Land of the Sick, Land of the Well

Parashat Tazria - Metzorah 5781

The room swelled with sound:
machines beeping, bags of medicinal fluids swishing, 
and inhaling, exhaling, inhaling, the respirator reliably breathing for him.  
Doctors, nurses, technicians, and loved ones glided around as if graceful dancers.  
His arms flailed towards me, reaching out, it seemed, amid the intensity of the ICU.  
After a long and grueling illness, he was in great distress: 
physically to be sure, and emotionally, spiritually, I’d guess.  
The referral form suggested he had interest in speaking about personal theology, 
but now, after a long illness, he could no longer speak.

This moment I describe, 
from a summer as a Chaplain at Memorial Sloan Kettering Hospital,
was in a place I had never before dwelled,
what Susan Sontag calls:
The Land of the Sick. (She uses the word Kingdom.)
Those I encountered that summer,
all inpatient on Sloan Kettering’s Head and Neck or ICU floors,  
were truly in this Land of the Sick,
part of the duality that Sontag describes in her 1978 book: Illness as Metaphor. 

I’m leaning on a treatment of Sontag’s work from an essay on illness 
by the inimitable Rabbi Larry Hoffman1 
shared with me by my friend Rabbi Hannah Goldstein.

“At birth,” Rabbi Hoffman paraphrases Sontag,

“we are issued two passports, 
One to the Land of the Well and the other to the Land of the Sick.
We pocket the first and put aside the second, determined never to use it.
But the day comes, for some of us earlier than others, 
when we must exchange passports.
And when we do, we are, inexplicably and against our will, 
transported across a river to a land and culture not our own.”

Rabbi Hoffman riffs on Sontag’s metaphor as he considers the gap,
the great breach between the Land of the Well and the Land of the Sick.
He notes: “From time to time brave boat builders (among whom we once lived)
visit us without realizing, however, 
that we are not the people we once were.
Across the river (in the Land of the Sick) 
we speak a language that only sounds the same as the language they still use.”

To drive home his point, Rabbi Hoffman imagines a conversation 
first in the Land of the Well.
“Hi, How are ya?” 
“Fine thanks, and you?” 
“Can’t complain.” 
It’s not a particularly meaningful conversation.
Just a regular greeting ritual and speech act that these days
might even bring forth comfort in its affirmation of normalcy. 

But in the Land of the Sick, that conversation would fail.
Rabbi Hoffman imagines a second conversation
between someone from the Land of the Well and someone from the Land of the Sick.  
“How are you?”  “Awful, I may be dying…”
“I am so busy at work”. “I’m so busy lying in hospital beds, waiting.” 
“I wish I had a vacation.” “I wish I could work.” 
The distance between the two Lands and their languages widen.

But at least the brave boat builders try, right?
Just like the priests of our double portion Tazria - Metzora.
In Torah, when one must join the Land of the Sick,
it is the obligation of the priest to go out of the camp
and visit those in the Land of the Sick
to determine when and if they are well enough to return to the Land of the Well.
In Ancient Days, it was the priestly obligation to make this visit.  
Of course, in modern times, it is upon all of us.

And yet - how difficult.
How difficult to build a boat to travel the rough waters between the two Lands.
Rabbi Hoffman points us to Tolstoy’s Death of Ivan.
As you can guess from the book’s title, Ivan had been sick, incurably so.
Some time later, Ivan’s colleagues are sitting around when one of them, 
Peter Ivanovich announces: “Gentleman, Ivan Illyich is dead.”
“I haven’t seen him since the holidays,” said Feydor Vasilievich.
“I always meant to go, but he lived so terribly far away.”
So far away.
There is a great distance between the Land of the Sick and the Land of the Well.
Metaphorically and actually.
Right now, as we know, in so many settings, 
family members can neither visit nor accompany
loved ones dwelling in the land of the sick.

But my assessment of this moment right now is that this gap has actually narrowed
because more of us are in the land of the sick
or have loved ones dwelling there than ever before.
All at once:
some facing arduous cancer treatments, 
some recovering from surgeries, 
some enduring long-hall covid symptoms, 
so many facing lengthy mental health journeys…
and so many suffering devastating grief.
From physical to emotional illness - 
SO many among us are invisibly dwelling in this Land of the Sick
and longing to return to the Land of the Well
that it is rare to meet someone in the Land of the Well anymore.

It seems like no one is actually well right now.

Land of the Sick and Land of the Well - 
is a stunning metaphor really.
And the irony of the metaphor is that the point of Susan Sontag’s masterpiece 
was to urge us to reconsider the ways we use metaphors to describe illness.

