This essay was originally the d’var Torah at Congregation Beth Shalom, Pittsburgh, Shabbat Vayetze/9 Kislev 5783/December 3, 2022. You can view the sources here. Online version originally posted at Pittsburgh Jewish Chronicle/Times of Israel.
There are two strange words at the beginning of Parashat Vayetze.
Bereshit 28:11 begins, “Vayifga’ bamakom.” “And he peh-gimel-‘ayin in/on/at the place.” That’s a strange verb. Most translations of this verse say something like, “And he came upon the place,” or “And he alighted there.” But paga’ in modern Hebrew means something like, “wounded.” When I was doing my medic’s training in the IDF, nifga’im was one of the words for “casualties.” Sure enough, in other places in Tanakh we do see this same shoresh have a much more negative, less happenstance meaning. Shlomo HaMelekh proclaims (Melakhim Aleph 5:18), “But now the LORD my God has given me respite all around; there is no adversary and no fega’ ra’ (mischance).” The BDB dictionary, an early 20th century scholarly dictionary of the Hebrew Bible compiled in the UK, defines fega’ as “evil occurrence.”
So, what exactly did Ya’akov do to the place when he got there? With all these definitions in my head, I hear this verse as, “And he struck that place,” consistent with the Open Scriptures definition, “to encounter, fall upon (of hostility).”
It’s a very 2022 understanding of the verse. As we move through the world, especially a world composed of seemingly eternal features like rocks and night skies, it is easy to believe that we pass like so many dreams that disappear by morning. But even the earliest life forms left a mark in their fossils, and the fuels that many of those fossils formed. How much more so our form of life, capable of leaving legacies in writing and film and sound, and altering the very rocks and skies themselves through our burning of those fossils for energy? And even more, our impact the other living beings, and on one another?
But this isn’t the climate change sermon (or the sermon about how makom is a name for God, for all of you who know that interpretation). Just be patient.
I said there was a second word that I “bumped” on (ooh, maybe that’s what vayifga’ means – bumped, like bumped into. What a klutz that Ya’akov was, no wonder he couldn’t hunt.). That word was m’ra’ashotav, translated everywhere I can find as “under his head.”
Problem! Head is singular, and even though I know resh-alef-shin means head, m’ra’ashotav is plural!!! What gives? Ibn Ezra notices this, too. “Me-ra’ashotav (under his head) is a plural. It is similar to margelotav (his feet) (Ruth 3:4; 14).” Except that this doesn’t help me – after all, we actually have two feet; we only have one head. Right?
There’s a neurological test, a simple one any clinician can do at the bedside, called the Romberg test. A person stands with their feet side-to-side – heel to heel, toe to toe, no space between them, on as narrow a platform as possible. They place their hands at their sides and, while the examiner stands ready to catch them if they fall, they close their eyes. It’s meant to test the person’s balance. One can only do the Romberg without falling over if both their vestibular system, the little curved canals in the inner ear that tell us which way we’re moving in space, and their proprioception, the long nerve fibers that bring up information about what position our joints are in, are in working order. Balance is a team effort. The third member of the team is vision, so when they close their eyes and remove vision from the equation, the proprioception and vestibular system have to take up the slack. Together, they can do it. Alone, neither one is enough, and a person either topples like a chopped tree or oscillates around in a precarious circle.
A few years ago, Rabbi Adelson spoke about the regel y’sharah, the stance of putting our feet together when praying, especially during Kedushah, to resemble the angels who have, according to midrash, a single fused leg. At the time, he explained that this is to remind us not only of the chorus of angels praising Hashem, but also that when we pray, we are vulnerable, a little off balance. At the time, I thought, simultaneously, “That’s profound,” and “Romberg!”
