Risk, Repentance, and Reward

Eldridge Street Synagogue, New York, photo by the author

One morning in my naval medics’ class, I walked into the classroom to find that my friend Tzion Bublil had written the following on the chalkboard:

What is the only disease that is 100% fatal?

Life.

How easily we forget.  Most of us conduct our lives as if we are operating on the opposite assumption: nothing bad will happen to use.  Even if we are aware of the inherent dangers of being alive, we tend to think in absolutes: If I do this, everything will be fine.  If I do the other thing, I will die.  Or, flipped on their heads, if I fail to do the good thing, I’ll die, and if I avoid doing the bad thing, nothing bad will happen to me.

It’s a recipe for a crisis of faith, whether you are praying or getting a medical checkup.  Risk and reward don’t operate that way, in the spiritual or the physical spheres.  Believing that they do can only lead to disappointment.

I’m a person of stable faith, but I have lots of friends whose belief in God has run aground on the words of the Unetaneh Tokef prayer on the High Holidays.  “On Rosh Hashanah it is written, and on Yom Kippur it is sealed, who shall live and who shall die…” and so on until the last hopeful coda, “But repentance, prayer and righteous behavior maavirin the severe decree.”  What maavirin means is a matter of debate, one artfully laid out by my longtime teacher Rabbi Larry Freedman this past weekend.  Let us assume that it means that one can change their fate, even after it is sealed, by engaging in these behaviors.  There is a moral order to the destiny inscribed for us in the Book.

And yet the righteous die, and the wicked perish, every year.  And every time someone with wavering faith reads those words, and thinks about that reality, they become less convinced that the Judge is Just.

Over the past two-and-a-half years, we have at times elevated our pandemic mitigation strategies to an Unetaneh Tokef of public health policy, to similar effect.  Every time a fully vaccinated person becomes critically ill, or a person wearing an N95 mask while jogging outdoors alone contracts COVID anyway, resolve weakens and skepticism grows.

As we will read this coming Shabbat in Ecclesiastes, “There is nothing new under the sun.”  The COVID-19 pandemic did not give birth to the phenomenon of misunderstanding and misusing the idea of risk.  Think of all the times you have joked about the Guinness record holder for world’s oldest living person attributing their longevity to, well, Guinness (the beer that spawned the book).  More tragically, think of James Fixx, the running guru who died of a heart attack in his forties, the non-smokers you know who succumbed to lung cancer, or the young adults who grew up having family meals and open conversations with their parents every night and still developed substance use disorders.  It’s no wonder that well-funded accusers from the tobacco, chemical and anti-vaccine industries have found it so easy to sow doubt in the medical profession, to create the equivalent of science atheists.

Whether in prayer or public health, there is no room for absolute certainty.  Four years ago, one of my first posts to my blog (“Make The Wind Blow”) talked about how the first thing actually created in the Biblical Creation story was chaos, and the whole rest of the Creation process has been an ongoing effort to create and maintain separation in that chaos.  As I said at the time, that effort fails frequently and dramatically.

There are things that we can do to maintain the separation, reverse the slide back to chaos, or postpone the inevitable – sometimes.  The great fallacy of Western medicine is that we are in control of the body; the great fallacy of pagan religion is that we are in control of God.  Even as the Abrahamic faiths turned from the worship of many to the worship of one all-powerful God, they could not uproot the deep-seated belief that there was some way to game the Great One, whether according to the recipe of one’s own creed, or by following the latest science or pseudo-science.

Let’s acknowledge that the chaos is always going to be there.  The science that describes the impact of changing any single risk factor is complex and dreadfully boring to read, so it’s no use trying to catch the public’s attention that way.  And the impact of spiritual change and growth is one of the universe’s eternal mysteries, one we may be fortunate enough to understand after it’s already too late to keep us alive in this world.

This Rosh Hashanah I heard the words of Unetaneh Tokef differently.  Not as a proclamation of a moral truth, but as a direct quotation of a question that God, and we, ask together, both in the chapel and in the clinic:

On Rosh Hashanah it is written, and on Yom Kippur it is sealed,

“How many shall pass on and how many shall be born?

“Who shall live and who shall die?

“Who shall come to a timely end and who to an untimely end?

“Who by fire, and who by water?”

And who shall I say is calling, as the poet wrote.  Or as Rabbi Dan Selsberg said when I heard him speak for the first time seven years ago, in two of the most impactful words I’ve ever heard from the pulpit, “Who knows?”

Some will pass on and some will be born, some will live and others die, and when they die some of those deaths will be in their season and some far too soon, some by fire and some by water.  In my time in medicine my partners and I have lost people to drowning, mourned deaths by suicide among people in their twenties, welcomed countless babies and bid farewell to people as old as 104.  But who will those people be this coming year?  Who knows.

It’s easy to feel powerless in the face of chaos, but we are not.  How much power do we have?  Who knows.  But it’s better than nothing.  We have repentance, prayer, righteous action, seat belts, vaccines, strong relationships, home care for the elderly, cholesterol medicine, exercise, suboxone, compassion, defibrillators, and emergency surgery, and we hope, no, pray, that it will be enough.

May it be the will of the Blessed Holy One that all of you reading this who have been inscribed in the book of “Who Knows?” be granted the power, all those powers I have listed and so many more, to do whatever it is we do to tip the scale in favor of at least one, and God willing many, more year together.  There are no guarantees, there is chaos, but while we are here together there is hope.  Let us make wise use of it.

About the Author
Jonathan Weinkle MD, FAAP, FACP is a primary care-physician in a community health center in Pittsburgh. He is not a rabbi, though he has often been accused of being one. He is an amateur singer-songwriter, teaches at both Chatham University and the University of Pittsburgh, and is the author of the book Healing People, Not Patients. For a complete archive of his writings, plus media, event listings, and even source sheets for further learning, visit healerswholisten.com.
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