​My daughter’s battle with leukemia taught me how to find consolation even in the midst of terrible pain.

In the midst of teaching a series of classes in San Francisco on the topic of suffering, my wife and I received the diagnosis that our daughter Rivka had leukemia — a cancer of the blood system. This began a very long process of dealing with our daughter’s illness, beginning when she was two years old and continuing until she passed away at the age of fourteen.

Within the first week of diagnosis we were given a very optimistic prognosis: 85-90% likelihood for a complete recovery. She would need to receive 26 months of chemotherapy, mostly on an outpatient basis. After that, varying degrees of follow-up check-ups would be gradually reduced to only once a year. Initially, everything seemed to go according to plan. Following these initial two years of treatment, we were very hopeful that as the years went on, our daughter’s leukemia would eventually become a thing of the past. She remained in remission and off treatment for seven additional years, during which time we returned to live in Israel.

Unfortunately, the nightmare, which every parent of a cancer survivor fears, occurred right after the holiday of Shavuot, in May, 1999. Her leukemia, which had somehow remained dormant and undetected for almost 10 years, came back into all of our lives. Rivka was then 11 years old. The doctors told us that this was almost unheard of, less than a 1% likelihood. 

Our daughter’s prognosis for a complete recovery was now significantly worse, and we were advised to attempt the risky procedure of a bone marrow transplant. This involves significantly higher doses of chemotherapy, along with intensive radiation over the entire body, in order to completely obliterate the patient’s immune system. The hope was that this would also eliminate the leukemia in Rivka’s blood system.

Fortunately, Rivka’s baby brother, Yehudah, not quite two years old at the time, was a complete bone marrow match.

She received the bone marrow transplant from her brother just before Rosh Hashanah, in Sept, 1999. It was a tremendously difficult process, involving a complete quarantine for over two months until her immune system was able to rebuild itself. Rivka successfully accepted the transplant and was able to leave the hospital after three months, just a few weeks before her bat mitzvah. Ten months after receiving the bone marrow transplant, however, Rivka suffered a second relapse. At that point, her odds of recovery, according to standard medicine, became dramatically lower. We had already tried everything conventional — chemotherapy for over two years, intensive radiation, plus transplanting an entirely new immune system into her body. That was when we were advised to add “Ruchama,” which means “compassion,” to her name as a type of plea to G-d that she should merit receiving extra compassion. This is customarily done only in cases of very serious illness.

The doctors attempted a number of different experimental approaches, involving a remarkable total of three additional bone marrow transplants, over the following two years. The first two transplants, which came from her brother, lasted six months each before she relapsed yet again. The final one, which she received from an unrelated donor in England, only lasted a couple of months. In the end, it was the complications from this transplant that caused her to pass away, early Shabbat morning, the 19th of Tammuz (June 29th, 2002).

I want to share some of the lessons that my wife and I found particularly meaningful and comforting throughout this exceedingly difficult process, in the hope that they will be able to help others who may be facing challenges in their lives. Whatever good can come from our tragic situation should be a great merit for Ruchama Rivka, a”h (may peace be upon her).

“Comforting” vs. “Comfortable”

One of the most well known books on suffering is When Bad things Happen to Good People, written by a conservative rabbi named Harold Kushner. In his introduction, he explains that he wrote the book in response to a terrible family tragedy — his son had been born with a rapid aging disease, and had died at the age of fourteen.

In order to reconcile a loving G-d with the existence of suffering, he presents a view of G-d that is antithetical to the traditional Torah understanding of a powerful and benevolent Creator Who personally supervises the events in all of our lives. He describes a G-d completely removed from the world, incapable of either intervention or supervision. His answer to the classical question — “Why bad things happen to good people” — is that G-d did not cause the difficulties to occur, nor could He have even prevented them from happening. As he wrote, “Fate, not G-d, sends us the problem… Life is not fair. The wrong people get sick and the wrong people get robbed and the wrong people get killed in wars and in accidents.”

Curiously, various reviewers of the book describe it as a source of comfort — “An unprecedented source of comfort and reassurance,” “Comforting answers,” “Will comfort and enlighten.”

How could one find comfort within Kushner’s chaotic universe which is necessarily devoid of reason, purpose, and meaning? What could be more bleak and depressing?

Perhaps the answer comes from misunderstanding two fundamentally different concepts — “comforting” and “comfortable.”

According to the traditional Torah perspective, G-d created the universe exclusively for our benefit and our pleasure. And not only did He create it that way; He continues to sustain and supervise everything for our ultimate good. While this view of the world is very comforting — because whatever happens fits into some greater, purposeful reality — it can also be quite uncomfortable since it involves clear obligations, responsibilities, and consequences.

