“Yosef is Still Alive” – Communicating Dramatic News to Patients

Vayigash 5780

They went up from Egypt and came to the land of Canaan, to Yaakov their father. And they told him, saying, “Yosef is still alive”, and that he is ruler over all the land of Egypt; but his heart rejected it, for he could not believe them. However, when they related to him all the words that Yosef had spoken to them, and he saw the wagons that Yosef had sent to transport him, then the spirit of their father Yaakov was revived.
(Bereishis 45:25-27)

 
“And they told him” (“Vayagidu Lo”) – the word Vayagidu is missing a letter Yud because they [the sons of Yaakov] did not tell him themselves: “Saying” – through Serach bas Asher.
(Medrash Sechel Tov)
 

Our essay for Shabbos Chol haMoed Sukkos[1] discussed the issue of disclosing medical information to a patient at great length. We dwelt upon the pros and cons of updating a patient regarding his condition and concluded that each case should be judged on its merits – will the benefit outweigh the possible harm that the knowledge may cause? A doctor must act wisely and judiciously when making this decision.

We also cited the following Gemara in Maseches Shabbos (32a):

Somebody who is sick and about to die should be instructed, “Confess! Many have confessed and not died, and many of those who did not confess, died. And there are many who walk in the marketplace who confessed, for in the merit of your confession, you will live.”[2]

In other words, though it is imperative to inform a patient of his dire condition, we must also soften the news by adding, “Many have confessed and not died” so that he doesn’t despair.

Receiving bad news about one’s medical condition does not only affect his psychological ability to fight his illness or disease. Sometimes, the shock of the news itself may cause him significant harm. This notion is the basis for the Halacha that one may not inform a person of the death of a relative if the news is likely to affect him adversely (Shulchan Aruch Y.D.  337:1).[3] A person who is charged with revealing bad news thus has a great responsibility to find the right words that will lessen the impact of what he says.

Below are three sources in Chaza”l that highlight and illustrate the care and sensitivity with which dramatic news should be relayed:

1) As mentioned above, when the sons of Yaakov wished to inform him of the joyous news that Yosef was still alive, rather than telling him themselves, they dispatched Serach bas Asher in their place. The Sefer haYashar cites a Medrash that describes these events:

And the sons of Yaakov traveled to Eretz Canaan in happiness and gladness to Yaakov their father. They came to the border and said to one another, “What shall we do with this matter [when we come] in front of our father? For if we come to him suddenly and tell him, he will be greatly shocked and will not want to listen to us”. And they continued traveling until they were close to home and they met Serach bas Asher who had come to meet them. And the girl was very good and wise, and knew how to play the harp. And they called her and she came to them and kissed them. And they took her, and gave her a harp and said to her, “Go in front of our father, sit in front of him, play the harp and say the following words to him”. And they commanded her to go to their home, and she took her harp and she hurried ahead of them and sat next to Yaakov. And she began to play the harp and sweetly sang, “Yosef my uncle is alive and is ruler of the Land of Egypt and he did not die.” And she continued to play and repeated these words, and Yaakov heard her and it was pleasant for him. And he continued to hear her words a second and third time and his heart filled with joy from her pleasant words, and the spirit of Hashem rested on him and he knew that she was correct. And Yaakov blessed Serach for what she had said to him and said to her, “My daughter, death will never conquer you for you have revived my spirit”.

In this episode, Serach informed Yaakov of the wonderful news deliberately, slowly, and with clever use of music so that he could slowly digest the news. This made it less dramatic than it would have been had her uncles told him. Following this example, we must also ensure to always select the most appropriate relative or friend for the task of informing a patient of dramatic news so as not to cause shock or hysteria.

2) The Torah also records a case where sudden news caused a tragic death – that of Sarah Imeinu. The following are the words of the Pirkey d’Rebbi Eliezer (32):

And Satan went to Sarah and appeared to her as an old man, meek and greatly humble, while Avraham was still offering a Korban to Hashem. And he said to her, “You surely know about what Avraham did to Yitzchak your son today – for he took Yitzchak and built an altar and slaughtered him and offered him up on the altar and Yitzchak was screaming and crying to his father but he paid no attention and did not have mercy on him.

