When Barbara Sherman lay dying, she knew what she didn't want: She did not want to end up in a hospital; she did not want the neighbors calling 911; she did not want someone sticking a needle in her arm. She wanted no interventions, not even morphine to ease the pain.
"Her greatest gift to us was to let my brother and I observe her dying," said her daughter, Linda Sherman, who was in her early 40s at the time of her mother's death at 73, in 2004. "It was so raw an experience, nothing sterile, nothing artificial. It was mom in her surroundings, and she allowed me to be there in the dying process. I saw how beautiful it was, how amazing, life-changing and haunting. As hard as it was, I am grateful to have that."
In the last few weeks of her life, Barbara Sherman had the help of Jewish Hospice Project-Los Angeles, which offers spiritual end-of-life care for the Jewish community, regardless of religious affiliation. Sherman, whom her family describes as a life-long spiritual seeker, was brought back to her roots upon hearing Jewish songs and prayers in her final days.
The Jewish Hospice Project was co-founded four years ago by Rabbis Carla Howard and Sheldon Pennes, who were concerned that, within a city with more than a half-million Jews, the Jewish community had no spiritual end-of-life care. They made it their priority to administer to the spiritual needs of the dying. Since 2001, the program has provided counsel to more than 600 clients and their families at affiliated hospices throughout Southern California.
And this year, Howard and Pennes established the Jewish Healing Project, which grew out of discussions with their Health Care Advisory Board -- made up of oncologists, physicians and alternative health care providers. Their idea is that patients should avail themselves of spiritual care upon diagnosis of a life-threatening illness, when they are still relatively healthy, rather than wait until after they've entered a hospice. Howard and Pennes hope the Jewish Healing Project will allow them more time to develop a spiritual dialogue with those who seek help.
Although other Jewish hospices have opened in recent years, the idea of hospice care is still "not very Jewish," Howard said.
"Bechor Chaim, to choose life, is the Jewish mandate to live life to its fullest," Howard said. "Particularly for Jews, death is an outrage. How does hospice and healing concur with this image? How does choosing the way we die fit into the mandate of choosing life?"
Howard has long reflected on questions of death and the Jewish community.
For 11 years, she studied Jewish healing and spirituality with Rabbi Jonathan Omerman, well known for his work in Jewish meditation.
"The Torah teaches 'and you should love your neighbor as yourself,' and we see that the rabbis added, 'and provide for them a good death.' We believe this is the responsibility of the Jewish community," Howard said.
Howard, who serves as executive director, spends much of her day traveling to clients' homes, hospitals and nursing homes. She also officiates at funerals. In addition, she sits on the faculty of the doctoring program at the David Geffen School of Medicine and on the bioethics committee of the Santa Monica UCLA Medical Center. Pennes is the rabbi at Temple B'nai Emet in Montebello and serves as chaplain for Trinity Care Hospice, as well as being Jewish Hospice Project-L.A.'s director of patient care.
The rabbis' hospice program does not charge for services and receives no direct funding from The Jewish Federation, relying instead on foundation grants and fundraising to support its $360,000 budget. Last year, the hospice program received a grant from the Jewish Venture Philanthropy Fund, a project of the Jewish Federation, and has also received grants from the Weingart Foundation, Steven Spielberg's Righteous Persons Foundation and the Skirball Foundation, among others.
"For those of us who might already have some kind of spiritual vocabulary, getting spiritual counseling is not a big issue," Howard said, "But for someone without one, it's a huge turnaround at a time when life is turned upside down with a diagnosis."
Ron Israelite was one of those. A successful media entrepreneur, Israelite's focus was his family and his business; spirituality came in a distant third at best. Although raised Jewish, he had stepped away from his faith a long time ago.
After being diagnosed with colon cancer two years ago, Israelite joined an experimental trial program at UCLA. His wife, Betsy, believes that the doctors and researchers extended her husband's life. But soon, it became a battle of wills, between Israelite and his aggressive cancer. When it showed up in his lungs. Israelite decided to stop treatment and seek hospice care in January 2005.
After accepting this crushing decision, Betsy Israelite recalled, her husband contacted Trinity Care Hospice. A few days later, Howard called and asked to speak to Ron.
Israelite gave the phone to her husband and his journey began.
"Of all the care he received through hospice, Ron looked forward to and benefited the most from his spiritual discussions with Howard," Betsy Israelite said. "He set up seeing the rabbi like a meeting. Howard engaged his curious mind in what the dying process was all about. She opened up the possibility that this was a new stage of life, a transition into a new place, to be with God. He was really there with her, totally engaged intellectually and spiritually."
Over the next few months, Howard came to Israelite's home a couple times a week and they would talk.
"I hadn't imagined it would be people sitting around laughing and discussing, like in a class," Israelite said. "But that's what they did: discussed, argued, laughed, and cried a little."
Both Howard and Israelite observed how Ron became more peaceful, and started looking younger and younger.
"I noticed how beautiful it was. I mean I was losing my husband, but he seemed content, peaceful," she said. "It became for him the next part of his journey."
For her husband, death was no longer a journey alone down a dark corridor, Israelite said: "He knew what was going to be on the other side. He knew it would be God and he was looking forward to it."
Ron Israelite died two months after entering hospice care. He was 61.
"There is a dance between spirit and body; the spirit is in touch with the body as it breaks down," Howard said.
Howard defines this dance between body and spirit as a healing process, differentiated from cure. This spiritual healing, she said, differs so radically from what doctors offer that she sees part of her mission as educating physicians, medical students and other health professionals about what spiritual end-of-life care really is.
"Physicians offer many treatments for the terminally ill -- feeding tubes, ventilators, etc.," she said, but they're typically ill equipped to help families decide when to discontinue treatment that is often invasive and painful. "The family is left with awful guilt: Am I doing the right thing? Am I causing him or her more pain?"
Terminally ill patients who choose to go into hospice prepare for death on their own terms. In practical terms, Howard said, this should include writing an advanced directive, consisting of a living will and the assigning of a health care surrogate. A living will allows an individual to convey wishes regarding future treatment. In a hospice that typically means using only palliative care, or pain management, and having in place a DNR (do not resuscitate) order. A health care surrogate is someone designated to make health care decisions when the patient is no longer able.
Howard believes that one of the most important and powerful repercussions of her organization's work is to help the dying, along with their families, return to their Jewish roots. In Barbara Sherman's case, the family buried their spiritually adventurous mom in a Jewish cemetery, something that was undecided before Howard began her visits.
For Ron Israelite, who had strayed far from Judaism, it meant coming home.
To learn more about Jewish Hospice Project-Los Angeles and the Jewish Healing Project, visit www.jewishhospicela.org, or call (310) 785-0856.