November 20, 2019

Hour of Separation, Hour of Connection by Rabbi Janet Madden

A few days ago, someone said to me “Oh, you’re a hospital chaplain,” and before I could respond, followed up with “So you go around and visit patients.”

The easiest answer was “Yes.”

I visit patients of all sorts and in all sorts of circumstances. Some are happily going home with a new baby or a new knee. Others are recovering from a surgery, have a newborn in the NICU or have survived a stroke or a cardiac event. Others are undergoing chemotherapy or are testing in hopes of discovering the cause of their illness. Still others are leaving the hospital and transitioning to rehab facilities or going home to the reality of a life-changing, life-limiting or life-ending diagnosis.

But I don’t just visit patients. In addition to providing spiritual care and advocacy to patients, I provide spiritual care to patients’ families and friends and caregivers and to the hospital staff. And because I am also an experienced hospice chaplain and a certified palliative care chaplain, my workdays often involve end-of-life decision making and death.

As a Clinical Pastoral Education-trained chaplain, I am prepared to serve patients and families of any faith tradition or none. As the hospital’s Visiting Rabbi, I am always assigned to spiritual care for the hospital’s Jewish population. In some instances, I work with patients and families over a period of months—even years. Or, as happened this week, my first meeting with a patient and family comes at the time of death. And sometimes, as in this case, facing death often prompts someone who has previously declined chaplaincy visits to open to spiritual care.

After more than a month in the ICU, there were no further treatment options for Ruth. I had been contacted by the palliative care team ten minutes earlier, notifying me that Ruth would be soon placed on comfort care. Her sister had asked for me to be present.

“She’s had a horrible life, a terrible life since she was a teenager,” Ruth’s sister Rachel told me. “Now, I want her to have peace.”

Nine years younger than Ruth, and her power of attorney, Rachel was both broken-hearted and resolute about her decision to place Ruth on comfort care.  Rachel is an RN and she was deeply involved in Ruth’s care. Rachel had steadfastly believed that Ruth would recover from some of the medical issues that had eroded her health and she had refused any spiritual care visits for her sister, fearing that Ruth would “give up hope” if a chaplain visited. Now, Rachel, her sister-in-law and her best friend and I sat together and Rachel shared her sister’s story.

Ruth, a social worker, was 57 years old. Her 72 year old husband lives in a facility for dementia patients; he is non-verbal and needs round-the-clock care. They had no children. For the last 8 years, since her husband had been moved to a facility where he can receive the care he needs, Ruth had lived with her beloved dog. When her dog died, she adopted a second beloved dog and her greatest worry, Rachel told us, was what would happen to her dog.

She cared more about her dog than she did about herself, Rachel said. Ruth drank too much. She gained an unhealthy amount of weight. She wouldn’t exercise. She worked too many hours and suffered from insomnia and didn’t get the medical care that she should. She had few friends and didn’t socialize. She was not connected to a Jewish community or any community.

Ruth mourned the loss of their brothers, both of whom had died, years apart, one as a child, one as a young adult, both on her birthday. She mourned the death of her parents. She mourned her husband, lost to early-onset Alzheimers.

Rachel said that Ruth acknowledged her depression but didn’t want treatment. Ruth had told Rachel months ago that she had had enough; she was ready to die. Ruth had been her babysitter when Rachel was a child and her lifelong friend and confidante. Ruth and Rachel were the last living members of their birth family, and Rachel shared her deep hurt that Ruth did not want to live, that she wanted to leave her.

In the hour that we spent together, the last hour of Ruth’s life, we engaged in life review, talked about grief and loss and about beautiful, sustaining memories. I chanted for Ruth and Rachel, and recited the Viddui and the Shema, We blessed Ruth for a gentle, peaceful transition. Rachel told Ruth how much she loves her, thanked her for the lifetime of loving care that Ruth had given her, and told her that wanted no more pain for her.

A couple of hours later, after Rachel and the others had left, after I had sat with Ruth’s body until it had been picked by by the mortuary transport, after I completed charting the visit, after I prayed and washed my hands, and stepped outside for a few moments of air, I reentered the hospital and went to another room to visit another patient.

Rabbi Janet Madden PhD was ordained by The Academy for Jewish Religion-California. She serves as the rabbi of Temple Havurat Emet and Providence Saint John’s Health Center and has been a student of the Gamliel Institute. She is a regular contributor to Expired And Inspired.

Rabbi Janet Madden

Rabbi Janet Madden




The Gamliel Institute will be offering course 5, Chevrah Kadisha: Ritual, Liturgy, & Practice (Other than Taharah & Shmirah), online, afternoons/evenings, in the Winter semester, starting January 9th, 2018. This is the core course focusing on ritual, liturgy, practical matters, how-to, and what it means (for everything other than Taharah and Shmirah, which are covered in course 2).


The course will meet online for twelve Tuesdays (the day will be adjusted in any weeks with Jewish holidays during this course).

There will be an orientation session January 2nd.

Information on attending the online orientation and the course will be announced and sent to those registered. Register or contact us for more information. Detailed information on the preview will appear here in the weeks leading up to that event.


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Gamliel Café

Gamliel Students are invited to an informal online monthly session, held on the 3rd Wednedsays of the month (but watch for any changes). Each month, a different person will offer a short teaching or share some thoughts on a topic of interest to them, and those who are online will have a chance to respond, share their own stories and information, and build our Gamliel Institute community connections. This initiative is being headed up by Rena Boroditsky and Rick Light. You should receive email reminders monthly. The next scheduled session of the Gamliel Café is November 15th with a discussion of creative liturgy by Jean Berman.

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Gamliel Continuing Education Courses

Graduates of the Gamliel Institute and Gamliel students should be on the lookout for information on a series of “Gamliel Graduate’ Courses, advanced sessions focusing in on different topics. These will be in groups of three sessions each quarter (three consecutive weeks), with different topics addressed in each series. The goal is to look at these topics in more depth than possible during the core courses. The first course took place in Fall 2017, focusing on Psalms. The next course will be in April, and will look at death as seen in the Zohar. Registration is required, and there will be a tuition charge of $72 for the three sessions. Contact us –  register at, email, or call 410-733-3700.



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If you have an idea for an entry you would like to submit to this blog, please be in touch. Email We are always interested in original unpublished materials that would be of interest to our readers, relating to the broad topics surrounding the continuum of Jewish preparation, planning, rituals, rites, customs, practices, activities, and celebrations approaching the end of life, at the time of death, during the funeral, in the grief and mourning process, and in comforting those dying and those mourning, as well as the actions and work of those who address those needs, including those serving in Bikkur Cholim, Caring Committees, the Chevrah Kadisha, as Shomrim, funeral providers, in funeral homes and mortuaries, and operators and maintainers of cemeteries.