Bikur Cholim
Rabbi Kaganoff
Bikur Cholim
By Rabbi Yirmiyohu Kaganoff
Question #1: How many mitzvos?
Which mitzvos does one fulfill when performing bikur cholim?
Question #2: Only visiting?
Is the mitzvah fulfilled simply by visiting the sick?
Question #3: How often?
How many times a day can I perform bikur cholim?
Question #4: Focus!
Do I need to focus on the fact that I am performing a mitzvah in order to fulfill it?
Foreword
The Gemara (Nedarim 39b) cites a reference to the mitzvah of bikur cholim in parshas Korach. After realizing the gravity of Korach’s rebellion against belief in Hashem, Moshe Rabbeinu declared to the Benei Yisrael: “If these (Korach and his cohorts) will die like all men do, and what happens to all other men will happen to them, then Hashem did not send me. However, if Hashem will produce a new creation and the earth will open its mouth, swallowing them and all that is theirs, such that they plummet alive into the grave, you will know for certain that these men have angered Hashem” (Bamidbar 16:29-30). Rava explains: “Most men take ill and are bedridden; they are then visited by people who check to see what needs to be attended to. If this happens to Korach and his party, people can say that Hashem did not send me.” The Gemara concludes that this is a Biblical hint to the mitzvah of bikur cholim.
Another allusion to bikur cholim is at the beginning of parshas Vayeira (Bereishis 18:1), where it says that Hashem visited AvrahamAvinu. Rashi points out that this occurred on the third day after his bris milah was performed, and Hashem was fulfilling bikur cholim, visiting and providing care for the ill.
Yet another reference to the mitzvah of bikur cholim is in parshas Tazria (Vayikra 13:45) where the Torah tells us that the metzora calls out to whoever can hear him that he is tamei. Chazal explain that this is so that they should daven for his swift and complete recovery (Shabbos 67a; Mo’eid Katan 5a; Sotah 32b; Chullin 78a; Niddah 66a). We will soon see the important role of prayer in the mitzvah of bikur cholim.
Praying for good health
The Gemara (Shabbos 32a) notes, “A person should always pray that he not become ill, because once he gets ill, he is told, ‘find merits on the basis of which you will be healed.’”
Other Biblical sources are quoted to demonstrate the mitzvah of bikur cholim, although it is disputed among the rishonim whether the specific mitzvah of bikur cholim is min haTorah or not. It is important to note that all halachic authorities agree that observing bikur cholim properly fulfills several mitzvos min haTorah, including ve’ahavta lerei’acha kamocha, love your fellowman as yourself (Vayikra 19:18) and vehalachta bi’derachav, acting in the ways of Hashem (Devarim 28:9). It could also easily fit within the heading of other mitzvos (Shu”t Sho’el Umeishiv 3:244), such as lo sa’amod al dam rei’echa, do not stand by idly when someone is endangered. The dispute among the rishonim and ge’onim is whether there is a specific mitzvah of bikur cholim among the count of the 613 mitzvos (opinion of the Behag), or whether it is an aspect of performing chesed and developing our character (Rambam, Hilchos Aveil 14:1).
The Gemara (Sotah 14a) teaches that we have a mitzvah to follow in Hashem’s ways, and that this mitzvah includes the requirement to take care of the needs of the ill. “Rabbi Chama the son of Rabbi Chanina said, ‘How are we to understand the words of the Torah: “You should follow Hashem, your G-d (Devarim 13:5).” How is it possible for a human being to follow the Holy One, blessed is He, when the verse states that “Hashem, your G-d, is a consuming fire?” (Devarim 4:24; 9:3) Rather, it means that we are to emulate Hashem’s attributes – just as he dresses the unclothed… takes care of the sick… consoles the mourners and buries the dead, so should we.’”
Similarly, the Torah teaches “You must clarify to them [your children] the laws and the teachings, and make known to them the pathways in which they are to walk and the deeds that they are to perform” (Shemos 18:20), which the Gemara (Bava Kama 100a) explains includes gemillas chesed, bikur cholim and other, similar, acts of kindness.
What does the word bikur mean?
Although the word “bikur” means “visit” in modern Hebrew, the original meaning of “bikur” is “examine” or “check.” Chazal refer to bikur korban, which does not mean to see how the animal awaiting hakravah is feeling or to check its blood pressure, but to check to see that it has no blemish (Pesachim 96a). The primary responsibility of the mitzvah of bikur cholim is to check and see what the ill person needs and to do whatever one can to meet those needs (Toras Ha’adam).
