What is the nature of this causal relationship?  If you say that the one who visits the sick asks for mercy that the sick person should live, while the one who does not visit the sick asks that the sick person should die, would you think that anyone asks for the sick person to die?  Rather, [Rav Dimi meant that] the one who does not visit the sick does not ask for mercy that the sick fellow should live or die.

Rava, on the first day that he was ill, said to [his students]: "Do not reveal my illness to people so that I not have bad fortune."  From the first day and on, he said: "Go out and declare it to all in the market place."

…Rav Shisha the son of Rav Idi said: "Do not visit the sick during the first three hours of the day or during the last three hours of the day, so that you not stop asking for mercy – for during the first three hours, the sick person looks healthy; during the last three hours, the sick person looks overcome with illness." 

(Nedarim 40a)

Before we explain Chazal's insights into the mitzva of bikkur cholim, visiting the sick, let us explore the nature of this mitzva.  Although bikkur cholim does not appear on the Rambam's list of the six hundred and thirteen mitzvot, it may still constitute the fulfillment of a Biblical mandate.  One gemara (Sota 14a) lists visiting the sick as one avenue for fulfilling the command to emulate the Divine, Imitatio dei.  The Rambam (Hilkhot Avel 14:1) mentions visiting the ill as a way of fulfilling "Ve-ahavta le-rei'akha ka-mokha," "You must love your neighbor as yourself" (Vayikra 19:18).  Apparently, even though bikkur cholim is only a rabbinic obligation, one who performs it fulfills a mitzva from the Torah.

            Indeed, our gemara certainly emphasizes the great worth of visiting the sick, suggesting that it can be a lifesaving endeavor.  How precisely does this occur in the story of Rabbi Akiva?  The Etz Yosef (in Ein Yaakov) and the Rosh suggest that Rabbi Akiva directs other people to clean the house and this cleaning helps the sick fellow recover.  In one of his two readings, Me'iri explains that Rabbi Akiva himself takes broom and mop in hand to clean the place.  Clearly, Rabbi Akiva does not consider menial labor for a good cause to be beneath the dignity of an important sage.

            Two other explanations of the commentators carry significant implications.  In his second interpretation, Me'iri says that the landlords of the house cleaned up in order to honor Rabbi Akiva.  If so, this tale shows the problematic priorities of the landlords.  For them, the visit of a scholar of the caliber of Rabbi Akiva is a reason to straighten up, but the serious illness of a tenant does not inspire much effort in this regard.  Rabbi Akiva simply intends to visit the sick, but his visit fortuitously generates a cleanup just when the patient needs it.

            Rav Achai (She'iltot 93) cites another interpretation in which the landlord sees that Rabbi Akiva values the patient and then decides that this patient is worth cleaning up for.  Even though this version has the landlord eventually cleaning up for the sick person, in some ways, the landlord exhibits greater insensitivity here than in the previous version.  The landlord initially thinks that significant patients deserve cleaning efforts but that the less-than-famous do not.  Only a get-well visit from a renowned individual convinces the landlord that he should put in some cleaning time for a tenant whose name fails to appear on the lists of any important community boards.

            It emerges that visiting the sick generates a ripple effect, with much broader implications than the individual visit proper.  On a basic level, one individual's efforts may inspire other potential visitors to follow suit.  On a deeper level, the visit may put the sick person on the social map.  Those who visit, even those not of the equivalent stature of Rabbi Akiva, help teach the community that the suffering individual matters and is worthy of attention. 

            According to Rav Dimi, visiting the sick does more than raise the awareness of other members of the community.  It also deepens the consciousness of the person visiting that the ill person needs many forms of help.  Thus, only the one who visits prays for the sick with sufficient intent.

            Rav Dimi says that a person who does not visit will not pray for the sick individual to live or die.  Rabbeinu Nissim infers from here (and from Ketubot 104a) that there are times when it is permissible to pray for the death of a sick individual.  He limits this possibility to a scenario in which the sick person suffers greatly and the doctors see no chance for recovery.  According to Rabbeinu Nissim, Halakha rejects euthanasia but permits beseeching God to end a person's suffering.  However, only the person who has visited knows when this unusual type of prayer would be appropriate.

            Why does Rava not want the world to know about his illness on its first day?  Some commentators explain that words have their own power and impact, and talking about a given illness can strengthen that illness.  I would add that sick people are sometimes embarrassed about their illness.  They are afraid of a communal perception that they are weak or unproductive.  Perhaps this explains why Rava counsels against quickly turning every illness into a public story.  On the other hand, once it becomes clear that the illness persists, it becomes more important to inform all the community members who might lend a helping hand.

            Rav Shisha's insight adds one final note of psychological sensitivity.  We occasionally visit a person who is sick in bed and are surprised to find that the person looking fairly robust.  This may lead us to conclude that the person is faking it to avoid responsibility or that the person is a hypochondriac.  Rav Shisha reminds us that illnesses have peaks and valleys and an early morning visit when the patient looks better may give us an incorrect impression.

            On the opposite extreme, a nighttime visit, when the patient looks exhausted and bedraggled, may mistakenly convince us that the patient has little hope of recovery.  Such a mistake may limit our efforts to help the sick and we may also convey our dismay to the sick person, thus further dampening his or her spirits.  Thus, Rav Shisha exhorts us to visit in a manner that will avoid these two errors.

            Chazal do far more than emphasize the importance of visiting the sick.  They provided detailed directions and nuanced guidance for fulfilling this mitzva with sensitivity and kindness.