Visiting Ruth

Like many others in the time of social distancing, I have had to give up regular visits with Ruth, a friend who is living in a nursing facility just a few blocks from my home. I worry that the virus disseminating among other long-term health care facilities will reach hers. I feel guilty about abandoning someone who is unable to care for herself—and I feel relief.

Relief, because the visits are often difficult to navigate and I frequently leave frustrated by my inability to meet the demands of being with someone in late-stage Alzheimer’s disease who, after 60-plus years, no longer appears to know me. I vacillate between thinking that even the slightest touch contributes to the moment-to-moment well-being of someone who is otherwise unresponsive to my attempts to make verbal contact and doubt that my visits register in her awareness, let alone leave her happier or more comfortable.

In the Jewish tradition the injunction to visit the sick, bikkur holim, is among the most honored mitzvot that we can undertake. It is mentioned no less than three times in the morning prayers we are also asked to recite. According to the Torah we visit the sick to help alleviate their suffering and earn dividends in the present for our mitzvot and accrue capital in the world to come.

When facing my reluctance to visit Ruth, I wish that I might be able to set aside a lifetime of skepticism and give myself over to the Jewish laws that have served so many for so long. I am listening and studying more these days: In recent years I have become increasingly interested in the Jewish heritage filtered through the progressive, Reconstructionist lens that I encountered in childhood. But I find myself caught in the tension between doubts about the efficacy of the visits and an impulse to continue forward with them despite the discomfort they cause. Perhaps after all its my yiddishe kop, the one that asks us to question and to live with complexity and contradiction rather than the one that asks us for a simpler obedience to the law, that prompts me to ask whose interests the visits serve. Am I engaging in acts of altruistic self-sacrifice or selfish attempts to right past acts of neglectfulness?

I came to know Ruth in the fall of 1958, the girl from Queens who traveled by subway an hour each way to attended our small, progressive school in Manhattan. Her sophisticated, Czech emigre parents were convinced she was running with the wrong crowd in the outer boroughs. Smart, attractive, with a buoyant sense of humor, she fit in easily at Walden, where the dual themes of social justice and free expression infused our daily lives. Three years after graduation, our classmate Andrew Goodman would lose his life in the struggle for civil rights; others, like Ruth, who spent eight years working on a kibbutz, would go on to live politically committed lives. Ruth ended up in Toronto and when I moved there in 2007 we were happy to reconnect.

When Ruth was first diagnosed, a process that took many months because of the ambiguous nature of her early symptoms, visiting was easier. At home, Ruth’s husband was a calming influence and mediated our time together. With infinite patience, he found ways to redirect her attention from preoccupations with imaginary people and things, and to soothe her with a warm hug or reassuring word. I was moved by his sensitivity to her every mood and their mutual regard for one another.

Seldom comfortable, either too hot or too cold, the room too bright or too dim, at times enjoying a physical affection and at others recoiling from touch, at home Ruth’s restless anxiety was punctuated by the occasional smile, familiar high-pitched laughter, and reminiscence of our shared past. And despite all the lapses and incomplete sentences, it was possible to feel that I was a making a connection, limited though it was, to the person who I had known for so long. Most importantly, hope and hopefulness were possible as she was still living time in all three tenses. But three years ago, when her needs for constant care became too great and began to take their toll on the health of her husband, their two adult children strongly supported the move to a long-term care facility.

When I began to visit at the nursing home Ruth was able to walk, to express a range of emotions, and to recognize familiar faces. I recall one affecting morning when I found her in an informal Shabbat service, swaying to the music and trying to repeat the words of a simple song. Mostly, however, we spent our time together pacing the halls, Ruth pressing me to move ever faster. Despite her increasingly fragile appearance she had a surprisingly strong grip powered by panic and despair. Intermittently she would demand that I take her home. She did not mention going to the family apartment or returning to specific activities. I came to read her demand as the expression of an existential longing for a return to a safe, pre-Alzheimer’s space where she could experience the kind of peace that eluded her now.

As an early childhood educator I have spent a lifetime advocating that teachers bear witness to the suffering of their students. I have argued that those growing up in poverty, or other difficult circumstances which we cannot fix for them, call us to acknowledge in our actions, spoken words and silent watching, the realities of their lives. We can’t know the experience of another from the inside but we can stand alongside them, hold their anxiety, unhappiness, and disappointments without flinching or looking away.

