Jonathan Weinkle
Jonathan Weinkle

Tearing Up the Decree

Photo by the author 8-1-21

We have a few rules in our house that are so well-known they have numbers.

Rule Number Two for the dog is “Don’t eat trash,” for example.  But Rule Number One is the same for all species:

Don’t die.

The circumstances under which that rule was written came up in conversation at dinner the other day, as my son recounted a story that involved oranges, lemons, and a passing car that resulted in a near miss.  Following that, we rehashed his own narrowly avoided 20-foot fall onto concrete. After 18 months of a global pandemic, we could think of nothing better to do over dinner than to discuss brushes with death that were avoided more than a decade ago.

In this season of the year, however, it seems apropos.  We are in between the Rosh Hashanah and Yom Kippur recitations of Unetaneh Tokef prayer, “We lend power to the sacredness of this day,” at the end of which we read, “And teshuvah (repentance), prayer and tzedakah (distributive justice) avert (ma’avirin) the severity of the decree.”

The late Rabbi Alan Lew, among others, pointed out in his essential work, This Is Real and You Are Completely Unprepared, that in the Talmud, the Hebrew/Aramaic word is not ma’avirin but ma’akirinMa’akirin doesn’t mean “avert,” but “uproot” or “tear up.”  In the Talmudic version, tzedakah, prayer, changing one’s name, or changing one’s behavior (essentially, teshuvah) actually remove the decree as if it never was.  In the Machzor, it “lessens the severity.”

For Rabbi Lew this represented “an immense theological sea change, a thousand years in the making.”  According to Unetaneh Tokef, our actions in this fraught time are not rewriting a calamitous future history, but merely softening its blows, changing our understanding of what the universe is doing to us, extracting some small measure of rachmones from God.  And yet paradoxically, it is this smaller, less-ambitious bit of salvation that looms largest in our minds.

My profession, medicine, defines itself in terms of “averting the decree.”  The greatest glory (and largest purse) in medicine is reserved for those who arrive on the scene when a person is in mortal danger and exit with them being wheeled, smiling, out of the hospital to cheering, waving family members.  The emergency personnel who revive a person after drowning, the cardiologists who perform the cath and place the stent that restores blood flow during a heart attack, and the surgical oncologists who remove the impossibly complicated tumor from a lung are “averting the severity of the decree.”  Amid phrases like, “touch and go,” “not out of the woods yet,” and “critical but stable,” there is the transformation Lew talked about, from fear of an imminent death to the rebirth of hope where it had been lost.

Yet my profession is also made up of lamed-vavniks, hidden heroes who are still engaged in a more Talmudic version of the repentance project, tearing up decrees that people don’t even realize have been made.  No one heaves a sigh of relief for the child who didn’t come close to drowning because her pediatrician said to her parents, “She has epilepsy, don’t let her swim alone.”  Few people come to bentsch gomel (say the prayer of being saved from disaster) after not dying of COVID19 that never infected them because their doctor successfully begged them to get the vaccine.  And fewer still sit around the dinner table regaling their families with tales of the heart attack they never had because the nurse at the state-sponsored “Quit Line” helped them stop smoking.

We will never know what decrees have been “torn up” through our painstaking work at keeping people healthy and safe.  I have written elsewhere about the toll the pandemic has taken on people in public health jobs, who are doing this exact sort of work in the face of violent protest and death threats.  No one individual will ever be able to say, “The director of our county health department saved my life,” but hundreds will certainly complain that she made them curtail their businesses.  The patient not telling the nonexistent tale of their never-happened heart attack may be cursing that nurse for the fact that they gave up the “one vice they had left,” as one of my patients used to say to any med student who would listen.  And even some of my close friends will never tire of telling us how annoying pediatricians are for “nannying” everyone into buckling up their kids in age appropriate carseats or putting them to sleep on their backs in their cribs with no soft bedding, especially the ones who did not lose a child to a motor vehicle crash or to SIDS because the child was never at risk.

I pray each day for the well-being and recovery of close to a dozen of my patients dealing with cancer, severe heart disease, unexplained but progressive illness, or crippling depression.  Yet I take care of more than a thousand people all told.  Why am I not praying on their behalf?

Va’ani Tefilati, the title of the siddur that I pray from and the beginning of one of the two phrases we chant in triplicate before the open ark while taking out the Torah on holidays.  I am my prayer.  The work I do, often behind the scenes, often without fanfare, often to open disdain or eye-rolls that would make a teenager seem enthusiastic by comparison, is my prayer for these people.  It is my prayer that their decree should be not just averted in its severity but torn up entirely.  That they should never know the ravages of cancer, the fear of heart disease, or the tragedy of a maimed child.  That is my prayer for them.  That the several hundred thousand more people who some predictions say will yet die of COVID 19 before the pandemic ends will never even know the danger they were in because of the selfless devotion of their friends and neighbors to choose life.  That the next pandemic will be a non-event because some anonymous technician in a biohazard lab is meticulous in wearing her hazmat gear and never deviates from annoying safety protocols.  That we “change our ways and live,” in the words of the paragraph that follows the Unetaneh Tokef.

As Yom Kippur approaches, may you be inscribed for a blessing in the Book of Life.  If you are grappling with a severe decree already, may it be averted and made less severe in the coming year.  If it is well with you, may whatever evil decrees may have awaited you be torn up on account of your many good deeds and heartfelt prayers and those of the loved ones who surround you – and may you never know what lay in store for you.

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.
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