Saying Kaddish Reluctantly – Ha’azinu 5776

One of the most uncomfortable things that I do as a Rabbi is to lead the Kaddish Yatom, the Mourner’s Kaddish, during services.

The Mourner’s Kaddish is one of several variations on this ancient prayer.  There is also the Chatzi Kaddish – the Half Kaddish, the Kaddish Shalem – The Full Kaddish, the Kaddish D’Rabbanan – Rabbis’ Kaddish, and the less familiar Kaddish D’Itchadeta – Kaddish of the Unification of the Divine Name, which is recited at funerals and at a siyyum marking the completion of study of a Tractate of Talmud.

While these variations developed over many hundreds of years, the core section of the Kaddish is one of the most ancient non-biblical prayers in our liturgy.  It has its origins in the Second Temple, before the prayer service as we know it took shape.

In numerous places, the Talmud heaps praises on the person or community that responds appropriately and with kavanah – spiritual intention – with the words: Amen.  Y’hei sh’mei raba m’vorakh l’alam ul’almeh al’mayah – “Amen.  May [God’s] great name be praised for ever and ever and ever.”  It does not specify the words that prompt this response, but it most likely resembles what we know today as the Chatzi Kaddish.

The central line is quite simple.  It proclaims the sanctity of the Divine name for all Eternity.  It is a simple statement of faith.

It is not clear in which contexts Jews would recite the Kaddish.  Most likely, it was recited after Torah lessons.  The teacher would proclaim God’s holiness, and the assembled would respond appropriately.  Thus, the Kaddish was a kind of prayer of dismissal.

The Kaddish is in Aramaic, which was the language that Jews spoke in their daily interactions.  This means that whoever instituted this prayer wanted to be sure that people understood what they were saying.

A midrash collection on Deuteoronomy called Sifrei Devarim connects this congregational response to a verse in this morning’s Torah portion, Ha’azinu.  (Sifrei Devarim 306)  In his poem to the Israelites, Moshe exclaims: Ki shem Adonai ekra,” – For the name of the Lord do I call.  Havu godel l’eloheinu – “Hail greatness for our God.”  (Deuteronomy 32:3)  When we hear someone extolling the Divine Name, we must affirm it with the appropriate response, according to the midrash.

The Talmud considers it extremely meritorious for us to do so.  One Rabbi declares that a person who responds with the words: y’hei sh’mei raba…  is assured of a place in the World to Come.  Another Rabbi claims that the evil decree against such a person is canceled.  A third Rabbi says that one should interrupt whatever one is doing in order to respond Y’hei sh’mei… – even if one is in the middle of praying the silent Amidah.  A story in the Talmud describes how pleased and honored God feels whenever the words of a congregation reciting Y’hei sh;mei raba… the Heavenly court.

But nowhere in the Talmud or in other writings of the era is there a single reference to the Kaddish as a mourners’ prayer.

The earliest oblique mention appears in a story from a text called Masekhet Kallah, “Tractate Bride.”  It is part of what are known as the Minor Tractates of the Talmud, which were actually composed several centuries afterwards but eventually came to be published together.  Masekhet Kallah, from the seventh or eighth century in Babylonia, deals with rules for brides and for conjugal relations.  It contains the earliest known version of the following story:

Rabbi Akiva was once in a cemetery where he came upon a “man” (actually, a ghost) who was carrying a heavy burden on his shoulders and was having difficulty walking.  He was crying and sighing.  [Akiva] said to him: “What did you do?”

He said to him: “There was not a single prohibition that I did not violate in this world.  Now there are guards set upon me who do not leave me alone for a single sigh.”

Rabbi Akiva asked him:  “Did you leave behind a son?”

He said to him: “Don’t ask me.  I am afraid of the angels who are whipping me with lashes of fire and demanding me ‘Why don’t you walk faster?’  Don’t tell me ‘you should rest!'”

[But Rabbi Akiva insisted, so] he said to him: “I left behind a pregnant wife.”

Rabbi Akiva went to that land.  He asked [the locals], “Where is the son of so-and-so?”

They said to him: “May the memory be uprooted of that one who deserves for his bones to be ground up!”

He said to them: “Why?”

They said to him:  “That robber stole from people and caused many to suffer, and furthermore, he had relations with a girl who was betrothed to another on Yom Kippur.”

[Rabbi Akiva] went to [the man’s] home and found his pregnant wife.  He stayed with her until she gave birth.  Then he circumcised [the baby boy].  When [the lad] grew up, [Akiva] brought him to the synagogue to recite the blessing before the congregation.

