Hasidic Jew Admitted for Bone Marrow Transplant

This is a great idea for an article contest! My first thought that came to mind was the month-long journey our unit took with a young Hasidic Jew who was admitted for his stem cell transplant. Yoshi was 25 and traveled from New York City to our Boston hospital to have a bone marrow transplant for CTCL. (Cutaneous T-cell lymphoma.) Nurses Announcements Archive Article

For those who don't live in leukemia/lymphoma world, this is a rare type of lymphoma that presents with open weeping, bleeding difficult to heal skin lesions anywhere on the body. The only definitive treatment for these sores is chemo followed by a transplant.

Prior to Yoshi's BMT admit, he had endured many rounds of chemotherapy, so he was somewhat familiar with the drill. He had a steady parade of Hasidic visitors- all from Boston. What we didn't realize is how closely knit this community is- and once the Boston Hasidic Jews heard that "one of their own" was in their city, they rallied and came to visit on a regular basis. It didn't matter that they didn't know him, they were there to support him through his treatment. On Shabbat (Friday, the Sabbath), the Rebbe (Rabbi) would come with many more visitors and have a modified worship service. Every visitor came with food- tons of Kosher food. They couldn't cook in our kitchen as it wasn't Kosher- so they brought their own hotplate! It was an honor to be approached by a bearded young man with a plate heaping full of food. Unfortunately, not all the staff embraced their show of gratitude with acceptance. Some nurses (and housekeeping staff) complained and moaned when they saw these visitors approach the kitchen with their food and hotplate... They were loud, took up a lot of space and monopolized the kitchen while they were cooking!

So the many chemo visits helped us to identify what was going to be important for this young man, and also draw up a contract. As the weeks of treatment passed, we began to see that the transplant admission was potentially fraught with problems. Coming in for chemo is a routine admission- the actual transplant a bigger deal. One must expect to stay 3-6 weeks on average while marrow recovery takes place. The patient is much much more immunocompromised for a longer period, and preventing infection that much more important. Though patients generally recover faster today due to growth factors, they still expect to get pretty sick- fevers, chills, mouth sores, diarrhea, possible sepsis, respiratory failure, etc etc. There is a slight chance that they won't recover.

Hasidic Jews don't worship with both sexes together- they are extremely modest. Yoshi preferred male nurses and docs, but that wasn't always possible. He frequently had a room full of visitors- as many as 10 men in huge fur hats, coats. Visiting hours didn't apply to his visitors. He was able to eat through his chemo treatments, so his room was usually covered with boxes, jars, bags of Kosher food- more than one person could reasonably eat in a 4 day period! One of his visitors even brought him a HUGE stuffed toy horse- what reason- I never did find out. As this is an adult BMT unit, we don't allow overnight visitors unless the patient is eminently dying or there is a language barrier and we need the visitor to translate.

Prior to his, BMT admits, the team sat down with Yoshi and his father. (His wife would stay behind in NYC.) It was agreed to keep visitors to 4, that food would be cleaned up and put away at the end of every day, that he could have one visitor stay with him at sundown on Friday night. Observant Jews are not permitted to do any work on the Sabbath. Pushing the call light- is work! Pushing the steel plate to enter and exit the unit- is work! I still remember the 3 or 4 men patiently waiting at the entrance of the unit for someone to come and push the steel plate. When they were ready to leave, again would stand patiently until someone noticed and let them out. (I never did find out how they got to the street level from the 8th floor- walking down 8 flights of stairs seems more work then pushing two elevator buttons, but what do I know?) He had to agree to sometimes having female nurses and doctors- who had to examine him. Even in his modesty, he complied. In general, most Hasidic Jews have tremendous respect for the medical community and are compliant with rules and treatment.

Male Hasidic Jews wear full beards, white dress shirts, and black pants and dress coat. After he was admitted, Yoshi maintained this dress during his entire transplant, though he did lose much of his beard and hair. He had open oozing lesions on his arms, back and abdomen- that by the end of the day, had oozed on his white dress shirt. Ugh. His visitors faithfully kept him in clean white shirts. The actual transplant was quite an ordeal, he got very sick. His friends didn't understand that when he had bleeding mouth sores and ulcers down his GI tract, that he couldn't eat. The food still flowed, it just was eaten by visitors and not Yoshi. We had to constantly reinforce the "food put away by end of the day" rule- they seemed to be mystified by our hypervigilance with hygiene. We repeatedly reminded them about the need to reduce bacteria in the room- hand washing, gels, no sick contacts, etc. I was explaining to one young man that bacteria could pose Yoshi great harm, only to come back later and find the visitor on the floor. He explained that he was "looking for the bacteria." These men typically spend many many hours studying and discussing the Torah-(the first 5 books of the Bible), but after doing my own research of this culture, often don't have more than an 8th-grade education. This visitor didn't have a concept of what bacteria are- invisible to the eye but potentially lethal.

