For my family, lighting the Shabbos candles is a magical time. Every week, we put our candles in the window box, gather around, and after the blessing, shut our eyes tightly while my three little children beckon the angels in with their arms and voices. "Come in Shabbos angels, we need you, we want you ..." Very slowly and carefully, as I have taught my kids, we open our eyes and look at the candles. Through squinty eyes, they flicker and appear to dance in the multiple windows of the box. "I see angels!" my kids joyfully scream and run into the dining room singing Shalom Aleichem, convinced the Shabbos angels are celebrating with them.
I love my kids' innocent enthusiasm, but I wish I were so easily convinced about the angels. While I believe in angels, souls and the afterlife, and have read extensively on the subject in both Jewish and non-Jewish texts, my training as a physician has taught me to view the world as a scientist and explain each occurrence in physical terms. The "miraculous recovery" of a patient is because a certain medicine was able to attach to the patient's specific cell receptors, penetrate the cell, incorporate into the DNA, etc. The "medicine failure" of another patient is due to their lack of a certain enzyme, their electrolytes were too high.... Usually, there are innumerable different enzymatic and biochemical explanations for everything that happens in medicine.
Usually, but not always.
A few months ago, while on call for my internal medicine group, I got a page from the ER. The ER doc got on the line. "Jackie, one of your partners' 92-year-old patients is here for what looks like a mild stroke. She has to be admitted."
I drove to the ER and walked into her cubicle. In the bed lay Mrs. Schwartz, an elderly, obviously well cared for woman who smiled feebly at me with one side of her face. She was able to squeeze my hand and follow directions with one side of her body. Her caregiver of many years was at her bedside, and handed me her living will, in which it stated that she wanted no heroic efforts to keep her alive.
I called her two sons who were both across the country and both extremely concerned. They wanted to know if they should come. I explained to them that while this seemed like a mild stroke now, occasionally strokes do progress. In this case I erred on the side of caution and told them to come. They both began making travel arrangements to come to LA.
The next day when I went to see Mrs. Schwartz, it was clear that the stroke had progressed.
The next day when I went to see Mrs. Schwartz, it was clear that the stroke had progressed. She lay in bed, with her eyes closed and head back, breathing with loud gurgling noises. We call this agonal breathing, which typically portends impending death.
"Mrs. Schwartz?" I called. No response; no eye opening, nothing. I tried a sternal rub; a fist rubbed with pressure on the sternum is thought to give a very painful stimuli. Only patients with severe brain trauma, in a deep coma, do not respond.
There was no movement. Nothing.
I called her son, Ira, on his cell phone. He was driving from Martha's Vineyard on his way to the nearest airport. I told him what happened and he said that the soonest he would be in LA was two days.
I started writing orders in the chart for comfort measures only when Mrs. Schwartz, with eyes still closed and with the bubbly breathing, suddenly motioned with her hand that she wanted to write. I was shocked. Two minutes prior, she had not responded at all to the most painful stimulation. The caregiver and I looked at each other. I gave Mrs. Schwartz a pen and held up a paper for her to write.
With wobbly but clear handwriting, she wrote, "I have to go."
"No! You can't go! Ira and David will be here in two days!"
The caregiver started weeping softly. Trembling, I stammered, "What?" Slowly, she wrote again, "I have to go."
I didn't learn anything about this in medical school. I screamed, "No! You can't go! Ira and David will be here in two days. Today is Wednesday; you have to wait until Friday. We're not ready for you to leave us."
I called Ira's cell phone again and held the receiver to Mrs. Schwartz's ear. He told her how much he loved her, but that she had to wait. The air in the room, which had taken on a tingly quality, seemed to shift. She put down her hand and basically returned to how I had found her a half hour earlier.
She did wait until Friday. I had a meeting with her sons, who told me that she had been an actress and a cabaret dancer in the ‘30's, and what a great mother she had been. A few hours later, with her family surrounding her, she died.
That night was Shabbos. We lit the candles, shut our eyes and squinted at them after the blessing. "I see angels!" my kids squealed. And that night so did I.