The similarity is striking and goes beyond the physical similarity between our davening position and the exam maneuver. The difficulty in doing the regel y’sharah (including all the legends of cantors sack-racing and pogo-sticking their way out of burning sanctuaries because they wouldn’t separate their legs even in an emergency) is the need for two inputs, two points of contact with the ground, just like in the Romberg test. This is true physically and spiritually. Angels lack free will. There is no internal conflict; according to some accounts each angel is created for a singular task and disappears once the task is complete. But human beings are, as stem cell researchers might say, pluripotent. We have the possibility of becoming all sorts of different things, making any number of free choices. And to do that, we must stand on more than one “leg:” our yetzer tov, good inclination, and our yetzer ra, evil inclination. So valuable is the yetzer ra that there are midrashim that suggest we would never procreate, conduct business, or do anything creative without it.
Ibn Ezra was all about that pshat, so I doubt this is where he was going with his comment. He was just making a point of grammar. But I, who am not constrained by being ibn Ezra, think I now understand why m’ra’ashotav is just as plural as margelotav. We humans do indeed have two heads – whether it is the two inclinations or a rosh gadol and a rosh katan (think of them as the forest and the trees, the one who pitches in and anticipates problems versus the one who does exactly what was asked of them to the letter and not a bit more). We are of (at least) two minds, and all human ethical philosophy and religious education is a battle to get the balance right between the two.
There’s a passage in the Yalkut Shimoni 3:3 that says, “The letters of emet (Truth) stand on two legs while the letters of sheker (Falsehood) stand on one leg.” This is correct; aleph, mem and tav all have two “legs” as they are written in Hebrew block letters, while shin, qoph and resh all have a single “leg,” touching bottom at only one point. Truth stands firmer than fiction.
Hold on. The angels, who have one leg, are Falsehood, and humans are truth?
Not exactly. Yalkut Shimoni continues, “The letters of emet are spread out (in the aleph-bet, at the beginning, middle and end) and the letters of sheker are close together (again in the aleph-bet, appearing sequentially though not in that order, just before the end).”
The falsehood occurs not in the angels themselves, but in humans attempting to appear like angels. When we bring our two honest feet, our disparate selves that include both good and evil impulses, too close together to convince ourselves, and others, that we are angels, that is a sheker. We can’t be all good, perfect, uncorruptible.
Which brings us back to the first word, vayifga’. Perhaps Ya’akov did “strike” that place. But what about what the place did to him?
At the end of the parsha, Bereshit 31:10-13, Ya’akov dreams about how his plan of increasing the spotted and speckled livestock (the ones he got Lavan to promise to him as payment of his wages) is facilitated by God causing spotted and speckled males to mate with the females and produce spotted and speckled offspring, not by Ya’akov’s trick of setting up almond branches in the field. An angel of God appears in the dream to point out to Ya’akov that this is God’s doing and tells Ya’akov to leave the land of Lavan and return home.
The Etz Chaim (the 21st century Conservative movement chumash) comments that the timing of the command to return home is not coincidence. God recognizes that this is Ya’akov’s second divine dream, but how different it is from the first! In the first dream, Ya’akov has one of the great spiritual revelations of all time: “God was in this place, and I, I knew it not.” This second dream is quite mundane by comparison, concerning God’s benevolence in helping Ya’akov accumulate wealth. The Etz Chaim observes that perhaps the angel is saying, “Ya’akov, where you used to dream of the very highest things of the universe, now you dream of money and livestock. This land has corrupted you – time to go.” Or as the Torah could have put it, Vayifga hamakom b’Ya’akov. The place had struck – and damaged – Ya’akov.
Ya’akov is vulnerable to this damage because he has two minds, two feet – the two competing impulses that all human beings have. But he is more vulnerable for believing himself to be entirely virtuous, the aggrieved and wounded party who has a right to take back his wages from Lavan, for believing himself to be immune to the deceitful ways that are the norm in Lavan’s place, and for forgetting that he got himself into this mess of being far from home through his own deceit of his brother Esav.
We’re all vulnerable to the same damage when we think ourselves immune to the influences around us. For all we may think social media in general, and Twitter in particular, is a cesspool, how many of us can honestly say we haven’t contributed at least a little to the muck after thinking we would just dip a toe in to see what was going on? The environment it creates can’t help but seep into our behavior when we’re there.
