A strange thing has been happening to me at work lately. Over the past few weeks I’ve probably seen half a dozen people for visits to “re-establish care.” I had been their doctor at some point, anywhere from two to ten years ago, until something intervened – a change of insurance, moving out of town, or simply not feeling they needed to come to the doctor. By some coincidence (coincidence, as we know, is just a series of similar events that happen while we are paying attention to them, as opposed to passing beneath our radar), they all decided to return to see me at the same time.
Every time I have this experience it is eye-opening. Over the years I have had children return to me having bloomed into teenagers, teenagers who have matured into adults, people in the throes of terrible addiction who have maintained months or years of sobriety, and people with disabling mental illness who are off medication, sleeping soundly, working gainfully and happy in their homes.
At the same time something else is returning after a long absence – the beginning of the Torah. Every year we return to this same place, begin reading again from creation, as we do this week. To the question of why we must do so every year, when the Torah hasn’t changed for millenia, I always received the answer, “The Torah hasn’t changed, but we have changed.” We come at the text with new eyes, new minds, new hearts, that we didn’t have the last time we read these words.
The people who come back to me may find me to be the same doctor – but they have changed, grown, aged and healed. When they return to me and nothing has changed, perhaps they are hoping to find me different – to find the same doctor has grown fresh eyes.
Two years ago that doctor had just published a new book about listening to people, finding the person within the patient, and overcoming systems and stigmata to provide them with kind, respectful, compassionate and excellent care. That doctor wrote a column about the second verse of Bereishit, “The earth being tohu va’vohu with darkness over the surface of the deep and ruach Elohim sweeping over the water.” That doctor thought the meaning was that the earth was in some primordial state, maybe one of awe, maybe one of sadness, or maybe one of complete chaos and randomness. That doctor likened this unsettled state to illness, and ruach Elohim to a spirit of God that might allow me to approach that chaos with kindness and compassion to help shape the illness back into an ordered life.
That doctor had no idea that over the next two years, the world would fall apart again, and again, and again. That doctor has changed, because he is exhausted.
But these people have returned anyway. They did not come back hoping to find that the fresh eyes I had grown were bloodshot and jaded. They wanted wisdom, not world-weariness. They did not want a doctor who would look again at Bereishit 1:2 and think, “Hey, this interpretation that says tohu va’vohu means, ‘shocked and confused’ sounds exactly right! (Bereishit Rabbah 2:2).”
Unfortunately, that’s how most of the world is feeling these days, and how a lot of the people I care for feel much of the time. Shocked and confused. “Why me?” God created a universe, and it is going to pieces around me. God gave me a body and it’s going to pieces on me.
One way that we get “fresh eyes” in re-reading the same material every year is to look at a different detail than the one we looked at before. I told the story in Healing People, Not Patients of the med student, truly a fresh pair of eyes, who went to see a patient I had known for two years, and chose to focus on something I never had before – her eyes. They were bulging like Marty Feldman’s in Young Frankenstein, a classic sign of Graves’ disease of the thyroid, but I had never really looked because the patient had never complained about her eyes, even when asked if she had any eye problems. This student looked at a different detail, and suddenly the rest of the symptoms made complete sense.
I’ve spent so long looking at the tohu va’vohu that I’ve really forgotten to look at the ruach Elohim – what popularly translates as “the spirit of God,” and which some Christians see as the first reference to the Holy Spirit. So that’s the detail I’m focusing on this year.
All three of the major Targumim (Aramaic translations) of the Torah, Onkelos, Jonathan, and Jerusalem, include the words min kodam – “from before.” I wonder if they mean before as in “earlier”, a more ancient wind or spirit than even the universe which is being created now, or “from in front of,” as in a spirit or wind emanating from God. What interested me more, however, was the extra word not directly present in the Hebrew that both the Jerusalem Targum and Targum Jonathan insert: rachamin, mercy. Ruach rachamin (in Jonathan, rucha d’rachamin in Jerusalem) min kodam Adonai. The spirit of mercy from before God. God, the ancient spirit of mercy. A Divine wind of motherly love.
It’s the perfect counterpoint, exactly what we need hovering over this chaos. In the morning service we recite, yotzer or u’vorei choshekh, oseh shalom u’vorei et ha kol. “Who invents light and creates darkness, makes peace and creates all.” God is responsible for all of it, the light and the dark, the wonderful and the miserable, and tries to make harmony out of all of it. My friend Gary Goldberg pointed out to me, just a month before the start of the pandemic lockdown, that this verse actually includes all three levels of action – doing (oseh), creating from raw materials (yotzer) and creating from nothing (borei) as only God can do. And what does God do with that light? In the very next line of the prayer we proclaim, Ha’me’ir la’aretz u’l’darim aleha b’rachamim. “Who lights the earth and those who dwell on it in mercy.”
Not everyone who comes back to my practice after a long absence is coming back alive with new potential. A person disappears from my schedule for two election cycles only to return with the exact same frustrating, intractable symptoms. They left because they weren’t getting any better, only to return because, well, they weren’t getting any better. Another returns to the place where we met seven years prior for the same reason we met seven years prior – because the six years of sobriety in between came to a screeching halt, and we are back at the halfway house. It’s easy to feel the divine spark when the reunion comes with good news. How do I carry on when we are back where we started?
By focusing on the ruach Elohim, which Targum tells me is a breath of divine mercy. It is the thing that keeps us trying in the hopeless situations, that pushes us to turn over one more stone, or to turn over the same stone again and hope we find something different. That mercy, my morning davening tells me, is the thing that is going to shine the new light on whatever it is I’ve failed to see before. Maybe it will help me remember the weird mnemonic about this symptom that I learned as a first-year med student. Maybe it will get me to pay a little more attention at the exact right part of a person’s narrative. Maybe it will drive me to do the one extra literature search that turns up the diagnosis – like learning that my patient with intractably itchy upper arms was not alone in their suffering and that there was actually a treatment with some data behind it.
Whatever it helps us do, all of us are going to need that rucha d’rachamin in the coming months and years. I am going to see a lot of people who get sick with, and die of, COVID19, and countless others who get sicker with whatever else they already had because of the disruption it caused, or the fear of getting it. I am going to be faced with a lot of people who simply can’t get better, who are still weak, still short of breath, still in a brain fog months later.
Two years ago, I approached this verse from the view that wholeness, completeness, was our natural state, and tohu va’vohu was something we fell into from time to time. I believe the opposite now – the world began as chaos, as shock and confusion. The miracle of the universe is that anything beyond that even exists – anything we have is a gift. The comfort I take is that the one thing older than the tohu va’vohu, the thing that hovered over even the unformed universe, was the rucha d’rachamin, and it shines light even before anyone has “let there be light.”
It’s nice to see everyone again.