Yoshi had specific times in the day when he studied the Torah and prayed- and I knew during this time he didn't like to be disturbed. He was scheduled for a CT scan at 2 pm, and he had to get washed up and changed into a hospital Johnnie. I reminded him in the morning, and as it got closer to 1, he was still in a white shirt and black pants. Getting nervous, I interrupted him while he was reading- and he gave me what I thought was the "thumb's up" sign. Great! He's going to get ready. Only to come back later, and he's still reading and hasn't changed. Once again, I interrupted, to get the same thumb. He put everything away later and explained he was trying to signal that at 1 pm he would get ready. They believe that you can't point your finger up- it's disrespectful to Adonai. (The Lord) Clearly, I didn't get it!

Yoshi made it through his transplant thankfully. Unfortunately, after he returned home to NY, his lymphoma returned, and he and his wife decided not to return for more treatment. He died last year, and his wife sent us a wonderful thank you letter- that she was impressed that we showed Yoshi and his visitors' respect and bent a lot of rules to accommodate his faith. I was struck by how tight this community is, and how they rally to support their members. I hope too, that our staff learned a bit of tolerance and acceptance of those from different faith and lifestyle. I grew up in a very liberal Jewish home and really didn't know much about this branch of Judaism.

I am not so naive as to not recognize the difficulties that particularly the younger members of this faith experience living a very conservative and simple lifestyle in the 21st "techno" century. Observant members must dress differently, are forbidden movies, TV, and a lot of modern conveniences. Knowing some of the challenges Yoshi faced, makes me even more impressed that he made it through one of the more aggressive therapies.

Specializes in school nursing, ortho, trauma.

Thank you for posting such a great article. I have always been fascinated by cultures different than my own, particularly the Hasidic Jewish community. I grew up with lots of very liberal jewish friends and was astounded to learn about not being able to do any work (even tearing toilet paper according to a woman i met through one of my jobs).

There is a misunderstanding by many people what "work" means when Shabbos rules are in question. "Work" that is not allowed to do on Shabbos according to the Torah is not necessarily work as we know it.

The work that is not allowed on Shabbos is really what has to be done to prepare food, starting from preparing the ground to grow crops. It is divided into 39 types of work. This is what is really prohibited to perform on Shabbos.

One example of this is the rule against turning on a fire. Electricity can be compared to turning on a fire, consequently, electricity is prohibited.

Another example: Preparing the ground to grow crops involves digging in the ground. Dragging a heavy object on a soft ground will cause digging. Consenquently this is prohibited too.

Specializes in acute care and geriatric.
(((achot chavi))) thank you! i deeply apologize if i insinuated that the majority of ultra orthodox or hasidic followers aren't well educated- i believe that the young man looking on the floor for bacteria was probably in the minority. i certainly know many faithful spend years, decades even in studies, and it's certainly more then just the torah. thank you for adding an important distinction.

i hope i didn't come across criticizing, i really just meant to clarify.

thank you for a well written essay sharing your out of the ordinary experience and enabling up all to gain from your insights. its funny but i see every day the outpouring of friends, family, and caring strangers who come to visit and help, bring food, and good cheer to our patients that i took it for granted.

there was even a sect who didn't want to see women and we nurses were asked to stay at the desk for the 2 minutes it took for them to walk from the elevator down the hall to the patients room. we respected the request as long as no one else needed us (no call bells etc)

in the local hopital, women prepare sandwiches and snacks, drinks and fruit for the sick and their families without knowing them. a couple comes every saturday (shabbat) to make a public meal for all the sick patients and their families "stuck" in the hospital so that they have a warm and family like experience suring the shabbat. they do this 52 weeks a year- and prepare food for at least 100 people. they package the meal if the patient cant come to the dining hall. when a neighbor is sick, we all pray for his recovery- altogether at the synagogue. so i am used to the outpouring of caring and food. its nice to see it from your perspective!!!

btw i know many other religous groups that also do similar caring acts to help those in need. it always warms the heart. as i know that people have full lives and despite it make room to help others.

thank you for caring, i;m sure it meant the world to yoshi and helped him when he felt vulnerable and helpless (as well as sick, weak, scared, tired, in pain etc.) this is what we do.

as a jew i was asked by my nursing instructors if i would be able to provide nursing care to adolf hitler if he needed, we were prepared from the start to help anyone. regardless of background, lifestyle, past misdeeds, outward appearance etc. you were handed a challenge and really rose to it.

btw to clarify someones post about tearing toilet paper- while it is best to prepare torn paper before the shabbat, if one doesn't have, they may tear the toilet paper using a different manner than usually done- in order to preserve their personal dignity and hygiene. one need not go dirty if they lack pre torn paper.

you may be just one person in this world but sometimes you are the world to one person!!!!!

i'm not a big fan of the streisand film "yentl",

neither was i but boy can she belt out a song!!!!!

but it does put an emphasis on studies, debate, and the thoughtful consideration of g-d's words.

and consideration of other people

Specializes in Education and oncology.

