December 14, 2018

Cancer took her limb, not her life

Veterinarian Erica Heim has no idea where her left arm is. It  turned to ash, most likely, more than a decade ago.

For years, the 42-year-old Encino native treated days-long bouts of excruciating shoulder pain with Tylenol, physical therapy and acupuncture, until an MRI located a nugget of deadly saboteur cells in the upper third of her left arm. It was Ewing’s sarcoma. Cancer. 

Eight months later, her surgeon amputated Heim’s arm, shoulder and half of her collarbone. After that, she says, she lost track of the limb, though its phantom pain haunts her every day. And though Heim’s Jewish roots run deep — her father, Fred, is a Holocaust survivor — she feels that her religious upbringing did little to prepare, support or help her cope with her frightening cancer and life as an amputee.

For starters, Heim, who said she felt “horribly fatigued and nauseous” from chemotherapy, had no idea that her villainous limb didn’t have to be cremated, like the majority of appendages amputated in a hospital. She was unaware that, for practicing Jews, the rabbinic ideal is to go underground.

“If it’s a full limb,” said Rabbi Elliot Dorff, chair of the Conservative Movement’s Committee on Jewish Law and Standards, “it’s supposed to be buried.” This is no proscription writ in Torah, only oral law derived from a central Jewish tenet that our bodies belong to God, and therefore require respect in death as well as in life.  

“Just like a body should be buried,” advised Yossi Manela of West Hollywood’s Chevra Kadisha mortuary, “so a toe, finger, certainly an arm, should too be buried and not be discarded.”

But this isn’t your usual Jewish burial. First, because hospitals usually have the amputated limbs cremated offsite, patients must request burial. Second, mortuaries often inter limbs for free. Third, the burial is performed without ceremony: There’s no formal recitation of prayer, no graveside service, no casket, no covered mirrors — just the simple act of interment in an unmarked plot.  

Although Heim didn’t have her arm burried according to Jewish custom, the idea appeals to her.

“Burying, in some ways, sounds kind of beautiful,” Heim said. “I think it honors … that it’s a part of your body, and that your body can be a beautiful place. I think it is also burying the evil that is your cancer, or whatever ugliness caused you to lose your limb.” 

Undergoing amputation doesn’t just change a person physically, of course. There can be intense emotional adjustments as well. Spiritual leaders encourage individuals to find a way to say goodbye before their surgeries.

“You have to stop and mourn loss,” said Rabbi Jason Weiner, a chaplain at Cedars-Sinai Medical Center. “It can be therapeutic and cathartic to say goodbye to the limb in a formal way, to help you recognize that it really happened and that life is different now.”

Reading a poem or psalm is one way to honor the impending loss. Other times, a patient might dialogue with God. “Dear God,” Weiner might start off, “I’m here with so-and-so, and they would like to say …” 

These rituals can help patients face emotional responses such as spikes of grief and profound doubt. For Heim, who attended Jewish day school until the seventh grade, the disease that took her arm also shook her faith. 

“Having cancer called into question everything I believe in,” she said. “I don’t even know if I believe in God.”

Her spiritual life thrown into a tumult, Heim nevertheless bid adieu to her limb in her own way, asking an artist to create a mold and plaster cast of the arm, immortalizing it forever. “I always had the thought of taking it to a foundry and having it cast in bronze,” she said. 

Burial and a parting ritual can bring some comfort to patients, but what of finding ongoing support after surgery? When someone is sick, you bring them soup. When someone dies, you wear torn cloth, recite prayers, feed their family. But what is the Jewish way to assist someone who’s lost part of his or her body and continues to live on? 

Jewish law requires that as a community, we care for the sick and the disabled, Dorff noted. An amputee is merely a person who is disabled in a specific way. 

However, Internet searches reveal scant resources specific to Jewish amputees, and organizations for disabled Jews don’t typically work with those who have lost limbs. 

The fact is, beyond burial guidance, there are few edicts addressing an amputee’s physical, mental and emotional needs. Instead, these individuals temporarily transition into the realm of the sick or disabled until corporeal wounds heal. After that, the level of care depends largely on family and friends. 

This is partly the result of the relatively small number of amputation cases. Chevra Kadisha, for example, may receive just five requests a year for limb burial. 

Apart from seeking counsel from a rabbi, an amputee’s most complete support network exists beyond Jewish circles. For Heim, the most uplifting sense of community came from a ski trip to Mammoth with Disabled Sports Eastern Sierra.

“It was a lot of great energy,” Heim said. “It wasn’t the pity party that I envisioned.” 

Today, Heim grapples with daily phantom pain, weekly questions and stares, and the fear of cancer's return. But for the most part, Heim lives a full, happy life. She’s the medical director at Best Friends Animal Hospital in Valley Village. In 2010, she married a man she met before her amputation. 

“My relationship to the arm … is sort of unemotional,” Heim said. “I think it’s funny and weird and I’m totally OK with it. I don’t need a ceremony.”

To Heim, the real burial is of the four-limbed life she used to live.

“The woman who existed in the 30 years before this happened is a different person,” Heim said. “And then there’s the one-armed person after that. I identify with her.”