Since we rule that mitzvos tzerichos kavanah, i.e., 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. Thus, a physician, nurse, nurse’s aide, or medical clown performs the mitzvah of bikur cholim all day long. If they regularly have in mind that they are fulfilling what Hashem wants us to do, they are rewarded for each and every time that they inquire about the ill and assist in their care.
However, one who performs the same activities while looking at it exclusively as a job, but not as an opportunity to imitate Hashem’s wondrous ways, misses the opportunity to receive all this reward. In addition, constantly recognizing that I am acting like Hashem and fulfilling His mitzvos makes a tremendous impression on one’s neshamah.
A pharmacist, who may not see the patients, should still begin the day by remembering that he is performing two mitzvos, one of emulating Hashem, and the other of bikur cholim, by making sure that the patients receive their proper pharmaceutical care. It would seem to me that, should a medical professional think they might forget to have this in mind all day, should express before beginning their day’s work, “I am declaring that all the acts of chesed I do today should fulfill the Torah’s mitzvos.”
Ramban
The earliest, most authoritative, and most extensive work we have on the topic of bikur cholim, pikuach nefesh, aveilus and related topics is the Toras Ha’adam, authored by the Ramban. When the Tur (Yoreh Deah Chapter 335) introduces the laws of bikur cholim, he goes out of his way to laud the Ramban’s work as his primary source. It is also important to note that the Ramban quotes frequently from halachic sources of Chazal that we no longer have, particularly from texts of Meseches Semachos that are now missing in our versions of this early work. (This fact is noted by the Gra and the Chiddushei Hagahos.) There is also a fascinating bibliographic detail about the Toras Ha’adam. It was published twice in the sixteenth century (1519 in Constantinople and 1595 in Venice) and then not again until the mid-nineteenth century!
Praying for the ill and attending to their needs
Many people err to think that the mitzvah of bikur cholim is simply to visit the ill and cheer them up, but do not realize that the mitzvah includes attending to the ill person’s needs and praying on their behalf. The Toras Ha’adam 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” (also see Beis Yosef, Yoreh Deah 335). We see that praying for the ill is 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.”
When praying for someone ill, always include a request that he get well together with the rest of the Jewish ill (Shabbos 12b). This helps the prayer be accepted, since the merit of the public is rallied (Rashi).
The many tefillah and tehillim groups that daven for lists of ill people to get better are thereby fulfilling some of the aspects of bikur cholim, while still being able to attend to the needs of their own household.
The authorities note that someone who visits a sick person without praying for his recovery has not fulfilled all the requirements of the mitzvah (Toras Ha’adam, based on Nedarim 40a; Rema, Yoreh Deah 335:4). Therefore, medical professionals should accustom themselves to pray for their sick patients in order to fulfill the complete 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, besoch she’ar cholei Yisroel,” as one leaves the person’s room. A doctor in his office can recite the same quick prayer. I know a physician who makes lists of his patients’ names and includes them in his daily davening. When wishing someone refuah sheleimah, what one is doing is offering a short prayer on behalf of the sick person.
When praying in the presence of the ill person, one can daven in any language, although when praying not in his presence, it is advisable to pray in loshon hakodesh (Shulchan Aruch, Yoreh Deah 335:5 and Taz ibid.).
Among several other lessons that the amora, Rav Pinchas ben Chama, derived from various passages in Tanach, we find the following: Whoever has an ill person in his household should go to a wise man (a Torah scholar) to ask that he pray for the ill person. Rav Pinchas derives this from a posuk in Mishlei (16:14), The anger of the King brings the angels of death, but the man who is wise can atone for this (Bava Basra 116a). This is the basis for asking tzaddikim to daven for the ill. The Rema quotes this in Yoreh Deah (335:10), mentioning that one should ask a great Torah scholar in the city to daven on behalf of the ill.
Small illness
The Gemara (Yerushalmi, Brochos 4:4) implies that one should pray for the healing of even a relatively minor illness. To quote: “Every illness has the potential to become life threatening.”
Rasha
The Sefer Chassidim discusses whether we should pray for a sick person who has separated himself from the Jewish community. He cites pesukim from which we see that one should not.
Aspects of visiting a choleh
The visit is to benefit the choleh. In most circumstances, a visit should be short and not tiresome or 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. They thought they were performing a kind deed, while, in reality, they were harming a sick person who desperately needed to rest.
Always cheer up the choleh (Gesher Hachayim). This is included in attending to his emotional needs. The Ramban states that one of the aspects of bikur cholim is that the ill person appreciates spending time with his friends (Toras Ha’adam, page 17 in the Chavel edition).
