The Book of Death

I’d like to tell you about one of my closest friends, Sara. We met in shul in 1995, just a few months before I made Aliyah. Sara contracted a rare cancer before she was born, when she was still in her mother’s womb. As a young child she received treatment at Christie’s in Manchester, one of the UK’s leading cancer hospitals. Back in the late 1960s, cancer treatment for children was very crude. Sara received aggressive treatment that was basically the same as for an adult. As a consequence, in her teenage years Sara developed a spinal tumour and a brain tumour. Years later, during her third brain operation, the surgeons were obliged to sever Sara’s optic nerve in order to remove as much of the brain tumour as possible. Since this surgery, Sara has been registered blind, with a very limited capacity to distinguish light, dark and some shapes, depending on the light and on her health on a particular day. Additionally, she suffers from over 15 serious medical conditions, and is on a constantly high dose of drugs for pain management.

Our friendship was sealed when Sara won the Jewish Woman of the Year award, with a holiday to Israel as the prize. She managed to get a special doctor’s dispensation to fly, despite the risks associated with her medical condition. We spent a memorable few days together in Jerusalem and Tel Aviv. For Sara, this was a once in a life-time dream come true.

I take every opportunity I can to talk about Sara, because she is a truly inspirational person. During that time in Israel, I asked her how she managed to stay so cheerful and positive, despite the many challenges she faces. This was her response, and I’ll never forget it:

‘I have my ‘’Why me?’’ days,’ she said. ‘But I make sure never to make it a ‘’Why me?’’ life.’

Every moment that Sara feels well and strong enough, she is busy doing mitzvahs for other people. She has a powerful sense that she, like all of us, was put on this earth to make a difference to other people’s lives. An entire book could be filled with the stories about how Sara was in just the right place at just the right time to change the entire course of someone’s life, often a total stranger.

On Rosh HaShanah we are instructed to reflect upon our lives, and to consider whether we live each day as we would really want to. Despite the challenges Sara faces, she draws strength from the satisfaction that she has directed her life towards serving others, and that she chooses to act as an instrument of God’s kindness and compassion in the world in every encounter.

On Yom Kippur we are instructed to reflect upon our death – the fact of our human mortality. And this is why I am sharing Sara’s story with you today.

‘Said Rabbi Kruspedai, in the name of Rabbi Yochanan: Three books are opened on Rosh Hashanah… the Book of Life, the Book of Death and the Book for those In-between.’

On Rosh HaShanah I spoke about what it will take, collectively, to write our community, SWESRS, into the Book of Life.

Today I want to talk about what it means, for each of us individually, to be written into the Book of Death.

Wrote Benjamin Franklin in 1789: ‘In this world nothing can be said to be certain, except death and taxes.’

The inescapable reality is that every one of us, is already written into the Book of Death. Yet, most of us do everything we can to avoid thinking about, and talking about death.

As that that Jewish observer of human nature in all its frailty and absurdity, Woody Allen, confesses:

“I'm not afraid of death; I just don't want to be there when it happens.”

And there’s the mystery and the frustration – perhaps, frankly, the blessing too: we none of us know when the hour of our death will come upon us.

As we gather on the evening of Rosh HaShanah and Yom Kippur and recite the shehecheyanu prayer, thanking God for having ‘kept us in life and enabled us to reach this season,’ how many of look around the shul remembering the faces that are no longer present, gratefully acknowledging that we are here to celebrate another year. As we listen to the list of names read out during Yizkor on Yom Kippur afternoon, naming those who have passed since last Yom Kippur, how many of us think, ‘There, but for the grace of God go I.’

In the Unetaneh tokef prayer, the liturgical climax of our Rosh HaShanah and Yom Kippur services, we cry aloud:

On Rosh HaShanah it is written, and on Yom Kippur it is sealed:

How many will pass away and how many will be born;

Who will live and who will die; who will complete their normal span and who will not;

Who by fire and who by water; who by sword and who by beast;

Who by disaster and who by plague…

On Yom Kippur we are instructed to reflect upon our lives, and on the inescapable certainty of death.  We are urged to allow the special holiness of this day to touch us, to transform us, to give us courage to choose what we write in the Book of our own lives. How do we do this? By facing our mortality.