On reflection, I understand my role during those tortuous walks through the halls of the nursing home as bearing witness to Ruth’s suffering, to staying close when it would have been so much easier to stand back. This is not to claim success or satisfaction. For although I have spent many hours caring for people with AIDS and for my aging parents—alternately confused, enraged, and despairing—I felt inadequate to the task of witnessing Ruth’s angry outbursts.

I tried to coordinate my visits with the daily visits of Ruth’s husband and, when conflicting schedules made these joint visits difficult to arrange, I enlisted the help of a close friend of Ruth’s. Together we try to engage Ruth when she is awake, less of the time now, and chat with each other while she sleeps. We muddle through as best we can, as anyone can. The staff, always treating Ruth with the utmost respect, encourages us to be less timid and more assertive in our attempts to draw Ruth into this world. I find that challenging, both because Ruth only seems at peace when sleeping and I am haunted by memories of earlier visits when Ruth was far more combative.

My own family history taught me that when anyone was hospitalized it was essential to visit so that staff would feel a stronger connection to the patient and experience directly the web of family and friends in which they lived. During their last difficult years, I felt overwhelming gratitude when I received reports that my parents had received a visit from one of their few remaining friends. Immediately feeling less alone in my caregiving responsibilities, I was reminded of better times before sickness defined their lives.

At 76 and in good health, I’ve lost enough friends and family, had enough health scares, to be forewarned. Despite the living wills, the DNR orders, and all the other attempts I have made to circumvent final years in an institution, life has its own plans for us. As Job testifies, circumstances beyond our control are more often the rule than not.

I want to believe that my visits to Ruth are selflessly motivated. I know better. I go as much for myself as for Ruth, my acts more transactional than transformative, more instrumental than generous. I don’t want to be abandoned even if impaired cognition prevents me from knowing I am alone. I visit Ruth so that someone will visit me. I am moved equally by ethical imperative and magical thinking.

If I do not wish to be forgotten then it is incumbent on me to remember others. Hillel put it this way when he was challenged by a gentile who asked to be converted to Judaism under the condition that the Torah be explained to him while he stood on one foot, “What is hateful to you, do not do to your fellow: This is the whole Torah; the rest is commentary; go and learn.”

The visits to Ruth won’t buy forgiveness from the people who I have forgotten in the past. But by making this simple commitment I feel better about myself, my prior failings ameliorated. And that’s a big payoff for a small act. The visits are a gesture, aspirational, pointing to the kind of person I would like to be and modeling the kind of person I hope will stand by me.

The Jewish tradition places infinite value on life itself, no matter the quality or anticipated duration. At the end, let alone in the midst of illness, we are entitled to be treated as living persons in all respects. But when Ruth lost the ability to walk, to speak coherently, or to know me, my commitment to this basic tenet of Judaism was sorely tested. While my ability to bring comfort or a few minutes of forgetfulness had been slowly dwindling, now I lost the possibility of bringing an essential gift, the gift of hope. Life lived only in the moment precludes the possibility of the smallest events to come. Without a future, there is no hope.

Discarding any certainty that I might be bringing something to Ruth, I was forced to ask myself a new question: What was she offering me? As disquieting as they are, the visits are an opportunity to confront my own mortality, the uncertainty and the loss of control brought on by illness, and discomfort in the presence of one who is suffering. The feelings of inadequacy, my anxiety about arriving empty handed in the sick room, a function not of a failure to bear gifts or to be an adequate witness, but rather a failure to see the gifts that the visits had afforded me.

For the moment my connection to Ruth is limited to the reports of her family’s weekly Skype sessions. I write in order to stay in closer touch with the roller coaster of emotions that has marked our relationship these past years and Ruth’s diminishing presence in the world. And I read with relief accounts of the mobile team from a nearby hospital descending on her long-term facility to test all the staff and residents to reveal a finite number of COVID-19 infections in one wing of the building.

When the pandemic subsides I’ll return to visiting Ruth with this new appreciation of what they hold for me. Ruth asks me to accept the uncertainty that is the ground of human experience and to give with no reward other than knowing that it is the right thing to do. The mitzvah of bikkur holim is not about storing capital to enjoy later but rather an opportunity in the present to embrace our fullest humanity. I need these visits to Ruth as much, if not more, than she does.