After some time, Rabbi Akiva went back to [the cemetery].  He saw [the spirit of the wicked man] which said [to Akiva]: “May your mind be at ease for you have set my mind at ease.”  (Masekhet Kallah 2:9)

The story reveals several important beliefs and practices: first, the concept that the soul of a sinner is doomed to punishment; second, that the son of a sinner can do something to earn merit for his deceased father’s soul, thereby saving him from such punishments; and third, that those merits can be earned by leading a community in prayer.

Later versions in subsequent centuries expand the story and specify that the son recited bar’khu and y’hei sh’mei raba m’vorakh l’alam ul’almeh al’mayah.  

It seems that, over time, the recitation of the Kaddish came to be associated with mourning.  At first, it was recited at the end of the seven days of shiva that was observed for a Torah scholar.  On the seventh day, a learned discourse would take place in the home of the deceased.  This learning would culminate with a recitation of the Kaddish.

Apparently, some people felt left out.  Maybe there was someone whose family thought he was more of a Torah scholar than he actually was.  Maybe there was an outcry from the non-scholars who wanted equal treatment.  It is hard to tell, but the practice gradually expanded to include all deceased.

Similarly, a practice developed for sons who were mourning the loss of a parent to lead evening services on Saturday night after the conclusion of Shabbat.  I can only imagine the disputes that arose: opposing mourners fight over the right to lead, those who do not have the skill to lead but still want the opportunity to earn merits for their parents’ souls.  The need arose to provide more opportunities.

These various beliefs and practices eventually came together.  Instead of leading the entire service, a mourner could just recite the Kaddish at the end of the service, and it would be “as if” he had led the entire thing.  Plus, multiple mourners could have the opportunity to recite the Kaddish.  Finally, the practice spread from just the Saturday night service to every service.

In many traditional synagogues today, mourners do not all recite the Kaddish in unison.  Rather, each individual mourner stands up and says the words independently from his or her seat.  Other congregants respond with Y’hei sh’mei rabah… to the person who is closest to them.  The result is a cacophony of voices reciting these ancient words at different volumes and speeds.

The standard Jewish belief about what happens when we die goes like this:

The soul of a person who lived a totally righteous life goes straight to the Garden of Eden/the World to Come/God.  The soul of a person who lived a totally wicked life goes to hell/Sheol/non-existence.  For the in-between souls – which is pretty much all of us – our souls go to Gei Hinnom, or Gehenna.  This is what Christians refer to as Purgatory or Limbo.  It is assumed that our souls will have the residue of at least some sins still clinging to them.  This residue is removed while in Gehenna over the course of up to a year, and the soul is cleansed.  Then, it can move on to wherever it is that souls go.

Mourners recite the Kaddish as a way to earn merits on behalf of the soul of the deceased, shortening its period of purification before it returns to its Source.  That was the initial motivation for reciting Kaddish on behalf of one’s parent.  There are other things that we do to help our loved ones’ souls move on.  People learn Torah, give tzedakah, and perform other mitzvot with this specific intention.  It is a way of saying that our loved ones’ positive attributes are still alive and making an impact in this world.

The Kaddish has gained added significance as a way to ritually mark a person’s period of mourning, to offer the mourner something to do in the supportive presence of the community, and to identify the mourner to the community so that it can come to offer comfort.  People who recite Kaddish for a loved one often find it to be a deeply cathartic activity which helps them move through the stages of grieving at a time when their loss is still raw.

According to Jewish law, children recite Kaddish for a parent for eleven months.  Why eleven, and not twelve?  It is a mark of respect, a way of saying, “even though it can take up to a full year to purify a person’s soul, my parent only needed eleven months.”  Someone who has lost a spouse, sibling, or child recites Kaddish for thirty days.

Kaddish is then recited on the yahrzeit (anniversary) of the death of an immediate family member.  Those who are not in their periods of mourning or observing yarzheit, generally speaking, should not recite the Mourners’ Kaddish.

I am blessed to have both of my parents living and in good health.  Many of you have met them, as they visit our community several times a year.  They were just here for Rosh Hashanah.

While it is pretty standard in Conservative synagogues for the Rabbi to lead the Mourners’ Kaddish, every time I do, I feel a powerful dissonance between the words I am saying and the reality that it is not the time for me personally to be saying them.

As a Rabbi, I have justified saying the Kaddish for two reasons.  1. It is important for someone to provide leadership so that numerous mourners in the congregation can recite the words together at the same pace.  2. Some people find it difficult to recite the words of the Kaddish.  The Aramaic can be very difficult.  It is much easier when there is a leader reciting them loudly and at a steady pace.

