October 5, 2018
Separation is a good thing. I don’t mean divorce or being away from your kids or breaking up the band. I mean the fact that thing A is over here and thing B is over there, and they stay that way. Air belongs over here, in the lungs; an unpopped popcorn kernel belongs over there, in the stomach. There is a structure in the body, the epiglottis, whose entire purpose is to keep it that way, but sometimes a little boy, who shouldn’t have been eating popcorn in the first place, gets a little too excited over his forbidden treat and accidentally sucked a kernel down the wrong tube. Mercifully, the x-ray says otherwise. Epiglottis 1, popcorn 0.
Other times, the separation fails. A fistula is a hole that connects two structures in the body that are supposed to be separated. We do this on purpose when creating a fistula between an artery and a vein to allow a woman whose kidneys are failing the chance at dialysis. When the body does it on its own, though, it’s usually bad news. People who suffer from Crohn’s disease, women who have had difficult childbirths (especially in low-income countries), and survivors of pelvic radiation or surgeries for cervical, bladder or colon cancer are all at risk of developing a fistula. Two loops of intestine can decide to open a pass-through in the wall. The bladder can begin emptying into the vagina. The colon can spill its contents into a passing blood vessel.
You can imagine how medically disastrous these things can be, especially that last one. But the social and emotional consequences can be just as bad: shame, loss of control over one’s body, exclusion from the activities that make life worthwhile. It is these consequences, as they affect Ethiopian women suffering from childbirth-related fistula, that Abraham Verghese describes movingly in his novel, Cutting for Stone.
Separation also forms a big part of the biblical creation story[i], the highlight of this week’s Torah reading in synagogues around the world. God separates light from dark, water above from water below, and dry land from sea. As my teacher Rabbi Danny Schiff likes to say, the very meaning of holiness (the Hebrew root k-d-sh) is “separate in order to elevate.” But before God does any of this, what is there?
Chaos. Bewilderment. Formlessness. Some primeval substance called tohu va-vohu. Genesis 1:2 reads, “the earth being tohu va-vohu, with darkness over the surface of the deep and a wind from God sweeping over the water—”[ii] is it “unformed and void?” “Chaos (the modern Hebrew translation)?” Rashi (11th century) says tohu means “astonishment and amazement,” and bohu “empty space.” Maimonides’ Guide to the Perplexed (about 100 years later) says the words mean “mourning and crying.” I imagine it as everything and nothing at the same time; all the distinct substances of the universe collapsed into one primeval goop, with no identity or form.
Illness can feel like tohu va-vohu. Things that should be separate run together, the wrong secretions coming out of the wrong orifices, the wrong activities happening at the wrong times, or the wrong thoughts leading to the wrong actions. An arm won’t lift. A mind won’t shut off to let sleep settle in. A bladder won’t content itself with only one outlet. And when that happens, life grinds to a halt. The only proper response seems to be mourning and crying.
As the healer, I can tell you that we can often feel this way. There is no denying the pain that we see laid out before us – yet when we try to help, our computer passwords are expired, there are six-month waits to see the right specialists, and the insurer is charging enough for the treatment to bankrupt the person’s family. Not only has separation been taken away – everything is being taken away.
There is second part of the verse: “a wind from God (or ‘the spirit of God’) sweeping over the water.” In Verghese’s novel, the character Shiva turns his compassion for the women coming to get care for their fistulas into a singleminded pursuit. With no formal medical training and few resources he wills himself to become an expert in the repair and care of fistula. I emphasize care because it is his ability to dispel the shame and embarrassment that the women feel, to make them feel human again, that is the necessary first step before he can heal their physical wounds, before he can surgically separate and elevate. There may be chaos and formlessness, but there is a spirit that causes Shiva to see things as they ought to be, not just as they are. He doesn’t content himself with astonishment and amazement, or with mourning and crying.
If a human being’s job is to walk in God’s ways, then our job here is to imitate the one who “causes the wind to blow and the rain to fall.” Getting the wind blowing doesn’t require a miracle; the sage Ben Zoma once had a vision of the separation between the waters being only two or three fingers wide. Just enough of an opening for someone to regain a wicked sense of humor or get back behind the wheel. I think of someone I met when they were falling apart physically, recently widowed, and too overwhelmed to understand what other doctors were telling them. When we parted company several years later, they were remarried, vibrant, and had a college degree. I couldn’t remember curing anything, but they were immensely grateful to me nonetheless. “What did I do?” I wondered. “You treated me with respect. You listened.”
That may have been it. Listened for several months, years even, to the confusion, helped pick up the pieces, assembled it into one story. When the question arose, “Why me?” I knew it wasn’t asking for an answer, just for understanding of how hard it was. When the time came for me to ask a question, it was, “What are we going to do now to get through this?” or, “What is missing from your life?” or, “What needs to change for you to have some hope?” And the answer? Let there be light.