Last update - 00:00 14/12/2006
No regrets
By Aviva Lori
Yehuda looked at the objects in the pile, picked up a small battery and said, "My wife is like this battery: she gives me the strength to go on." Another participant pulled a small doll from the pile and said, "The doll reminds me of my four children. Six years I've been in this story, and thinking about the family gives me strength." Each of the people in the hall was asked to choose an object from the pile on the floor and say a few words about himself in connection with the item he or she had chosen.
That was the beginning. Each of those present introduced himself, explained why he had chosen that particular object, and noted how long he had been in the story. "Being in the story" became a buzzword among the participants, meaning how long I have been ill with cancer, or with some other serious illness, such as multiple sclerosis. Almost all of them talked about grandchildren. Even those who at the outset couldn't muster the courage to speak, did so at the end. "I hope I live long enough to see grandchildren" became almost the motto of the workshop, an imaginary ray of light at the edge of a receding horizon.
The group that gathered in the guest house of Kibbutz Ein Gedi, on the Dead Sea, was very diverse. Thirty-four couples had arrived for a workshop based on spiritual support to strengthen their spousal relationship. "Partners for Life" is the title of the workshop, and its aim is to bolster relationships not because of an ordinary crisis but in the wake of a serious illness, usually cancer, contracted by one of the partners.
Gabi Ifergan, 38, and Avivit Ifergan, 33, parents of two young girls, came from Haifa. In February of this year, Gabi was diagnosed with chronic leukemia known as CML, a disease that usually requires numerous chemotherapy treatments and in some cases a bone marrow transplant. Gabi worked for six years in the sales unit of Delta Film in Haifa. He no longer works. He was fired, he says, five months after the illness was discovered. "It's not the end of the world, and you can live with it," Gabi says, infecting the entire workshop with his optimism. "You can live with far more serious conditions. It's your choice how you want to live."
"You can go into a permanent black funk," Avivit adds, "but Gabi chose a different route. We chose. We have a family, we have to give them their lives, as far as possible. Gabi strengthens everyone."
Why did you come to the workshop?
Gabi: "I came with the aim of contributing. I usually try to give to others, because when you give, you also receive."
Avivit: "We came to meet people, to get insights from them, to learn from their experience. An illness in the family breaks the home and brings in a great deal of sadness, crying, pain and worries, and it's obvious that whatever there was before is no longer relevant. On February 6 our lives changed totally. One of the first things that happened was that we didn't know how to touch the deepest places. When there's a problem you don't know how to approach your partner. He is close, but he is distant and he is different. We came to see whether what we feel is normal. Maybe there are standards for crises, and we wanted to see if we meet the standards."
A healthier perspective on life
The spiritual support workshop, the first held in Israel, was organized by Tishkofet (Perspective), a nonprofit organization funded to the tune of NIS 150,000 a year, in part from donations, and by a grant of NIS 40,000 a year from the UJA - Federation of New York. It was the federation that three years ago brought the idea of spiritual support - or chaplaincy, as it is also known - to Israel and established the first unit in the country in Jerusalem's Shaare Zedek Medical Center.
Tishkofet was created four years ago by Ben and Dvora Corn, both 46, who immigrated from Philadelphia nine and a half years ago. Ben, an oncologist, is the director of the radiology unit at Ichilov Hospital in Tel Aviv, and Dvora is a family therapist. The goal of the organization is to give couples who are coping with serious illness tools to deal with the illness and to use it as a springboard for growth.
It all sounds very New Age.
"There is no New Age element involved," says Elisheva Oren, the UJA's program director in Israel. "We just learned from the American experience and we saw that in Israel the palliative sphere was not being dealt with and was needed, because the patients are preoccupied with essential questions, such as 'Why me?' and 'Why do I deserve this?'
