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The Exquisite Challenge of Care
On Shavuot we learn from Ruth to pause before the logistics, to face our elders, to see them as God sees them, and to proclaim that they are not alone.

Reprinted with permission from Gleanings: Reflections on Ruth, Maggid Books and YU Press, 2019

The fear is not for what is lost.
What is lost is already in the wall.
What is lost is already behind the locked doors.
The fear is what is still to be lost.

– Joan Didion, Blue Nights

Imagine, for a moment, that your mother-in-law confronts you on a desolate road. She is depressed and overwrought, needy and with­ drawn, desperate for help and emotionally unreachable. Now imagine you are alone with the responsibility. Your husband, her son, has died, and there is no one else left to care for her. What do you do? What are the limits of your responsibility?

Most of us, living in the twenty-first century, in a world of medical technology, material comforts, and institutional options, jump to the logistics. We ask ourselves, what do I need to do to make sure she stays healthy? We run through the length of a day and map out countless scenarios: who will purchase the food, do the baths, fill out the paperwork, count the pills, and be there at night? Our minds fill up with the anxiety-ridden questions of maintaining the status quo. How will she get to the bathroom? What happens if she falls? How will I get her to all the appointments? Responsibility becomes a mental occupation, full of depleting details devoid of spiritual grandeur and meaning.

In Being Mortal, the physician and author Atul Gawande encapsulates this experience of care in the age of the medical possibility as an “overwhelming combination of the technological and the custodiaI.” (1) He describes the daily tasks of Shelley, the daughter caregiver of Lou, a man devoted to his independence whose health begins to deteriorate after his wife dies. Gawande writes: “Lou was on numerous medications, which had to be tracked and sorted and refilled. He had a small platoon of specialists he had to visit – at times, nearly weekly – and they were forever scheduling laboratory tests, imaging studies, and visits to other specialists…. And there was almost no help for Shelley. Shelley had become a round-the-dock concierge/chauffeur/schedule manager/ medication-and-technology troubleshooter, in addition to cook/maid/ attendant, not to mention income earner. She felt her sanity slipping.” (2)

This is the crisis of care in the medical age, primed to overwhelm the mind and deplete the soul. Megillat Ruth offers another way to care, a way centered on the gravity of the task and the moral sustenance of the response.

When Ruth faces her mother-in-law in the desert, she hears the agony of old age and responds with an affirmation of life. She turns to Naomi and utters these timeless words:

Do not entreat me to forsake you, to turn back from you. For
wherever you go, I will go. And wherever you lodge, I will lodge. Your people is my people, and your God is my God. (Ruth 1:16) (3)

To better understand how these words unlock the sanctity of eldercare, we must first go back and investigate the challenges that often mark the experience of aging.

In the twentieth century, old age came to be defined chronologically, at the age of sixty-five. But for many experts in the field, chronology has never been a perfect marker of health, of wisdom, or of a stage of life. “Old age,” Ollie Randall, one of the pioneers of eldercare, wrote in1947, “is a period of losses – loss of family, of friends, of job, of health, of income, and most important of all, of personal status.” (4) It does not begin at the same time for everyone. It begins when the losses trigger unexpected needs.

For Naomi, as with so many elders, the losses came in stages. First, there was famine and the loss of economic security. Then there was the loss of home and land, familial intimacy, and the self-worth that comes from being known.

And it happened in the days when the judges ruled that there was a famine in the land, and a man went from Bethlehem to sojourn in the plains of Moab, he and his wife and his two sons. (Ruth 1:1)

In retrospect, these losses seem tame. There is more to come. Naomi loses her husband, Elimelech, and “she, together with her two sons, is left.” The text alerts the reader to the way in which the loss is not yet eviscerating. Naomi has her sons; she is needed, respected, and cared for. And yet, she is left without a partner, without someone who knew her in her youth, who understood her history and her home, who connects her past to her present. And then comes the truly destabilizing loss, the deaths of her sons, Mahlon and then Chilion.

And the two of them, Mahlon and Chilion, died as well, and the woman was left of her two children and of her husband. (Ruth 1:5)

The additional phrase, redundant in fact but necessary in emotion, “and the woman was left of her two children and of her husband” accentuates the agony. Naomi has no spouse, no children, and no grandchildren; she has no hope for continuity or a future for her family. It has all perished.

This is the loss that Joan Didion describes in Blue Nights, her wrenching memoir about the loss of her husband, her daughter, and her own connection to the purpose of life. She explains, “When we lose that sense of the possible, we lose it fast. One day we are absorbed by dressing well, following the news, keeping up, coping, what we might call staying alive; the next day we are not.” (5) The “not” does not hit Naomi right away. She is busy surviving. She has to leave Moab, she has to keep the last of her loved ones, her two daughters-in-law, alive.

We can imagine the scene: valuables packed away, food purchased, and yet another round of painful goodbyes. Naomi has done this before; her daughters-in-law Orpah and Ruth have not.

And she went out from the place where she had been, with her two daughters-in-law, and they went on the way to go back to the land of Judah. (Ruth 1:7)

It seems that the minute they set out, Naomi changes her mind and tells them to return. Perhaps this was her plan all along. She waited until they had to face the emptiness of the road, the deep sadness of a life without anchors, and encountered the fear of the unknown. Or perhaps she only now realizes the folly of continuing their bond, of assuming that she is the only one who can protect them, that she is the one who is needed. The audacity of her self-importance hits her, and then the eviscerating, suffocating, reality of her own limits, her own inability to provide, her own mortality.