“I want to describe,” she writes, “not what it is really like to emigrate to the [land of the sick] and live there… [but that] illness is not a metaphor, and that the most truthful way of regarding illness— and the healthiest way of being ill— is one most purified of, most resistant to, metaphoric thinking.” (page 3)

Coupled with our societies desire to hide away illness and death, 
defying both by containing them in fortresses of medicine,
we know these sentences:
She lost her battle… the obituary will read.
After a long illness… the eulogy says.
They are on medical leave… the email away message responds.
Pandemic fine… we all say.
But these metaphors stand for:
She had cancer.
He had Alzheimer’s. 
Death by suicide, of opioid overdose.
They suffered a tragic late term miscarriage.
They cannot get out of bed because of deep, dark depression
Because of painful grief.
But pandemic fine because it's an easier statement than saying how we really are.
We don’t really want to talk about it…
A casserole or a lasagna will do 
as long as I don’t have to share with you that I am not fine,
because we are not fine.

A later edition of Sontag’s book was published at the height of the AIDs crisis.
People were not fine.
The Queer community especially was not fine.
Metaphors were insufficient and frankly dishonest.
And today while our society dwells together in this Land of the Sick,
we are not fine.
Further, experts suggests that every person who has died of Covid this year, 
leaves behind at least 9 newly bereaved loved ones.2
A grief pandemic is what comes next, they say.

What does it mean, what could it mean...
if our society, our world remains in the Land of the Sick for years to come?

For folks who have been dwelling in the land of the sick for their lifetime,  
whether with chronic illness or disability or something else none of us can imagine,
I imagine them saying to us: 
“it’s about time that you got it,
it’s about time that you understood what our life is like over here, 
how we feel so alienated outside the camp…”

I know they never wished for us to find out this way,
and I’m grateful that they can finally access so much of Judaism and life from home.
This year of living in the Land of the Sick has become a universal design:
the weighted blankets we can all buy now 
that make it accessible for folks who really need them.

We have an urgency, an opportunity,
now more than ever - to stop the metaphors
(and y’all I LOVE METAPHOR 
but only to deepen meaning, not to dishonestly conceal.)
We have an urgency now more than ever to ask ourselves:
How do we narrow the distance between these two lands...?
How do we cross the river?
How can we be the priest/esses?
Is it a prayer for healing?
A Bikkur Cholim visit to the sick?
And when we cross the river to visit, what do we say?

First, even though I absolutely love it
I want you to know hard it is for clergy to visit the Land of the Sick, too.
That’s why most of us are required to do chaplaincy training in medical settings.
But I admit, I would’ve much rather spent another summer 
at a URJ summer camp in the Land of the Well,
than in the Sloan Kettering Land of the Sick.
It was so difficult for me to encounter face to face what it means to be sick.

So how do we cross the river and when we cross it, what do we say?

If you can recall a time when you were visited in the Land of the Sick, 
what words brought you the most comfort?
What words brought you relief?
My guess is that it was purely the fact that you were visited
at all
in the Land of the Sick
and not the conversation that ensued. 
It was the showing up, 
the reaching out, 
the empathy, 
the regard, 
the time taken.
It wasn’t the casserole, it wasn’t the lasagna.
It was the person holding it.

My friend Rabbi Goldstein taught me a possible biblical model
for how to cross the river to the Land of the Sick.
When God visits Abraham after Abraham’s covenantal adult circumcision,
Genesis (18:1) says that God “appeared to him by the terebinths of Mamre;
he was sitting at the entrance of the tent as the day grew hot.” 
God is our model.
For there were no words exchanged between Abraham and God that day.
Rather, God simply “appeared” in the hot part of the day.  

I wish I had visited my patient a day or two earlier
when he had requested a chaplain visit to speak about God.
I didn’t yet know how to have that conversation;
my visitation obligations were already quite full.
So I waited an extra day.
But by the time I arrived he couldn’t talk anymore.
But I suppose that was never the point of my visit to begin with.
Rather, I was serving the role of one who would appear
and be present to him in the Land of the Very, Very Sick.
He wasn’t one who would ever return with me to the Land of the Well.

So through my medical mask, I tried to voice what he no longer could.
And I sang.  
First niggunim, the melodies that, though wordless, manage to communicate so much.  
And then “Esah Einai, I lift up my eyes unto the hills…” 
His eyes darted around the room, to the windows, to his beloved.  
Then I prayed “Hashkiveinu Adonai Eloheinu… shelter us beneath your wings, God…”
God appeared to us both in the hot part of his days. 
And I touched his now stilled hands as his eyes met mine.

In this Hebrew month of Iyar, known for its powers of healing,
may we cultivate this Divine energy of presence
as we traverse through worlds of sickness and pain.



Rabbi Larry Hoffman, “Illness and Inculturation”, The Kavanagh Lecture delivered October 12, 2004. 


 Allison Gilbert, The Grief Crisis is Coming, NYTimes