Taking Care of the Ill — The Mitzvah of Bikur Cholim

Those of us living in Eretz Yisroel, are reading parshas
Korach
this week, from which the Gemara cites a source for the
mitzvah of bikur cholim. Those living in chutz la’aretz, can
certainly find ample reason to study the laws of bikur cholim this week.

Question #1: “Rabbi,” asked Mr. Greenberg, “My neighbor,
Mrs. Friedman, is having an operation. Is it appropriate for me to visit her?”

Question #2: Does Dr. Strauss fulfill the mitzvah of bikur
cholim
when he makes his hospital rounds?

Question #3: “My sister-in-law is hospitalized for a few
days for a minor procedure. I should really visit her, but I just can’t find
the time. Is it halachically sufficient for me to call her?”

Based on a pasuk in parshas Korach, the Gemara
(Nedarim 39b) teaches: “There is an allusion to the mitzvah of bikur
cholim
in the Torah: When Moshe declares, ‘If these people (Korach’s party)
will die like most people do, and the destiny of most people will happen to
them, then Hashem did not send me.’ How do we see an allusion to the mitzvah
of bikur cholim in the pasuk? Moshe declared: If these people
will die like most people do – if they will become ill and bedridden and people
will come to inquire about their needs (in other words, illness provides an
opportunity for people to fulfill the mitzvah of bikur cholim) – then
people will say ‘Hashem did not send me.’” Thus, the Gemara cites
this week’s parsha as one of the sources in the Torah for the mitzvah
of bikur cholim since Moshe specifically asked that Korach and his party
not die in the manner that most people, where this a chance to achieve this
important mitzvah.

Another allusion to bikur cholim is in the beginning
of Parshas Vayeira, where is says that Hashem visited Avraham
Avinu three days after his Bris Milah. Rashi points out that Hashem
was performing bikur cholim, visiting and providing care for the ill. In
the same way, by taking care of the ill, we fulfill the mitzvah of emulating Hashem’s
ways, in addition to the special mitzvah of bikur cholim (Sotah
14a). Thus, physicians, nurses or other medical professionals should have in
mind before every visit or appointment that they are performing two mitzvos,
one of emulating Hashem, and the other of bikur cholim. Since we
rule that mitzvos tzerichos kavanah, to fulfill a mitzvah requires being
cognizant of that fact, any medical professional gains much merit by being
aware of this every day and all day.

Every community should have an organization devoted to the
needs of the sick, and it is a tremendous merit to be involved in organizing
and participating in such a wonderful chesed project (Ahavas Chesed 3:3).

The Kli Yakar (Bamidbar 16:29) offers an
additional reason for fulfilling bikur cholim to benefit the
visitor. Seeing someone ill influences the visitor to think about the
importance of doing teshuvah. And this influence provides extra merit
for the sick person, since he caused someone else to do teshuvah!

The Gemara (Nedarim 40a) reports that when one
of Rabbi Akiva’s disciples was ill, no one came to check his welfare. Then
Rabbi Akiva entered his dwelling, cleaned it and sprinkled water on the floor
(to prevent dust from rising), and the student exclaimed, “Rabbi Akiva, you have
brought me back to life!” After this experience, Rabbi Akiva taught that
someone who visits the ill is considered to have saved his life!

WHY “BIKUR” CHOLIM?

What does bikur cholim mean?

It is worth noting that although “bikur” means
“visit” in modern Hebrew, the original meaning of “bikur” is not “visit”
but “checking.” In other words, the actual mitzvah of bikur cholim is to
check which of the sick person’s needs have not been attended to (Toras
HaAdam
).

There are two main aspects of this mitzvah:

I. Taking care of the physical and emotional needs of someone who is
ill.

II. Praying for the recovery of the ill person (Toras
HaAdam
, based on Nedarim 40a).

I. TAKING CARE OF PHYSICAL NEEDS

In addition to raising the sick person’s spirits by showing
concern, the visitor should also ensure that the physical, financial, and
medical needs of the ill person are properly being attended to, as well as
other logistical concerns that may be troubling him/her. Often, well-meaning
people make the effort to visit the sick, but fail to fulfill the mitzvah of bikur
cholim
properly, because they fail to take care of the choleh’s
needs (Gesher HaChayim).