I don't want to "pollute" this thread, but our hospital is in Chinatown, and many of the elderly Chinese pts don't eat hospital food. Their 2nd and 3rd generation children bring in all their food. Even had one pt whose adult son would bring in his own microwave from home, electric tea pot and all chopsticks and dishes. We have several Muslim pts who come in for chemo and their families do the same. Funny how important food is when it comes to being in the hospital!

Second "off the thread" issue. Achot Chavi- I'm surprised your instructor asked you about caring for Hitler- seems a bit off, though as a nursing instructor I know what they were "fishing" for. It's like our docs and medics in Iraq- as medical professionals, we provide the best possible care that we can regardless of politics, religion, ethnicity, etc. I have to say that using Hitler was a poor choice I think IMHO. First- thank G-d he's dead, and second, he was an extreme example horrendous cruelty to peoples who have been persecuted for centuries. (Jews, homosexuals, mentally ill, etc etc.)

Last (I promise!) off thread question- my Hewbrew is virtually non existant- what does "Achot Chavi" mean? (thanks...)

Specializes in acute care and geriatric.
i don't want to "pollute" this thread, but our hospital is in chinatown, and many of the elderly chinese pts don't eat hospital food. their 2nd and 3rd generation children bring in all their food. even had one pt whose adult son would bring in his own microwave from home, electric tea pot and all chopsticks and dishes. we have several muslim pts who come in for chemo and their families do the same. funny how important food is when it comes to being in the hospital!

[color=sienna]food is very important to people- see the post "descrimination- hot meal or soup and sandwich" also for a loved one, food is the way of showing you care. when i have an obese patient i instruct their family to bring nonfood gifts- perfume, lotions, balloons, books and magazines etc.

second "off the thread" issue. achot chavi- i'm surprised your instructor asked you about caring for hitler- seems a bit off, though as a nursing instructor i know what they were "fishing" for. it's like our docs and medics in iraq- as medical professionals, we provide the best possible care that we can regardless of politics, religion, ethnicity, etc. i have to say that using hitler was a poor choice i think imho. first- thank g-d he's dead, and second, he was an extreme example horrendous cruelty to peoples who have been persecuted for centuries. (jews, homosexuals, mentally ill, etc etc.)

[color=sienna]exactly, but no one is accusing our nursing instructors of tact and sensitivity (ha ha) but i understood her point, and it has helped me to care for people that personally i may not care for.

last (i promise!) off thread question- my hewbrew is virtually non existant- what does "achot chavi" mean? (thanks...)

achot is hebrew for (would you believe) nurse. chavi is a shortened version of a biblical name i like.

There are many things I don't understand about Orthodox Judaism, such as why it's ok to have a Shabbos Goy do work that is forbidden for the Jews themselves to do when Scripture says that foreigners (non-Jews) and animals living among the Orthodox are also not to work on Sabbath but I guess there must be other Scriptures that cover this. Anyway, this was a most moving and interesting example of lovingkindness and great Nursing.

Blessings upon the OP.

Specializes in Psychiatric.

What a wonderful story :)

It is indeed small things, and bending the rules the way you did, that can really matter to patients.

Thank you for a wonderful article. When I was a young PICU staff nurse at CHOP I had the opportunity to care for children of many different cultures. I was working nights and one of the fellows was an Orthodox Jew. I realize this is different from Hasidic but we had some great middle of the night conversations regarding religion and family. I find Judiasm facinating.

Specializes in med-surg, cardiac care, pacu.

The Hasidic patient article reminded me of my own sheltered upbringing in a small town of 1200 people. I became an RN and worked in Phoenix and also Los Angeles. My Lutheran upbringing hadn't prepared me for what I was to experience. After several employees at the hospital touched my heart with their sincerity, I discovered that each one was a Jew. I began reading about the Jewish faith and 15 years later went through conversion. Their values, concern for each other, and the world changed my life. Studying Torah has given me the guidance and peace that fills the void. I am a better nurse today and more tolerant of all faiths because of what I learned from my Jewish co-workers and patients. Thank you for an inspiring article, and for your great care given to another human being.

Specializes in Education and oncology.
ACHOT is hebrew for (would you believe) nurse. Chavi is a shortened version of a biblical name I like.

Thank you. No, I didn't know Hebrew for nurse and I'm sorry my spelling was terrible. So Achot is nurse. Love it. Chavi is a nickname? Or abbreviation?

Biblical name you like- I am partial to Ephriam. Fred. In this country Eprhiam doesn't go over so well.

blessings:heartbeat to you!