First three days
The Gemara teaches that when a person becomes ill, for the first three days he should be visited only by family and close friends. After these days pass, others (the beraisa quoted states, “the more distant ones”) should also come to visit. (The Ramban understands that the “distant ones” come on the third day, and apparently explains the passage I will cite shortly in the same way.) However, if it is clear that he is seriously ill, others may come in the first three days.
In this context, the Gemara (Yerushalmi, Peah 3:7) tells us a somewhat amusing anecdote. Rabbi Yosi, one of the most frequently quoted amora’im in the Talmud Yerushalmi (some have the text that it was either Rabbi Asi or Rabbi Yonah), had fallen ill. On the fourth day of his being bedridden, Rabbi Chuna (some say it was Rav Huna [Penei Moshe; Chavel]), Rabbi Pinchas and Rabbi Chizkiyah came to visit him. Rabbi Yosi teased them for following the words of the beraisa too literally when it states that non-family members should wait until the fourth day to visit. Since you are my friends, you should have come right away (Toras Ha’adam; Penei Moshe) – friends are as good, sometimes far better than, family. The Reshas (the earliest commentary that we have on the Yerushalmi) understands the passage slightly differently: Rabbi Chuna, Rabbi Pinchas and Rabbi Chizkiyah were his disciples and should never consider themselves “the more distant ones,” regardless of whether or not they are close biological family. Thus, he was upset at their tarrying to come, notwithstanding that they were well intentioned.
Two visitors
Many people have the custom to go with another person when they fulfill the mitzvah of bikur cholim. This practice is based on a statement of the She’iltos of Rav Acha’i Gaon (#93), one of the few full-length halachic works that has been passed down to us from the era of the ge’onim. Rav Acha’i simply states that when going to fulfill bikur cholim, he should not go alone but with someone else. In his commentary, Ha’amek She’eilah, to the She’iltos, the Netziv suggests a source for this ruling, and then comments that he has not found this opinion mentioned in any other work, from the earliest to the latest.
Don’t visit
The Gemara (Nedarim 41a) teaches that certain sick people should not be visited. Specifically, it says not to visit someone with:
(1) A stomach ailment, because it is embarrassing for the patient who may need to excuse himself to the restroom for long periods of time.
(2) Headaches, for whom talking to others or even a small amount of noise is disturbing.
(3) Eye ailments (some say that those with eye ailments are also very sensitive to noise; others mention other reasons why they should not be visited).
Obviously, the Gemara is teaching that one should use common sense not to visit someone who would prefer to be left alone.
In all of these cases where the ill person should not be disturbed, one fulfills bikur cholim by coming to the hospital or wherever the ill person is and inquiring and observing from outside the ill person’s room what is needed (Toras Ha’adam). When a patient has visitors, the staff is more likely to provide better care since they see that other people care for the sick person.
Similarly, the Rema (Yoreh Deah 335:2) rules that one should not visit someone who thinks that you despise him, since the visit will have the opposite effect of what bikur cholim is meant to accomplish. In this, the Rema overrules an earlier authority who contended that such a person could visit a choleh.
Substandard care
What should one do if he realizes that 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). However, the Gesher Hachayim points out that discussing directly with the sick person that he needs better care could easily be an aveirah, not a mitzvah, because this causes the sick person to become agitated and perhaps to lose hope, which is the opposite of what they need in order to get better.
Since it is more likely that a poor person is receiving inadequate care or has no one to care for his needs, it is usually a greater mitzvah to visit a poor choleh than a wealthy one (Sefer Chassidim #361). Additionally, the poor person is more likely to be in financial distress because of his inability to work due to his illness (Ahavas Chesed 3:3).
If two people need the same amount of care and one of them is a talmid chacham, it is preferable to attend to the talmid chacham first. If the talmid chacham is being attended to adequately and the other person is not, first take care of the other person (Sefer Chassidim).
We have not yet finished the topic of bikur cholim, and we will return to it iy”H next week.
Conclusion
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). In addition to all the obvious reasons for the mitzvah of bikur cholim, the Kli Yakar, in his commentary to Bamidbar (16:29), offers an additional reason for fulfilling bikur cholim: to benefit the visitor -- because it can serve him as a wakeup call. Seeing someone ill influences the visitor to think about the importance of doing teshuvah. This provides extra merit for the sick person, since he caused someone else to do teshuvah, even if it was unintentional. May Hashem send a speedy recovery to all the ill!