"The approach used to be," she continues, "that the move to palliative treatment comes only when there is nothing left to do medically, and then people didn't want the treatment, because it signified death. Today there is no need to be at death's door in order to receive supportive treatment. And there is no need to go to India in search of oneself, it can be done by simple means, such as by turning to the world of Jewish content - not from an Orthodox religious viewpoint, but from a popular perspective, such as playing Psalms. And one can also commune with the desert, practice breathing, yoga. There is no one way to reach spirituality. Whatever people choose, goes. It is absolutely not something esoteric."
Indeed, the participants here do connect with the desert. At sunset, on the shore of the Dead Sea, as the hills turn dark, the group sits in a circle by candlelight. Rachel Aton, a family therapist, sends each of the participants with his or her partner to commune alone with nature for a quarter of an hour. The mission: to bring objects found along the way - a stone, a branch from a bush, sand.
"There is something in nature that gives energy," Aton says. "The sea, the desert, the mountain - they do not get up in the morning and ask why they are here. They are simply present. There is something in this simplicity that summons us to connect with it. This sunset, this transition between day and night, takes place without noise, it just happens."
A quarter of an hour later, shadows in an embrace emerge from the darkness and return slowly to the circle. They hide covert smiles, as in Natan Zach's poem "Love of two people."
"I know this world," Aton says. "Our daughter died 10 years ago at the age of 11 and a half. We have three healthy girls and a boy of 17, who also has CP. One of things that stood out strongly for me was the loneliness of the families who have children with chronic illnesses. And therefore one of the things I engage in is spiritual accompaniment."
Why the desert?
"It is infinite, all-inclusive, nonjudgmental and has no agenda. You enter it and receive the anchor and the support. The quiet that enables you to accept yourself as you are. If one learns how to listen to the external desert and the internal desert, the heartbeat drops, the pressures and desires are moderated. One of the most powerful experiences after returning from Sinai is that we swear that from now on we will start to take things easy, though usually we don't. If we introduce awareness of the desert into day-to-day life, people will learn to stop for a few minutes every day, to appreciate the things they see, even when they are in pain, when they receive an infusion."
Do people have the strength to practice growth between chemotherapy and radiation treatments?
Dvora Corn: "Ironically, a person who is coping with a serious illness has an opportunity to acquire a healthier perspective on life. The most revolutionary thing, we believe, is that these people can encourage us all and we can draw inspiration from them. They have a special angle of vision that we healthy individuals do not. Because until one reaches that place, heaven forbid, one does not see the world through those spectacles. It's a matter of perspective. These sick people are an asset from whom we can derive benefit."
That sounds a bit exploitative.
"No. Because first of all, the moment they hear that, they feel better, because many people in such situations despair and say 'That's it, I'm past my prime, I have nothing more to contribute.' Second, it's a bonus for society, it adds depth to our lives. It sharpens the understanding that life is fragile, on the one hand, and teaches us that a healthy society does not place those who are sick or those who are different beyond the pale. A healthy society contains us all."
Discovering new forces
All the members of the workshop, both the sick and the healthy, are sitting beneath a 300-year-old tree and rollicking with laughter. The air is filled with contagious merriment. "In the mid-1990s, in Bombay, Dr. Kataria discovered laughter as a healing element," explains Yehudit Kotler, facilitator of the "Laughter Yoga" workshop. "Laughter massages internal organs, sends blood to the digestive system, the face, the brain. It strengthens the immune system. And the bonus? An hour of laughter burns 500 calories."
"Bring out the rooster that's inside you," Kotler urges, "and the monkey." Some participants volunteer to play zoo to the loud cries of delight of the others. Everyone is already wiped out from laughter, but they are still enjoying the special atmosphere that has been created beneath the tree.
"I'm amazed at the people here," says Noah Shalev, from Anatot, who has come with his wife, Batya. The Shalevs, both 58, find a great resemblance between themselves and the other couples in the workshop, even though most o f the others are secular.