Always cheer up the choleh (Gesher HaChayim). 
This is included in attending to his emotional needs.

The visit is to benefit the choleh. In most
circumstances, a visit should be short and not tire out or be uncomfortable for
the ill person. Sometimes the sick person wants to rest, but feels obligated to
converse with a visitor (Aruch HaShulchan, Yoreh Deah 335:4). In such
cases, visitors think they are performing a mitzvah, while, unfortunately, they
are actually doing the opposite. It is important to remember that the entire
focus of bikur cholim is on the sick person’s needs and not on the
visitor’s desire to feel noble or important. I remember my mother, a”h,
having such guests during one of her hospital stays; although she kept hinting
that she wanted to rest, they didn’t catch on and stayed put. They thought they
were performing a kind deed, while, in reality, they were harming a sick person
who desperately needed to rest.

OVERNIGHT CARE

One of the greatest acts of chesed is to stay
overnight with a choleh (Aruch HaShulchan, Yoreh Deah 335:3; Shu’t
Tzitz Eliezer, Volume 5, Ramat Rachel,
#4). A similar act of bikur
cholim
and true chesed is to stay overnight with a hospitalized
child to enable parents to get some proper sleep and keep their family’s life
in order.

A person can fulfill the mitzvah of bikur cholim even
a hundred times a day (Nedarim 39b). If one frequently pops one’s head
into one’s sick child’s bedroom to see how the child is doing, or periodically
drops in to visit a shut-in, one fulfills a separate mitzvah each time, so long
as it does not become burdensome to the choleh. Similarly, a nurse
fulfills the mitzvah of bikur cholim each time he/she checks on a
patient, and, therefore, she should have intent to do this for the sake of
fulfilling the mitzvah.

This applies even if the nurse is paid, because the
proscription against being paid to do a mitzvah applies only to the mitzvah’s
minimum requirement. Once one does more than this minimum, one can be paid for
the extra time one spends. The same certainly applies to someone paid to stay overnight
with a sick patient.

IS THERE AN OPTIMUM TIME OF DAY TO VISIT?

The Gemara states that one should not
visit a sick person during the first quarter of the day, since one usually
looks healthier in the morning and the visitor may not be motivated to pray on
behalf of the ill person. One should also not visit a sick person at the end of
the day, when he looks much sicker and one might give up hope. Therefore, one
should visit an ill person during the middle part of the day (see Nedarim
40a, and Ahavas Chesed 3:3). Rambam offers a different reason for
this halacha, explaining that at other times of the day, visitors might
interfere with the attendants and medical personnel who are taking care of the choleh
(Hilchos Aveil 14:5).

Thus, the ideal time for visiting an ill person is in the
middle of the day, unless he is receiving medical treatment at that time.

Despite the above, the custom is to visit the ill person,
regardless of the time of the day. Why is this so? The Aruch HaShulchan
(Yoreh Deah 335:8) explains that the Gemara’s visiting times are
advisory rather than obligatory. The Gemara is saying that one should
visit the ill person at the time most beneficial for his care, which is usually
the afternoon, either because this does not interfere with medical care or
because it is the best time to detect the patient’s medical status. However,
this is only advice and can be tempered by other practical concerns.

WHAT IF THE ILL PERSON IS RECEIVING SUBSTANDARD CARE?

In this instance, one should try to upgrade the choleh’s care
without agitating him in the process (Gesher HaChayim).

WHOM TO VISIT FIRST

Usually, it is a greater mitzvah to visit a poor choleh
than a wealthy one. This is because there is often no one else to care for the
poor person’s needs (Sefer Chassidim #361). Additionally, he may need
more help because of his lack of finances, and he is more likely to be in
financial distress because of his inability to work (Ahavas Chesed 3:3).

If two people need the same amount of care and one of them
is a talmid chacham, the talmid chacham should be attended to
first (Sefer Chassidim #361). If the talmid chacham is being
attended to adequately and the other person is not, one should first take care of
the other person (Sefer Chassidim #361).