On Yom Kippur we rehearse our own deaths. We wear white. Some of us wear the white kittel that we will be buried in. We refrain from those activities that distinguish us as living creatures – eating, drinking, washing, sex and the comfort of wearing leather shoes. During ne’eilah, the ark remains open throughout the service, and we stare into it as if into our own coffin.

On Rosh HaShanah it is written, and on Yom Kippur it is sealed:

How many will pass away and how many will be born;

Who will live and who will die…

And so back to my friend Sara. Alongside directing her energies to doing mitzvahs, serving her fellow human beings and choosing to act as an instrument of God’s kindness and compassion in the world, Sara is also preparing for her own death. She knows that her physical condition will only continue to deteriorate, and she has made her wishes known to her next of kin for the different scenarios that may eventually unfold.

This is something we should all have the courage to do, whether we are old or young, in good health or poor. Preparing for the end of life gives us a much better chance of experiencing a good death, and relieves our loved ones of having to make difficult decisions in the event of being unable to communicate our wishes at the end of life, whether our decision-making faculties are compromised by dementia or Alzheimers, by a long-term physical condition or a sudden, traumatic disaster.

In his excellent book Being Mortal, Boston physician and surgeon Atul Gawande laments the over-medicalisation of death, and how humanity is losing the art of dying. Not so many years ago, most of us died at home, surrounded by family and friends, and death was as much a part of the fabric of life as birth, marriage and children. Today, so many of us die in hospital, and death has become something distant, removed from us, something to be afraid of, even alien. Doctors are driven by the need to defeat death, pressing more and more aggressive treatments on patients who don’t always feel empowered to decline treatment if they so choose. Gawande is a powerful story teller. He opens up this most sensitive of subjects with humour, telling the stories of real people; drawing on his medical and personal experience.

The key message I took away from Being Mortal is that we cannot make assumptions about someone’s wishes about the end of life. For each of us, these are deeply personal, and vary greatly.

Gawande learned this in the most immediate way when his own father faced terminal cancer. Despite Atul, his father and his mother all being medical professionals, they found it very uncomfortable to begin the difficult conversations necessary to plan for his father’s end of life. Atul assumed that his father would want to take every measure possible to prolong his life. When the three of them finally had the courage to speak openly, Atul’s father was shockingly clear that quality of life was more important to him that gaining an extra few months in a severely compromised condition. He wanted to be able to entertain his family and friends, enjoy a good meal, engage in stimulating debate and to maintain his dignity. Once he was no longer able to do all of these things, he wished to pass peacefully as quickly as possible. However painful it was for Atul and his mother to hear this, it meant they were able to put everything in place to enable his father to die the death he chose – at home, free of pain, surrounded by those he loved.

Here at SWESRS, on Sunday October 7th, we are hosting an all-day seminar entitled End of Life Matters, organised with our ECAMPS Progressive Jewish neighbours and open to the wider community. Here you will have an opportunity to learn about Advanced Directives, writing a will, and organ donation. There will be workshops on Having Difficult Conversations, Woodland Burial, and the Jewish rituals around death. At lunch-time there will be optional table discussions with Chai Cancer Care, Death Café facilitators, and the possibility of starting a local Progressive Chevra Kadisha. Our morning keynote speaker is Dr Adrian Tookman, head of Palliative Care at the Marie Curie Hospice, who is a highly entertaining speaker, despite his field! Our afternoon panel will discuss ‘What Makes a Good Death.’ I urge you to come along on October 7th, and to bring your children, parents, loved ones, friends. If you can’t make all day, come for either the morning or the afternoon. Remember to register beforehand at the Eventbrite website. The day is free, but we need to know who is coming ahead of time for security.

The three Books are opened in heaven. The Book of Life, The Book of Death, and the Book for Those suspended In-between. On this holiest of days, let us face our own mortality, courageously committing to having those difficult conversations, and to preparing for the end of our lives.  So may we have a hand in writing the closing chapter in the Book of Death that one day will be opened for each of us. For now, may our prayers in the remaining hours till ne’ilah successfully inscribe us in the Book of Life for another year.

Ken yehi ratzon