I feel that the time has come for an adjustment to the way that we recite the Mourners’ Kaddish at Congregation Sinai so that I no longer have to say it.  Some communities invite all mourners to assemble at the front of the sanctuary to recite the Kaddish together.  If someone prefers to remain at his/her seat, it is, of course, perfectly acceptable for them to do so.  Other communities invite an individual mourner to step up to the podium to set the pace for all those who are in mourning or observing a yahrzeit.  These are both possibilities for us.  I will be engaging the Ritual Committee to identify a solution that works for Congregation Sinai and helps me to feel more comfortable.

This adjustment might feel awkward at first, but I believe it will ultimately strengthen the bonds between those who are in mourning and the rest of our community.  I appreciate that Sinai is a community that is open to change.  It means a lot to me to be the Rabbi of a community whose members are always supporting each other’s efforts to increase in our knowledge of Torah and our commitment to Judaism.

Let’s Talk About Death So That We Can Live – Yom Kippur 5776

This is going to be a difficult sermon for some of us to listen to.  But it is an important one for all of us to hear.  And today, Yom Kippur, more than any other day, is the time for us to hear it.

On this day we face our own mortality, and admit to ourselves that so much of our destiny is out of our control.  Any of us could die tomorrow.  We could be hit by a bus or diagnosed with cancer.  We owe it to ourselves, and to our loved ones, to begin a serious conversation about our own deaths.  Let this be our resolution for the new year.

Our Jewish tradition is totally unequipped to answer questions about end of life issues in the modern era.  The prayer that I have been spending a lot of time with these High Holidays, B’rosh Hashanah Yikateivun, lists the various decrees that are at God’s disposal – who by fire, who by water, who by sword, who by beast, hunger, thirst, earthquake and plague.

Notice something common to all of these deaths.  They are all sudden.  There is nothing in this medieval prayer about Congestive Heart Failure, breast cancer, kidney disease, or Alzheimer’s.

While the language of the mahzor suggests that God has decreed our fates for the coming year and there is little we can do about it, the truth is quite the opposite.  We have an unprecedented ability to extend life, in some cases indefinitely.  We do not yet have the religious language to address all of the new challenges this presents.

This is not unique to Judaism.  Until the onset of modern medicine, most human death came suddenly.  People died from things like a kitchen injury that got infected, or the flu.

For the last one hundred years, though, humanity is increasingly gaining the ability to prolong dying.  The quick progression of medicine has taken us completely off guard.  We are no longer prepared to confront our own mortality under these circumstances.

In 1900, the average life expectancy in the United Staes was under fifty years old.  By the 1930’s it had risen to over sixty.  As of 2012, it was nearly seventy nine years old.

One hundred years ago, most people died in their own homes.  Nowadays, about a quarter of us die at home.  The rest of us die in hospitals, nursing homes, and other managed care facilities.

And that means that we, our loved ones, and the medical establishment, are faced with decisions that no previous generations ever had to consider.

You may have experience with this.  Some of you have had to make decisions about whether to continue treatment for a person you love.  Perhaps you felt confident that the decision you made was perfectly in line with the decision that your loved one would have made.  Or perhaps there was doubt.  You were not one hundred percent sure.  Maybe there was disagreement between siblings.  Perhaps there is still guilt and uncertainty about the decisions that were made, or about things that were said.  These scenarios are unfortunately all too common.

My grandmother, Baba Fania, may her memory be a blessing, passed away six years ago.  She was eighty four years old, and was struggling with Congestive Heart Failure.  Baba Fania lived in her own home until almost the end.  A few weeks before she passed away, she moved to a rehab center.  There were trips back and forth from the hospital.

She continued to decline, and I, along with my parents and brother flew down to Southern California to join my aunts and their families.

When I arrived, Baba Fania was in the ICU, the Intensive Care Unit.  Her heart rate had dropped dangerously low, and so the medical team had put her on an intravenous medication to bring the rate back up.  It was not a permanent solution.  They tried to wean her off the IV, and when her heart rate dropped again, the treatment was restarted.

Then, the Resident who was running the ICU initiated a conversation with us that does not occur frequently enough.  In his own words, he said “ICU’s have a tendency to take over.”  A treatment is started, and it leads to one after another and another progressively more invasive intervention.

Our medical system is very good at finding alternative treatments to fight illness.  If the first round does not work, then there are second and third rounds to follow.  But our system does not do a good job of determining when to stop.