CROSS-GENDER VISITING

Should a man pay a hospital visit to a female non-relative,
or vice versa?

The halacha states that a man may attend to another
man who is suffering from an intestinal disorder, but not to a woman suffering
from such a problem, whereas a woman may attend to either a man or a woman
suffering from an intestinal disorder (Mesechta Sofrim Chapter 12). This
implies that one may attend to the needs of the opposite gender in all other
medical situations (Shach, Yoreh Deah 335:9; Birkei Yosef, Yoreh Deah
335:4; Aruch HaShulchan, Yoreh Deah 335:11 and Shu’t Zakan Aharon
2:76).

There is a famous story of Rav Aryeh Levin, the tzaddik of
Yerushalayim. He was once concerned that a certain widow who had been told not
to fast on Yom Kippur would disobey orders, he personally visited her on Yom
Kippur and boiled water for a cup of tea to ensure that she drank. In this way,
he fulfilled the mitzvah of bikur cholim on Yom Kippur in a unique way (A
Tzaddik in Our Time).

However, some halachic authorities distinguish
between attending to a sick person’s needs, and visiting, contending that
although a woman may usually provide a man’s nursing needs and vice versa,
there is no requirement for a woman to visit an ill man (Shu’t Tzitz
Eliezer, Volume 5, Ramat Rachel,
and Zichron Meir pg. 71 footnote 24
quoting Shu’t Vayaan Avrohom, Yoreh Deah #25 and others).
Other authorities contend that when one can assume that the woman’s medical
needs are provided, a man should not visit her, because of tzniyus concerns
(Shu’t Chelkas Yaakov 3:38:3; Shu’t Tzitz Eliezer, Volume 5,
Ramat Rachel,
#16). Instead, the man should inquire about her welfare and
pray for her. I suggest asking your rav or posek for direction in
these situations.

II. PRAYING FOR THE ILL

The Beis Yosef (Yoreh Deah 335) writes, “It is
a great mitzvah to visit the ill, since this causes the visitor to pray on the
sick person’s behalf, which revitalizes him. Furthermore, since the visitor
sees the ill person, the visitor checks to see what the ill person needs.” We
see that Beis Yosef considers praying for the ill an even greater part of the
mitzvah than attending to his needs, since he first mentions praying and then
refers to attending to the other needs as “furthermore.”

Someone who visits a sick person without praying for his
recovery fails to fulfill all the requirements of the mitzvah (Toras HaAdam;
Rama
335:4). Therefore, physicians, nurses, and aides who perform bikur
cholim
daily should accustom themselves to pray for their sick patients, in
order to fulfill the mitzvah of bikur cholim. A simple method of
accomplishing this is to discreetly recite a quick prayer (such as “Hashem,
please heal this person among the other ill Jewish people [b’soch she’ar
cholei yisrael
]”) as one leaves the person’s room. (A doctor in his office
can recite the same quick prayer.)

MUST ONE PRAY FOR A SICK PERSON BY NAME?

When praying in a sick person’s presence, one does not need
to mention his name, and one may recite the prayer in any language. The Gemara
explains that this is because the Shechinah, the Divine presence, rests
above the choleh’s head (Shabbos 12b). However, when the ill
person is not present, one should pray specifically in Hebrew and should
mention the person’s name (Toras HaAdam; Shulchan Aruch Yoreh Deah
335:5). If one cannot pray in Hebrew, one may do so in English or any other
language except Aramaic (see Taz, Yoreh Deah 335:4).

[Incidentally, since the Shechinah is in the choleh’s
presence, visitors should act in a dignified manner (Shabbos 12b; Shl”a).
This includes both their behavior and their mode of dress.]

Why must one pray in Hebrew when the ill person is not
present? Rashi explains that in such a case, when one prays for an
individual, angels have to transport the prayer to the Divine presence (the Shechinah)
– these angels transport only prayers recited in Hebrew and not those recited
in Aramaic (Rashi, Shabbos 12b s.v. Deshechinah). However,
when praying in the presence of the sick person, one may pray in any language,
since the Shechinah is nearby and the prayer does not require the angels
to transport it on high (Shabbos 12b).

