The mitzvah of Sefirat HaOmer, or counting the Omer—the 49 days from the second day of Passover until the day before Shavuot—is often overshadowed by the frenzied build-up to Passover and the exhaustion that sets in after the Seder. But for one group of cancer patients I met, counting the Omer carried a unique significance, and how they counted the Omer revealed a great deal about how they viewed their illness and handled their treatment.Last spring, an intriguing analogy bubbled up from the chat rooms and waiting rooms frequented by many of the people who receive care at our oncology department in Israel. These cancer patients intuited a parallel between the formal counting of the Omer and the nearly ritualistic counting of days during their radiation treatments. As it happens, the average course of radiation treatment spans seven weeks, the precise duration of the period of the Omer.Rebecca, a woman I was treating for a lung tumor, drew the attention of her patients’ group to a subtlety embedded in the wording of the daily blessing that accompanies the counting of the Omer. She pointed out that two variants of the text for the prayer have evolved: In one version, participants proclaim, “Today is the nth day within the Omer (in Hebrew, BaOmer).” In the other, they state, “Today is the nth day toward the Omer (in Hebrew, LaOmer).” As a retired English teacher and self-described pathological punster, Rebecca suggested that the worshiper’s selection of preposition might have a lot to do with his or her prepossession about time. I found her play on words to be clever, though I admit to having needed a dictionary to fully appreciate her verbal proficiency.After the group’s groaning subsided, Rebecca proceeded to develop her theory. Counting toward the Omer (LaOmer), she proposed, seemed to indicate an orientation to the future, by focusing on how many days remained ahead: 20 days to go, then 19, then 18, and so on, counting down toward the end. By contrast, when articulating BaOmer, or within the Omer, one appears to be emphasizing the present, by focusing on how many days have elapsed so far: 18 days completed, then 19, then 20, and so on, counting up from the beginning.The members of the patients’ group, not all of whom characterized themselves as religious Jews, made a pact to count the Omer together. Practicing this custom spoke to them because it was reminiscent of the way they related to the radiation treatments they were undergoing. Some patients counted down toward the end, focusing on the number of treatments left and anticipating the conclusion of irradiation. Others counted up from the beginning, gathering up their energy to concentrate on the treatment scheduled for that day, often visualizing the X-ray beams killing the malignant cells to bring about healing. Although I did not conduct a formal study, it was fascinating to observe these unique group dynamics.In my observations, patients who told me that they were drawn to the present tended to place emphasis on the first word of the phrase Sefirat HaOmer. In Hebrew, sefira literally means counting, but in The Book of Our Heritage, author Eliahu Kitov points out that the word also has a more abstract connotation since it refers to the unique attributes that personified seven biblical figures. Abraham’s key attribute, for example, was loving-kindness (chesed). For Joseph, the defining trait was morality. King David exemplified sovereignty or self-worth. And so on. Throughout the Omer, the calendar can be mystically re-configured as a seven-by-seven matrix with cells containing pairings of these human qualities. Specifically, each of the seven weeks is colored primarily to represent one of the seven attributes. Then, within the week itself, each day is tinted according to one of the same seven attributes.As an exercise, group members who playfully characterized themselves as “BaOmer personalities” tried to connect with the present by pondering the pair of features that define the “now” of any given day. So, it was possible to find oneself situated simultaneously in the week that stressed loving-kindness, and on the day of that week that emphasized self-worth. On that particular day, patients might contemplate the challenge of being kind to others without forfeiting their self-esteem. It could be quite intense to consistently carry out this drill with all 49 possible “virtue doublets” weaving their way through the seven weeks, but those who persevered often described a deeper appreciation for the moment.The patients’ group, of course, also included those who oriented their thinking around the future. They pointed out that the Omer was counted during the seven-week period when the Children of Israel were en route to the giving of the Torah at Sinai, an event that tradition links to Shavuot. Such people, who are in essence affirming the LaOmer aspect of the prayer, seem to reason that when a person counts the days leading up to a fixed goal—be it receiving the Torah on Shavuot, or the conclusion of radiation treatment—it is an indication of longing to reach that goal. Thinking forward, they reason, conveys optimism. Who doesn’t enjoy looking ahead to upcoming trips or milestone events, like weddings and graduations?The upsides of focusing, respectively, on the present or the future are self-evident but there also can be negative implications. On the one hand, those who weight the present too heavily may not set goals for the future or use sufficient caution, and so may endanger themselves or the people who depend on them. An example that I recall vividly is a gentleman who decided (to the chagrin of his wife) to add big-wave surfing to a “bucket-list” of to-do’s that he wanted to undertake before dying. On the other hand, those who think too far ahead may invite different elements of risk. For instance, there are patients who, when looking downstream, become overly fearful about the possibility of disease returning or the development of long-term side effects from treatment. Some even become nervous when they entertain the possibility of cure—they worry if there will still be access to support systems that were already in place and whether they will be able to bear the responsibility or the possible stigma that can accompany cancer survivorship.It’s tempting to see only one worldview as valid, but that, I think, would be an oversimplification if not a deception. Whether they prefer to count up or count down during their treatment—or do the same when counting the Omer—these patients forged an association with others in similar circumstances to derive new insights about both present and future. I feel exceedingly privileged to learn from human beings who have acquired such a refreshing awareness of time, quite likely because of their circumstances.As the current Omer season gets under way, I will include in my daily prayer not only BaOmer for the present but also LaOmer for the future. I will adopt this custom—using both terms—not out of legalistic (i.e., halachic) uncertainty about which one is “correct,” but owing to a need to affirm two distinct concepts that seem to complement and even temper each other. Such a practice will require a small amount of additional time each day, but I see this as a worthwhile investment by all accounts.