Noah, who is the director of the society and youth unit in the Education Ministry, and Batya, an educational adviser and group facilitator in schools, have three children. At the end of May, Noah was diagnosed with cancer of the pancreas, and since then his life has changed utterly. He underwent a complicated 10-hour operation in which some of his internal organs were removed, and then a series of chemotherapy sessions. He took a lengthy period of time off from work and has now begun radiation accompanied by chemotherapy. The results of tests that were received two weeks ago indicate that his condition is stable and good. Recently Noah has begun to speak in the first person plural and to practice a new type of relationship with Batya.
"Batya is the discovery of my life," he says with a tone of surprise, referring to the earthquake they experienced as a result of the illness. It was an earthquake which, as with many other couples here, made them say that maybe it's a good thing it happened. In the past Noah was the dominant, strong, assertive figure, the person everyone relied on, both at home and at work. To ask for the help of others or to collapse and indulge in self-pity was out of the question.
"I was always the weak and dependent type," Batya admits. "The children went to him with every problem. Now it's all upside down. I have become the strong and supportive one. I discovered forces I didn't believe I had. I said maybe we needed this illness so that we could all make all kinds of changes. Thanks to this, very good things are happening to everyone in the family, including our relationship and our two married sons."
Life passes in perpetual distraction, without notice being taken of the small details, Noah and Batya say, and then one day the illness strikes and the true life begins - life that leaves the healthy years behind like a passing episode, or a dress rehearsal.
"Apparently you can make a change in life only in the wake of such a serious crisis, to start listening to each other," Batya says. "To show consideration, to pay attention. The most dramatic proof of this is that Noah is now doing things that he once never wanted to hear about. I always did yoga and I asked him to come, but he absolutely refused. Now he goes three times a week and even enjoys it. He also didn't want to remove his mustache for 32 years, but in the hospital, on the day of the operation, while he was still in intensive care, dazed, he said, 'Don't you think this is a suitable time for me to take off the mustache?'"
"Today," Noah says, "we can already look back and get a handle on things. Half a year is already long enough to say that a very meaningful change has occurred in our relationship. I know I need you, but I feel that I have become much closer to you in this period. It's much more than the mustache and the yoga."
What will you take home from the workshop?
Noah: "I can connect to spirituality and I know that it can help to improve the emotional feelings I have with myself and thus strengthen my immune system. I very much believe that a person who is in harmony with himself can maintain a system of balances and become a calmer individual. And a calmer individual preserves his personal health better. The doctors explained that a large part of my recovery is to do things, aspire, plan, set schedules, see the far future. And I see it very soberly, on the one hand, but I also know that it's not guaranteed. I very much believe, but I am also very realistic and know that situations can arise in which my illness will return."
"But it doesn't have to return," Batya says with her new assertiveness. Noah almost agrees with her: "I am counting on it not returning, but I am ready for the possibility that it might."
In this optimistic spirit, the group proceeded to an evening of community singing. The sounds of music came forth from painful throats, as though there were no chemotherapy in the week ahead.
Great expectations
Edie Ilan, a communications coach, fell ill with cancer of the bladder two years ago. In the workshop she led the participants learned to listen to their partner. Afterward she asked them to dream dreams and tell the group about them. "I thank God that I learned coaching," she says. "Now I have this tool and I can help myself and others to cope with the disease." Daniel, from Beit Shemesh, has lung cancer. One lung was removed three and a half years ago; a month and a half ago, metastasis was discovered in the second lung. His dream is to see himself growing old. His wife has the same dream. "I am angry at him for stealing the dream from me," she says. "In my dream we are sitting on the porch and watching the grandchildren play." Yehudit Kfir, 58, from Moshav Massuot Yitzhak, a cooperative farming community, is here with her husband Kelly, 60, because of her illness. Three years ago she was diagnosed with intestinal cancer, and two years ago the cancer spread to the lungs. Yehudit has gone through four operations and now feels fine. "I feel very healthy these days, but I don't delude myself. I know what metastasis is, and it's clear to me, to come out with it bluntly and directly, that I will die of cancer. But in the meantime I have learned to enjoy every day that I am healthy, and I feel full of energy and vitality."