The Satan related this message to Sarah with no prior warning and in a way that suddenly triggered extreme feelings of maternal love and concern. Pirkey d’Rebbi Eliezer continues:

And Satan repeated these words to Sarah and then left. And Sarah heard the words of Satan and she thought that the old man had been with her son and had come to tell her what had happened. And Sarah raised her voice and wept and screamed a loud bitter scream over her son and her heart sank and she threw earth on her head crying, “My son Yitzchak, my son, would that I would have died in your place on this day”. And she continued weeping, saying, “It is distressing for me as I raised you, nurtured you, and now my joy has turned to mourning”. And after that she got up and walked along asking [others of the whereabouts of her son] and she went to Chevron and asked all of the passersby that she would meet, but nobody could tell her what had happened to her son… Then Satan appeared to her in the form of a man and he stood in front of her and said to her, “I lied to you, for Avraham did not slaughter Yitzchak and he did not die”. And when she heard this she was extraordinarily happy about her son and her soul left her from the joy and she died and was gathered unto her people.

The Satan also gave Sarah the second, joyous tidings in a sudden manner and disguised as a random stranger. It was no surprise that Sarah’s heart could not cope with the sudden change of news and she died.

3) The final source is a lesson in preparation for the delivery of difficult news. Even if the correct person is chosen to relate the dramatic tidings and even if they are adept in informing the patient in a gentle and perceptive manner, it is still worthwhile that they prepare themselves so that the message will be delivered in the gentlest manner.

A woman of valor, who can find [her]? They said – there was a case with R’ Meir who was lecturing in the Beis haMedrash on Shabbos afternoon and [during his lecture] his two sons had died. What did their mother do? She placed them both on a bed and spread a sheet over them. On Motzei Shabbos, R’ Meir returned from the Beis haMedrash to his house. He said to her, “Where are my two sons?” She replied, “They went to the Beis haMedrash.” He said to her, “I looked in the Beis haMedrash and I didn’t see them!” She gave him the cup with which to make Havdala and he duly did so. He then asked again, “Where are my two sons?” and she replied, “They have gone somewhere else and now they are coming”. She gave him some food to eat and he ate and said Birchas haMazon.

After he had said Birchas haMazon, she said to him, “My teacher, I have one question to ask you”. He said to her, “What is your question?” She replied, “Earlier in the day, a man came and gave me an item to guard (a “Pikadon”) and now he has come to reclaim it. Should we return it to him or not?” He said to her, “My daughter, somebody who has a Pikadon must return it to its owner.” She replied, “Without your consent I wouldn’t have returned it to him”. What did she do? She took him by the hand and took him up to that room, drew him close to the bed and took the sheet off them [the two dead sons]. He saw them both dead, lying on the bed. He began to cry, “My sons, my sons, my teachers, my teachers – my sons in Derech Eretz and my teachers in that they would light up my face with their Torah. At that moment she said to R’ Meir, “My teacher, did you not say to me that I have to return the Pikadon to its owner?” Then R’ Meir said, “Hashem gave and Hashem took, may the name of Hashem be blessed” (Iyov 1:21). Said R’ Chanina, in this way R’ Meir was comforted and calmed, and for that it was stated, “A woman of valor, who can find [her]?”

(Medrash Mishley 31:10)

These sources can serve as valuable models for how a doctor should relate dramatic news to his patients. He should involve family members in the process, prepare the patient deliberately and slowly for the news, and deliver it in a kind and sympathetic manner that takes the feelings and condition of the patient into account.

May we only merit to hear of good tidings.

[1] See http://bit.ly/37q9OdG. The archive of Divrei Torah can be found at https://www.medicalhalacha.org/torah-archive.

[2] As explained by the Ramban in Toras Ha’adam based on Maseches Semachos and Shulchan Aruch Y.D. 338:1.

[3] For this reason, many Poskim rule that one should not reveal to a patient the seriousness of his condition (Betzeil haChachma 2:55). See the aforementioned essay (Shabbos Chol haMoed Sukkos 5780) for more details.