May the Lord grant that you find a settled place, each of you in the house of her husband. And she kissed them, and they raised their voice and wept. And they said to her, “But with you we will go back to your people:’ And Naomi said, “Go back, my daughters, why should you go with me? Do I still have sons in my womb who could be husbands to you? Go back, my daughters, go, for I am too old to have a husband. Even had I thought ‘I have hope. This very night I shall have a husband and bear sons; would you wait for them till they grew up? For them would you be deprived of husbands? No, my daughters, for it is far more bitter for me than for you because the Lord’s hand has come out against me. (Ruth 1:9-13)

Ruth listens to Naomi, not just to the content but to the call. Naomi describes a body that can no longer attract physical love, a body that can no longer carry life, a body that no longer feels useful. Itis that final line Ruth hears, not just the words but the full meaning for Naomi. There is nothing for her to live for, no love, no intimacy; no life. It feels as if even God has left her. This is also how we age. Understanding this truth is how we learn to care for the aged.

For years, elderly patients with dementia were drugged. Doctors and nurses gave them medications to make them sleep, to make them go to the bathroom, and to reduce constant agitation. At Beatitudes, a retirement community in Phoenix, Arizona, Tina Alonso, the director of education and research, has a different approach. “When you have dementia, we can’t change the way you think,” explains Alonzo, “but we can change the way you feel.” Dementia is an experience of such acute loss for the patients and their families that it is often challenging to see what remains. Research, however, demonstrates that even with dementia, human beings retain emotional lives and that endorphins released during moments of pleasure last past the intellectual memory of the experience. (6) For this reason, caregivers at Beatitudes have the gift of being explicitly tasked with providing moments of joy. There are teacarts and chocolate, hand rubs and enjoyable fabrics, objects designed just for comfort, and practice in making repetitive conversations fun. Gawande supports this approach to eldercare in Being Mortal, when 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.” (7)

But how do we help loved ones embrace life in the years of loss? This is the question at the center of Ruth’s majestic response to Naomi. Ruth sees Naomi, she sees her as a widow and as a grieving mother and while Orpah turns to kiss her mother-in-law goodbye, Ruth responds with a dramatic act – she clings to her.

And they raised their voice and wept once more, and Orpah kissed her mother-in-law, but Ruth clung (davka) to her. (Ruth 1:14)

The word davka, to cling or cleave, connects Ruth’s act to the deliberate joining of man and wife. It is a word deployed to explain a grasping of one to another for the sake of creating life.

Therefore, a man shall leave his father and his mother and cleave
(vedavak) to his wife, and they shall become one flesh. (Gen. 2:24)

The Sforno explains that “the expression divuk, ‘cleaving,’ being in a state of true union, is not possible between two people who are not alike in their common purpose in life.” (8) Ruth draws on the metaphors of marriage to establish not just a common purpose but a common future with Naomi. Ruth gives Naomi a reason to be alive, but what does this form of care give to Ruth? How does clinging transform the caregiver?

In Marilynne Robinson’s Pulitzer Prize-winning novel Gilead, the Reverend John Ames explains to his young son that having someone to honor is a “great kindness” bestowed by God.

Every human being is worthy of honor, but the conscious discipline of honor is learned from this setting apart of the mother and father. Believe me, I know this can be a hard Commandment to keep. But I believe also that the rewards of obedience are great, because at the root of real honor is always the sense of the sacredness of the person who is its object. (9)

What is the sense of sacredness and how does one begin to see it in another?

Ames, in an almost inversion of the rabbinic tradition, explores this idea by describing the kind of love a parent feels for a child and that a child feels for a parent: “When you love someone as much as you love your mother,” he tells his son,”you see her as God sees her, and that is an instruction in the nature of God and humankind and of Being itself.” (10) The act of honoring and loving elders can be the act of seeing them as God sees them.

It is a joy to see divine beauty in an infant; it is a discipline to see it in the elderly and frail. Ruth’s magisterial act is twofold: she sees the existential pain at the center of Naomi’s words and she expresses a form of divine sight when she sees the sacred beauty ofher mother-in-law. We must remember that Naomi feels as if God has forsaken her. By clinging to her, Ruth pulls her back into a world ofholiness and establishes holiness at the center of their relationship. Ruth proclaims, “Do not entreat me to forsake you, to turn back from you. For wherever you go, I will go. And wherever you lodge, I will lodge. Your people is my people, and your God is my God:’ But that is not the end of Ruth ‘s proclamation. She continues,

Wherever you die, I will die, and there will I be buried. So may the Lord do to me or even more, for only death will part you and me. (Ruth 1:17)

You will not be alone Ruth proclaims. You will not be alone where you walk and where you sleep. Your tradition and peoplehood will still gain another life, even if you can have no more children. God will not forsake you because your God is now my God and – I am here.

Now, imagine again that your mother-in-law confronts you on a desolate road. She is depressed and overwrought, needy and withdrawn, desperate for help and emotionally unreachable. Now imagine you are alone with the responsibility. Your husband, her son, has died, and there is no one else left to care for her. What do you do? From Ruth we learn to pause before the logistics, to face our elders, to see them as God sees them, and to proclaim that they are not alone.

 


 

NOTES

1. Being Mortal: Medicine and What Matters in the End (New York: Metropolitan Books, Henry Holt and Company; 2014), 85.
2. Ibid.
3. Translations slightly modified from Robert Alter, Strong as Death Is Love: The Song of Songs, Ruth, Esther, Jonah, and Daniel, A Translation with Commentary (New York:
W.W. Norton & Company).
4. “The Psychological Aspects of Aging,” May 28, 1947, folder 403, box 34, Ollie Randall
Papers, 1.
5. Blue Nights (New York: Vintage Books, 2011), 183.
6. Rebecca Mead, ” The Sense of an Ending ,” The New Yorker, May 20, 2013, .
7. Gawande, 259.
8. Translation taken from https://www.sefaria.org/ .
9. Gilead (New York: Picador, reprint edition, 2006), 139.
10. Ibid., 139.