The perspective which Kushner presented in his book, on the other hand, in which nothing and no one is supervising the events of the world, may feel quite comfortable due to its lack of obligations and consequences. However, it ultimately offers no possibility for true comfort because there is no meaning, and no greater reality for all the events of our lives to fit into.

Victor Frankel, a prominent psychiatrist and Holocaust survivor, who developed a treatment methodology from his experiences in the concentration camps, explains in his classic work, Man’s Search for Meaning, that we can deal with anything in our lives as long as it contains meaning. Without meaning, however, even the most trivial events can be devastating.

He writes:

“…any attempt to restore a man’s inner strength in the camp had first to succeed in showing him some future goal. Nietzsche’s words, “He who has a why to live for can bear with almost any how,” could be the guiding motto for all…efforts regarding prisoners. Whenever there was an opportunity for it, one had to give them a why — an aim — for their lives, in order to strengthen them to bear the terrible how of their existence. Woe to him who saw no more sense in his life, no aim, no purpose, and therefore no point in carrying on. He was soon lost.”

Meaning from Suffering

The Talmud gives us direction on how to derive meaning from suffering.

Rava said: If a man sees that afflictions are coming upon him, he should examine his deeds, as it says, “Let us search and examine our ways, and return to G-d” (Eichah 3:40). Talmud Brachot 5a

The basis of this introspection must be our realization that a complete and perfect G-d is only interested in our good. The Hebrew word “onish,” which is usually translated as “punishment,” is more accurately understood as a combination of both consequences and therapy. Taking G-d seriously means taking the time to think what areas in our life require fixing or elevation. As unpleasant and uncomfortable as this attempt at introspection and improvement may be, it does, however, mean that we are relating to whatever occurred to us in a meaningful manner.

It is ultimately the individual’s response to his personal suffering that determines the meaning of his difficult circumstances, and whether its impact will be positive or negative.

The reality of an All-Powerful, All-Caring G-d is accepted much more widely than we might imagine. One of the clearest indications of this is the very question, “Why do bad things happen to good people?” This question is based on the expectation of fairness and justice that seems to have been violated in this case. We very strongly expect that bad things should not happen to good people. This expectation of fairness and justice, of course, only makes sense within a world that is supervised by an All-Powerful and All-Caring G-d.

However, since this reality of G-d can feel so uncomfortable, many of us have a strong resistance to incorporating its awareness into our daily lives. Quite often, G-d’s reality seeps into our consciousness only when we are confronted with tragedy or fear. Thus “there are no atheists in foxholes.” When we feel that we are surrounded by the proverbial “foxhole,” with the mortar shells falling down all around us, we are sometimes willing to — at least temporarily — give up our so-called “atheism.”

Accepting Tragedy with Simcha?

There seem to be two contradictory aspects to how Judaism wants us to relate to difficulties that occur in this world. On the one hand, the mourners at the funeral of a close relative must express what they see as bad with a blessing of acknowledgment and acceptance — “Baruch dayan ha’emet” — “Blessed is the true Judge.” On the other hand, this blessing is supposed to be said with “simcha,” generally translated as “joy.”

How do we reconcile these two different aspects?

I realized, while making this blessing on the day of Ruchama Rivka’s funeral, that there are two distinct aspects to every tragedy which occurs. First, there is the intense pain of the loss. Beyond this, is the possibility of nechama, comfort.

The pain of loss is obvious. Losing a child is like having a limb amputated. The pain of loss will always exist, and will never be washed away with time. However, time does help us adjust to living with this new reality of the “missing limb.”

Then there is nechama — true comfort — that comes from the realization that everything that happens in this world serves some ultimate purpose. This nechamah, however, does not require understanding the real nature of this metaphysical reality beyond our world. In the future, when all of the difficulties and pain in our present-day world will finally come to an end, we’ll be able to look back and understand why everything that occurred to us needed to happen. Although we may presently lack this full understanding of their necessity, there is a tremendous comfort and consolation right now in simply knowing that they do all fit in to some bigger picture, and therefore the suffering and the pain is not for nothing.

“There is no deed, great or small, whose ultimate end is not the universal perfection, as stated by our sages [Brachot 60b]: ‘All that is done by Heaven is for the good.’ For in the time to come, the Holy One, Blessed be He, will make known His ways…showing how even the chastisements and tribulations were precursors of good, and actual preparation for blessing. For the Holy One, blessed be He, desires only the perfection of His creation.” (Da’at Tevunos, Rabbi Moshe Chaim Luzzatto)

Our family experienced a dramatic example of awareness of purpose, helping to make even severe pain manageable. The main experimental treatment methodology for Ruchama Rivka, once all the conventional approaches had failed, required the creation of a very debilitating condition within her immunological system. However, since she understood that this was her best chance for a cure, she actually welcomed this exceptionally painful process. If you know the suffering is for a purpose, if you know there’s some bigger reality, then even severe pain can be somewhat manageable.