Specializes in acute care and geriatric.

To explain the work thing on Shabbat- it is FORBIDDEN to ASK or HIRE or PAY a non-jew to do "work" on the Shabbat (Saturday) What is permitted is to state the need and if a non jew volunteers to help- then its ok. For example, our electricity failed one week on Shabbat, we mentioned it to a non jew who then opened our electricity box, flipped the switch and presto she was nice enough to give us our electricity back.

Specializes in OB, HH, ADMIN, IC, ED, QI.

Reality and Hospitality Differ:

Cultural differences have been a way of life in large cities with many different ethnic groups. It's very important to seek help from the leader (in Yossi's Chassid sect that would be the Rebbe in charge), and ask questions about what is and isn't possible for his group. Then mutually establish a plan that incorporates adjustments to those impossibilities. Then the Rebbe would communicate the regime/plan and it would be enforced by him.

The good intentions of the nursing staff for Yossi's religious needs didn't include boundaries, as our needs to accommodate differences can lead to an "anything goes" attitude. A chain of command was needed, to ensure compliance that benefited Yossi, even if some were disappointed.

As another poster indicated, the educational level in earlier times was quite low, as it was for most groups. However, education became the pathway to success and so most Chassids respect that and attend school as long as is feasable economically.

A great sense of humor, particularly for themselves exists, and is illustrated in the "Stories from Chelm" about European Jews whose sense of the ridiculous entertains everyone. I think the bacteria searcher under the bed was an example of that.

It's easy to think that the observances of one of the members of another culture, reflects that of all. In ancient as well as modern times, disagreement is a way of life, which explains the need for constant discussions among Chassids the goal of which is to come to some agreement about the subject of the disagreement. That involves a lot of talking, hence noise.

No patient should be subjected to extreme noise when in a compromised state, and Yossi's needs as well as those of patients near his room needed to be respected, so it would have been prudent when the Chassids' voices escalated, to arrange for a conference room, classroom, whatever for the participants who could then have a spokesperson deliver the results, having ascertained from the group that what would be said is actually what had been decided. Disagreement could erupt if diversion occurred from some who hadn't really accepted the decision.

Chassids are a jolly group who like to have their antics appreciated, so it sounds like the exaggeration of Yossi's gustatory needs is an example of that. It certainly isn't required that a banquet is given nightly. In fact the usual hospital discouragement of visitors eating with patients would have been appropriate. Mothers in the culture tend to overfeed their children and make them feel guilty if every morsel isn't consumed. Hence pressure to do that may have made Yossi uncomfortable. The remaining food could have been taken to the cafeteria to be consumed on paper plates with their own plastic utensils by the visitors. Nothing in Jewish Law prescribes that it be kept by the patient. Usually the Saturday meal is cooked Friday before sundown and left in a warm oven, so a small crock pot would have sufficed for Yossi's Saturday meal.

Religious services can be done only when a "Minyan" of 10 or more people is present. If someone is ill, they need not attend. In Judaism one does not say prayers for another, as Christians do. "Say one for me" isn't done. If Yossi felt up to it, Shabbat services Friday night and Saturday might have been done with 10 men, in an abbreviated form in his room. If his dressings were changed before that, grungy linens and his white shirt need not have been seen.

It surprised me that on Shabbat, heavy dishes of food and apparati were carried by the Chassids into the hospital. Possibly that happened before sundown on Friday. Then those necessary for Yossi would have to stay there until sundown Saturday. However a non Jewish person could have carried the other accoutrement down to a waiting taxi (whose driver was not Jewish) to be delivered wherever the group agreed they should go. However, money cannot be exchanged on Shabbat.......another dilemma which might be resolved by someone who wasn't Jewish lending the money for the cabbie. Ingenious ways are invented for such things, with the enjoyment of all afterward.

In Jerusalem for Shabbat the very Orthodox place a rope around as many houses as is wished for a large group, making the area within the rope like the same house. Then heavy casserole dishes, etc. could be carried to all. Otherwise, that isn't done house to house. So accommodations in observance result from all the discussions, and can happen on the spot, if needed and the head Rebbe is present.

I remember a Gypsy sect whose leader was dying in the hospital where I was Inservice Coordinator. Hundreds of members camped in the parking lot of the hospital and frustrated police by their refusal to be removed. The police wanted to be respectful and let them stay. That also avoided angry demonstrations. By the time the leader died, the whole lot of them were regarded as guests who had overstayed their limits. My job was to keep the peace between hospital employees and the gypsies so resentment didn't swell and accommodation needs were respected.

Jews/Chassids will not resort to anger if their requests are denied, but will find a way to circumvent the inconvenience (like walking down 8 flights). In Jewish hotels in America and Israel, there is one working elevator on Shabbat, which can be used by the infirm or non religious. A meeting of minds solves everything.