Doctors, after all, are trained to treat illness.  They wage war against death, the enemy.  When a patient dies, the battle has been lost and the doctor has failed.  Of course, the deck is stacked, and death always wins in the end.  Nevertheless, we ignore what is inevitable because it is too difficult for us.  That is why the conversation about whether a treatment should be undertaken in the first place often does not happen.

We were lucky.  In our case, it did.  My aunts and father discussed what their mother’s wishes would have been in this situation, since she was unable to answer for herself.  They agreed that my grandmother would not have wanted to initiate a series of interventions which had little chance of extending her life and had every chance of increasing her suffering

The decision was made to wean her off the heart medicine one final time.  If she could not support herself, then no further interventions would take place and my grandmother would die.

And that is what happened.  The medication was withdrawn and she was transferred out of the ICU into a regular hospital room.  She died there a day and a half later.  I was in the room at the time with my aunt and uncle.

We were really lucky.  Lucky that my father and his sisters were in agreement about what to do.  Lucky that my grandmother had filled out a health care directive, and that everyone was aware of it.  Most of all, lucky that the physician running the ICU that day took the time to have a big picture conversation with us rather than speaking about the next treatment options – because it very easily could have gone in that direction.

As a I look back from a six year vantage point, I wonder if it might have been better if my Baba Fania had never gone to the hospital in the first place.  She could have been enrolled in a hospice program that would have focused on quality at the end of her life.  She could have stayed in the home that she had lived in for forty six years.  She could have died in her own bed, surrounded by her children, grandchildren, and the hundreds of photographs that lined her walls.  But the discussions that would have led to that decision never took place.

It is nobody’s fault.  Most of us do not know how to have that conversation.  It is not part of our culture to talk openly about our own mortality.

The dialogue that needs to happen rarely does.

The truth is, most of us know virtually nothing about dying.  We do not understand how the health care industry functions – and this includes the people who work in it.  We know little about the various treatments and their attendant risks and complications.  We do not understand the choices that we are going to have to face.  What we imagine it is going to be like and what it actually is going to be like are vastly different.

As someone who is married to a physician and is in the business of spiritually helping people with issues relating to mortality, I probably have more exposure to these kinds of conversations than most people.  I first completed my Advance Health Care Directive when I was twenty five years old.  Dana, fresh out of medical school and entering her residency, came home and insisted that we fill them out.  Death is a fairly common topic of conversation in our home, including with our nine and eleven year old children.

And yet, I will be the first to admit that I know practically nothing.  I do not know what it is like to receive chemotherapy, unlike some people in this room.  I do not know what it is like to have the first round of treatment fail, and to have to turn to second or third tier drugs.  I do not know what it is like to be on a ventilator, or in a medically induced coma.  I have never had to go into a procedure knowing that I might not wake up from it.  So how can I possibly be expected to make a decision now about what I would want done if and when any of those scenarios become real?

So what can we do?

Many of us have filled out an Advance Health Care Directive.  We have designated a Proxy, a person who will make decisions for us if we become incapacitated.  We may even have discussed it with our physician.  We have taken responsibility.  I am sad to say that the form is close to worthless.

The California Advance Health Care Directive asks two essential questions.  The first asks do you or do you not want your life to be prolonged if you have an incurable and irreversible condition that will result in death in the near future, or if you are unlikely to regain consciousness, or if the likely risks and burdens of treatment would outweigh the expected benefits?

The second question asks whether or not you want pain relief, even if it may hasten your death.

That’s it.  In the event of an emergency, two questions cannot possibly cover the range of scenarios that could arise.  And that is assuming that the directive you filled out made its way into your medical file, and that somebody actually bothered to look at it.  And, that the family members in the room with the physician are doing their best to decide what you would want rather than what they want.

No.  Those are not the right questions.

What is needed is not so much the answers to a list of medical scenarios, but rather a conversation about what is important to us.  Begin a conversation with the people in your life who are going to have to be with you at the end of it.

I once attended a class with a Geriatrician who had a lot of experience working with patients and families around end-of-life issues.  He described the relationship with the health care proxy, the person entrusted to make decisions for another, as a sacred “covenant.”

Nobody can account for all of the possible medical scenarios which he or she might be faced – so don’t bother to try.  What is more important is that the person entrusted with making decisions for you knows your values.

What matters to you?  What are you living for?  What in your life, if you lost it, would make you feel that living was not worth it any more?  What do you want your final weeks and days to be like?  Where do you want to die?

When the person you have trusted knows this about you, then if he or she ever has to make a decision, it will be your decision.