As the Chazon Ish, one of the greatest Jewish leaders of the previous generation, expressed this regarding the Holocaust: “For the believer there are no questions; for one who is not, there are no answers.”

While this approach certainly does not eliminate the pain, it can help us to achieve a degree of consolation, knowing it is all ultimately for the good.

This can help us to understand the requirement to say the blessing of “Blessed is the true Judge” with “simcha” — usually translated as “joy.” Rashi, in his commentary on the Talmud, explains that this means we need to strive “to make a blessing on the difficult situations with a complete heart.” “Simcha,” in this context, refers to being at peace, with no complaints. Specifically through the awareness that the terrible tragedies of this world fit into the overall picture of a much larger reality, even if beyond our present-day understanding, it becomes possible to accept them.

In a manner which is impossible for me to articulate, as I actually made the blessing of “Baruch dayan ha’emet” — “Blessed is the true Judge” at the funeral, I did feel the intensity of the pain actually mixed with an awareness of an inner feeling of peace.

Loss of Potential

Besides the unavoidable pain of loss, there is also the feeling of how much more a person could have done with their life – especially one that passed away so tragically young. This second pain, however, is clearly based on assumptions that are impossible for us to ever know. For Ruchama Rivka, it was specifically through difficulties that her life had, perhaps, its greatest meaning. Via e-mail and the internet, as well as simply word-of-mouth, her story and her battle for life managed to touch literally thousands of people all around the world. Along with widespread prayers on her behalf, numerous spiritual efforts were initiated and dedicated to her recovery. Her numerous challenges, particularly during these last three years, elevated all those around her to a much deeper appreciation of reality.

Through their identification with the “foxhole of difficulties” surrounding her, they felt compelled to acquire this deeper awareness of reality in their own lives as well. Using this as an example, the absurdity of even attempting to evaluate anyone’s loss of potential accomplishment serves as a strong nechama for this second category of pain.

It is important not to confuse our pain from the loss with the thought that we have a legitimate complaint against G-d. Our numerous expectations in life cause us both to devalue the blessings that we have, as well as to complain when those expectations are not met. From Ruchama Rivka’s “perspective” in her present reality of complete truth and clarity, there are certainly no complaints. She had begun her life with an enormous task ahead of her, to lift and inspire many individuals through the very great difficulties that she would face throughout her life. And she fulfilled her role more completely than most people do in their entire lifetime.

She is now able to appreciate not only every one of her own accomplishments, but also every one of the accomplishments that she inspired in others. This explains why the focus of the mourning process is specifically to comfort the mourners who are left in this present “world of darkness,” and not for the deceased who is now in the “world of light.” As one of my wife’s teachers told her at the very end of our shivah (seven day period of mourning), according to Jewish tradition, after the soul leaves this world, it begs for the family to be comforted.

While Ruchama Rivka was still battling her leukemia, I felt strongly that if somehow it would be possible for her to fully recover, we would probably end up looking back on this entire challenge, with all of its incredible lessons and realizations, as the best thing that had ever happened to our family. At this point, I can merely say that I would certainly never trade the realizations and achievements that we acquired throughout this overwhelmingly difficult period of time for anything else.

There’s a well-known expression: “All prayers are answered. Sometimes, however, the answer is, ‘No.’” While this is certainly true, it is also somewhat limited. The answer “No” is only true in terms of a prayer’s physical impact on this world. In terms of spiritual impact, however, all prayers are answered, and the answer is always “Yes.” There’s never such a thing as a prayer or a mitzvah that is offered in vain. While our prayers will not always accomplish what we hope they will in this world, every single effort ultimately makes an eternal difference, both in this world as well as in the world to come.

One of my relatives told me that upon hearing that Ruchama Rivka had passed away, her daughter had said in astonishment, “But I prayed for her so strongly!”

I told the mother to assure her daughter that while her prayers did not accomplish what she had hoped for; even so, by praying so strongly, she ultimately gave Ruchama Rivka the best possible present she ever could have. And Ruchama Rivka, may peace be upon her, is fully enjoying that present right now. 

This should be l’zechut ul’illuy nishmat Ruchama Rivka, a”h, bat Asher Zevulun