MAY ONE PRAY IN ENGLISH FOR THE ILL?

This explains the difference between Hebrew and Aramaic. What
about other languages? Do the angels “transport” prayer recited in a different
language?

To answer this question, we must first explain why angels do
not transport Aramaic prayers?

The halachic authorities dispute why the angels do
not convey prayers recited in Aramaic. Some contend that angels communicate
only in Hebrew and, furthermore, only convey a prayer that they understand (Tosafos,
Shabbos
12b s.v. She’ayn). According to this approach, the angels convey
only Hebrew prayers. However, other authorities contend that the angels do not
convey Aramaic prayers because they view this language as corrupted Hebrew and
not a real language (Rosh, Berachos 2:2). Similarly, the angels will not
convey a prayer recited in slang or expressed in an undignified way. According
to the latter opinion, the angels will convey a prayer recited in any proper
language, and one may pray in English for an ill person even if he is not
present.

The Shulchan Aruch quotes both opinions, but
considers the first opinion to be the primary approach (Orach Chayim
101:4). However, in Yoreh Deah 335:5, the Shulchan Aruch omits
the second opinion completely. The commentaries on the Shulchan Aruch
raise this point, and conclude that the Shulchan Aruch felt that praying
for an ill person is such a serious matter that one should certainly follow the
more stringent approach and pray only in Hebrew when the choleh is not
present (Taz, Yoreh Deah 335:4). Therefore, one should not pray for an
individual sick person’s needs in any language other than Hebrew. Only if one
is unable to pray in Hebrew, may one rely on the second opinion and pray in any
language other than Aramaic.

DOES ONE FULFILL BIKUR CHOLIM OVER THE TELEPHONE?

To answer this question, let us review the reasons for this
mitzvah and see if a telephone call fulfills them. One reason to visit the ill
is to see if they have any needs that are not being attended to. Although a
phone call might discover this, being physically present at the bedside is
usually a better method of ascertaining what is needed. The second reason one
visits the ill is to motivate the visitor to pray on their behalf. Again,
although one may be motivated by a phone call, it is rarely as effective as a
visit. Furthermore, although a phone call can cheer up the choleh and
make him feel important, a personal visit accomplishes this far more
effectively. Therefore, most aspects of this mitzvah require a personal visit.
However, in cases where one cannot actually visit the choleh, for
example, when a visit is uncomfortable for the patient or unwanted, one should
call (Shu’t Igros Moshe, Yoreh Deah 1:223; Shu’t Chelkas
Yaakov
2:128). Some authorities contend that it is better for a man to
call, rather than visit, a hospitalized or bed-ridden woman who is not a
relative, since it is difficult for an ill person to maintain the appropriate
level of tzniyus (Chelkas Yaakov 3:38:3).

ALWAYS PRAY FOR GOOD HEALTH

A healthy person should daven for continuing good
health, because it is far easier to pray that one remain healthy than to pray
for a cure after one is already ill. This is because a healthy person remains
well so long as no bad judgment is brought against him in the heavenly
tribunal, whereas an ill person needs zechuyos to recover. This latter
instance is not desirable for two reasons — first, the choleh may not
have sufficient zechuyos, and second, even if he does, he will lose some
of his zechuyos in order to get well.

Before taking medicine or undergoing other medical treatment
one should recite a short prayer: “May it be Your will, Hashem my G-d,
that this treatment will heal, for You are a true Healer” (Magen Avraham
230:6; Mishnah Berurah 230:6, based on Berachos 60a).

People who fulfill the mitzvah of bikur cholim are
promised tremendous reward in Olam Haba, in addition to many rewards in
this world (Shabbos 127a). Someone who fulfills the mitzvah of bikur
cholim
properly is considered as if he saved people’s lives and is rewarded
by being spared any severe punishment (Nedarim 40a).

May Hashem send refuah shleimah to all the cholim
of Klal Yisrael!