In a 2010 New Yorker article called “Letting Go,” Dr. Atul Gawande tells the story of a colleague.  Dr. Susan Block is a palliative-care specialist who has had thousands of difficult conversations with patients and family members, and is a nationally recognized trainer of doctors and other professionals entrusted with managing end-of-life issues.

Some years ago, her work became personal.  Dr. Block’s seventy-four-year-old father, a retired psychologist from UC Berkeley, was admitted to a hospital in San Francisco with a mass growing in his spinal cord. The neurosurgeon said that the procedure to remove the mass carried a twenty-per-cent chance of leaving him paralyzed from the neck down.  Without the operation, it was a one hundred-percent certainty.

The evening before surgery, Dr. Block and her father chatted about friends and family, trying to keep their minds off what was to come.  Then she left for the night.  Halfway across the Bay Bridge, Dr. Block realized, “Oh, my God, I don’t know what he really wants.”  So she turned the car around and went back to her father’s bedside.

Even for her, an expert in end-of-life discussions, the conversation “was really uncomfortable.”  “I just felt awful having the conversation with my dad.”  She told him, “I need to understand how much you’re willing to go through to have a shot at being alive and what level of being alive is tolerable to you.”

It was an agonizing conversation for her, but he said something that totally took her by surprise —”Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive.  I’m willing to go through a lot of pain if I have a shot at that.”

“I would never have expected him to say that,” Dr. Block said.  “I mean, he’s a professor emeritus. He’s never watched a football game in my conscious memory.  The whole picture—it wasn’t the guy I thought I knew.”

After the surgery, he developed bleeding in his spinal cord.  The surgeons told Dr. Block that, to save his life, they would need to go back in. But he had already become nearly quadriplegic and would remain severely disabled for many months and possibly forever. What did she want to do?

She recalls, “I had three minutes to make this decision, and, I realized, he had already made the decision.”  She asked the surgeons whether, if her father survived, he would still be able to eat chocolate ice cream and watch football on TV.  “Yes,” they said, and so she gave the go-ahead for another operation.

“If I had not had that conversation with him,” she later said, “my instinct would have been to let him go at that moment, because it just seemed so awful.  And I would have beaten myself up.  Did I let him go too soon?”  Or she might have gone ahead and sent him to surgery, only to find—as occurred—that he survived only to go through what proved to be a year of “very horrible rehab” and disability.  “I would have felt so guilty that I condemned him to that,” she said.  “But there was no decision for me to make.”  He had decided.

After a difficult recovery, Dr. Block’s lived for ten more years. When complications developed that made it impossible for him to eat, he decided to stop fighting.  He went home on hospice care, received treatment to make him comfortable, and died with his daughter at his side.

Talking about our own mortality is one of the most difficult conversations we can have.  It seems so scary and daunting.  Where do we begin?  Let me offer a few conversation starters:

Describe a time when you were part of a difficult medical decision, either for yourself or for someone else.

Have you ever been present when another person died?  Talk about what that was like.

Then you can begin to talk about your own death.

Complete the following sentence:  What matters most to me at the end of my life is…

Is there something that, if you could no longer do it, would make you not want to continue medical treatment?  The equivalent of eating ice cream and watching football for Dr. Block’s father.  One Rabbi told his family that if he can no longer tell stories to children, he does not want to continue living.  What is it that makes your life worth living?

Where do you want to spend your final days?  How important is that to you?

The answers to these questions are different for all of us.  One person may want every possible treatment, regardless of the impact on his quality of life.  Another may feel that she would not want to continue if she could not feed herself.

The answers to these questions are likely to change.  This means that the subject of our mortality should not be a one-time conversation.  It is a topic that we should introduce now, when we are healthy and at full capacity.

I have had conversations about death with some of you, and I am honored to continue to help you work through these issues.  But I am not the most important person to speak with.  This conversation should be had with all of the people who are likely to be with us when our health declines.  This could mean spouses, children, siblings, parents, and close friends.

One of the greatest gifts we can give to the most important people in our lives is a conversation about our death.  We can save them from having to make an agonizing decision.  We can save them from years of guilt.  And we can prevent the kind of family squabbling that occurs when children, siblings, and spouses project their own fears on their loved one because they do not actually know what their loved one wants.

You owe it to yourself, and you owe it to them, to talk about your death.

Our Jewish tradition focuses on living in the present.  We do not have any certainty about what awaits us in the world to come, and it is certain that death waits for us in this world.  So we focus on our time here in the world of the living.  That time is made immensely more precious when we can face our mortality openly and honestly with the people we care about.

Today, or sometime in the next couple of weeks, begin the conversation with your loved ones.  Let’s talk about death so that we can live.