The environment I know best is medicine. When I started medical school, the overt influence of the pharmaceutical industry was at its peak (yes, if you can believe it, where we are now is actually better than the turn of the millennium). High-powered healthcare delivery research was emerging that showed pharma-sponsored lunches, conferences, and swag (like those adorable stuffed zebras promoting the Zithromax “Z-Pak”) clearly changed providers’ prescribing practices, while those same doctors were simultaneously convinced that while “other” doctors were clearly on the take, their own practices hadn’t changed one bit, no ma’am. Even the researchers weren’t immune; many of the cutting-edge studies were being funded by companies who stood to profit mightily from the results if they were good, yet the researchers continued to believe they could clearly deliver unbiased findings without fear of suddenly finding the lights off and the doors locked in their labs.
But it wasn’t just Pharma that threatened to take down physicians who thought they were angels. I wrote a good bit in my book about the hidden curriculum – the subtle messages from administration, senior physicians, nurses and even our immediate superiors who were only a year or two ahead of us in training. These messages taught us things like, “Your primary mission is to discharge everyone,” or “Get out of the hospital before someone asks you to do something else and you never leave.”
They put doctors and patients on opposite sides of what amounted to a war of attrition. They put altruistic, healing-focused physicians and nurses in the service of a profit-driven machine. They asked the staff, from senior medical officers to front-line receptionists to enforce the rules and policies of a system that we are now, belatedly, acknowledging has still got built-in structural remnants of enforced segregation and legal discrimination. Those of us who believed ourselves to be angels, to be uncorruptible, often found ourselves following one of two paths – becoming cynical, jaded and therefore willing participants in the system that had taken away the good leg that helped us stand firm against the pull of the bad one, or by causing us to burn out, either destroying us or rendering us useless.
This week, however, I was reminded that I am blessed to be in a different place, one which does its level best not to wound me or wound the people I care for. My boss, Susan Kalson, CEO of the Squirrel Hill Health Center, came to speak to the undergraduate students I have been teaching all semester about how to resist the hidden curriculum. They had brilliant questions for her: how we educate people to be caring and humble instead of coldly efficient and arrogant; how we balance the financial and meaningful; whether we are part of a Patient Revolution of elegant care and how we overcome stigma. Susan’s response hinged on a word that is ubiquitous in most of the healthcare world: productivity. “We don’t use that word, because patients are not products, they are not widgets coming out of a machine, they are people,” she explained. People, I would add, whom we do not expect to be angels, and with whom we are prepared to admit that we are not perfect either.
What’s more, she continued, we are not in this alone. Our brand of care, which goes under the title of Community Health Centers or Federally Qualified Health Centers, is a movement. A network of 1,400 centers in densely populated urban neighborhoods and remote rural areas, FQHCs began as part of the social medicine movement in the 1950s and 1960s, came to early fruition under the Johnson administration’s War on Poverty, and were firmly established in 1972 as an ongoing part of the healthcare safety net. There is at least one FQHC in 433 of the 435 congressional districts in the US, and apart from a very scary moment in 2017, funding has always been a broadly bipartisan priority. Our center was founded during the W. Bush administration and underwent several major expansions and received critical grant funding under the Obama administration. Not only do we learn and teach that every sick patient is a person first, but we are proof that caring and compassion do not have a political party affiliation.
In short, FQHCs are places that do not wound, but instead exemplify a different meaning of the word vayifga: “to meet with kindness.” Ibn Ezra suggests this when the word appears in Isaiah 64:4, “and You did meet him who rejoices in doing justice and remembers You in your ways, when You were enraged because we had sinned – can we be saved?” There is so much rage, so much distrust, so much cynicism in the world, and in the healthcare industry as we’ve described it – yet when we p-g-a someplace that knows how to treat people with kindness, it restores hope, it encourages us to do more. It doesn’t p-g-a wound us – it heals us, and we can heal others.