She has returned to work as an occupational therapist in her private clinic and for the Be'er Tuvia Regional Council. "By nature I don't like this group thing," she says. "If there are things that are bothering me, I prefer to sit with a private therapist, but the subjects this time are interesting and don't require exposure."
For Yehudit, too, as for others, the illness altered perspectives and patterns of behavior. "Until the illness I was judgmental, demanding and a perfectionist, and now I feel as though a certain arrogance has left me. I understood that we are all flesh and blood and can face difficult situations, and I have learned to be patient and understanding toward others."
Maybe the cosmos tried to tell you something?
"I believe in that. All these years I counted myself fortunate, because life was good to me. Everything came easily to me. I was very successful in everything I did and I felt very good with myself. And suddenly your life is in danger and the good fortune is over. That softened me, and I see a certain gift in that."
Kelly and Yehudit are a bit bothered by the mystical spirit that envelops the workshop. Even though they live in a religious community and Kelly wears a skullcap, their expectations were to hear more about how secular people cope, without the Creator.
They do it by means of chaplaincy, also known as clinical pastoral care, a relatively new concept in medicine. In the United States, the leader in the field, the chaplain is a combination of cleric, psychologist and social worker. In recent years, the model of the army chaplain, who offers religious services and psychological counsel to soldiers, has been brought into the field of medicine, and the chaplain has entered hospitals as an integral part of the therapeutic staff. The role of these spiritual supporters is to strengthen regular medical treatment for patients with serious diseases and their families.
In Israel, the unit in Shaare Zedek Medical Center - part of the hospital's Cancer Pain and Palliative Medicine Unit, in the Department of Oncology - is headed by Dr. Nathan Cherny and includes experts in supportive therapy. Similar units are about to be opened in two more medical centers, Soroka in Be'er Sheva and Rambam in Haifa.
"The chaplain, or spiritual supporter, meets with patients and their families and tries to clarify with them what spiritual expression is closest to them," Dr. Cherny explains. "Some people say it is religion, others discover spirituality in nature. The spiritual supporter works with each person in his language, in cooperation with physicians, nurses, psychologists, psychiatrists and social workers."
What is the difference between a spiritual supporter and priest or a rabbi?
"It's a matter of touching other places. It is not a deathbed confession, but a plan for the continuation of life. People talk about beliefs and hopes. Non-religious patients compose a personal prayer. They talk about memories, about the meaning of life. This is not alternative medicine or complementary medicine - it is part of conventional medicine."
Dr. Harvey Chochinov, a Canadian Jew and an expert in palliative medicine from the University of Manitoba in Winnipeg, carried out a study among terminal cancer patients. He found that the factors that most influence the will to live are related to the spiritual aspect of life, to concepts such as hope, future goals, self-respect, self-image, the way patients are perceived by others, and the desire not to be a burden on others.
"That was an impressive piece of research," Dr. Cherny notes. "By means of conversations with patients, in groups and in private, he discovered how it is best to strengthen the self-image, the sense of self-respect and the meaning of life for those who know they will soon die. In many cases we build ourselves in terms of what we will do in the future, and if it turns out that we don't have so much future left, then the present is not worth anything. One of our most important challenges is to help the patient see that what he can do now with his family and friends is of great importance both for him and for them."
Ben Corn: "A word that we are trying to erase from the lexicon is 'regret.' In its place, we teach people how to stop making accounts and instead change their order of priorities, so there will be time to do what is truly important. There are couples here who never talked to one another, and I don't mean about the hard things. We try to encourage them to talk, to think about the offspring, to say what is meaningful in this life, and to do it while there is time, and not at the last moment, minutes before death."
In the workshop, they are trying to do some of this in less than two days, and it seems to have some effect. The relations between the workshop participants look like the start of a beautiful friendship, and in the final session a feeling of esprit de corps was palpable. They didn't want to go home. They were afraid to part. They asked the organizers for another workshop and then another. Maybe the thought of the workshops yet to come will keep them going. W