Parsha Toldot

“Isaac was old and his eyes were dim” (Genesis 27:1).

What’s wrong with Isaac? Even our best doctors would have difficulty answering the question. This biblical verse lacks a description of symptoms that would help us make a reasonable diagnosis. Does Isaac have a vision problem, or is Isaac, perhaps due to his advanced age, afflicted with a more serious condition? If only Isaac’s medical records accompanied the biblical text, then we would know with some degree of certainty the nature of Isaac’s illness.

For the purpose of this commentary, let us assume that Isaac develops dementia as he grows older. If Isaac’s memory had not diminished, he would have recalled the prophecy reportedly given to Rivkah during pregnancy. At the beginning of Toldot, Rivkah asks God for the meaning of her discomfort. God’s oracle declares that Rivkah will bear twins and that in time the older child (Esau) will serve the younger child (Jacob). If Isaac had not become cognitively impaired, he would have remembered that his blessing should be directed toward the younger son, Jacob.

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Isaac must have observed the behavior of his two sons. He would have seen that Esau repeatedly showed disregard for his birthright. He even sold it to Jacob when he was thirsty. Rabbi Shmuel Goldin, in his insightful book “Unlocking the Torah Text,” wonders, “How could Isaac have been so unaware as to believe that Esau, not Yaakov, should be heir to the spiritual legacy of the family?” Isaac’s desire to bless Esau demonstrated that the patriarch’s judgment was severely impaired. This interpretation was reinforced by the realization that Rivkah assumed the role of Isaac’s guardian.

Rivkah took responsibility to ensure that Jacob received the proper blessing from his father. We all know the story. In preparation for giving his blessing to Esau, Isaac asked Esau to hunt for game and to prepare a meal for him. Rivkah overheard Isaac’s conversation with Esau, and Rivkah cooked a meal just as Isaac liked it. Also, she instructed Jacob how to disguise himself so Isaac would think that he was Esau. Rivkah told Jacob to cover his arms with an animal skin because Esau’s arms were hairy and not smooth like Jacob’s. Even though Isaac was suspicious, noting that “the voice is the voice of Jacob but the hands are the hands of Esau” (Genesis 27:22), Rivkah’s deception was successful; Jacob received the blessing that Isaac meant for the elder brother.

I have met several Rivkahs and Isaacs while serving as a social worker on an extended care unit at Bergen Regional Medical Center in Paramus. The cognitive functioning of some of these “Isaacs” is so impaired that a guardian must assume responsibility for the patient’s decision-making. Sometimes a guardian is a relative like Rivkah; at other times, the Superior Court in Hackensack appoints a third party, sometimes a lawyer, or often a social worker from the Office of Public Guardians.

These patients and their guardians deserve our compassion and our support for they tread on turf that none of us wishes to walk. When the guardian or caregiver is a spouse, like our matriarch Rivkah, both are able to at least share their burden with a love strengthened by years of marriage. These patients and guardians both benefit if family and friends support them in their time of need. If ignored by relatives and community, the guardian’s loneliness may be more severe than that of the patient. Of course, when a patient with dementia outlives his/her relatives, the patient’s isolation is very sad to behold.

Many of us distance ourselves from these Isaacs and Rivkahs. Seeing them arouses within us fears that dementia might afflict us, or that we might be forced to assume the role of a guardian. Perhaps we fear dementia because we so cherish our cognitive abilities and our memories. Our tradition urges us to pray six days a week, “You grace humans with knowledge and teach mortals understanding. Blessed are You who graces us with knowledge.” As much as we honor a life with full cognition and memory, we should not diminish – through denial or fear – the value of life when cognitive impairment increases with age.

A few weeks ago, I shared an elevator ride to a long-term care unit at Bergen Regional Medical Center with a woman whose mother was afflicted with dementia. She told me how depressing it was to visit her mother and the other patients on her mother’s unit. She was burdened with guilt. She loved her mother and wanted her to live but at the same time she was haunted with the thought that life with dementia was perhaps not worthy of being called life. She was embarrassed by her ambivalence. I suggested to her, “Of course, you have mixed feelings. You cannot be upbeat when you witness your mother losing her sense of self…. Perhaps you will find it comforting to know that our religious traditions teach that each breath of life is special and even holy. Your mother may be losing her memory but her life remains as holy as yours or mine…. Thank you for coming so often to visit your mother; your visits honor your mother and your love for each other.” She smiled for the first time, and she thanked me for sharing the elevator ride with her.

Our society, like this conflicted daughter, views aging with ambivalence. When the elderly are healthy, being alive is a blessing. When the elderly are infirm, the value of being alive appears diminished. In contrast to this somewhat callous perspective, Judaism teaches us to view each breath of life as reminiscent of the breath that God blew into Adam’s nostrils at the moment of creation.

Rabbi David Feldman considers the relative or absolute value of life in his thoughtful book “Where There’s Life, There’s Life!” He asserts unequivocally, “regardless of medical ‘futility,’ life is precious because every moment of life has infinite value and intrinsic sanctity.”

Rabbi Feldman infers that the inability of our culture to honor with equanimity all life diminishes the self-respect of many elderly patients. If life is truly sacred, then the aged with dementia must be encouraged not to view their continued life as a burden upon their family or society. Conversely, we must challenge our society’s propensity to diminish by attitude, word, or deed the value of life when dementia afflicts an elderly patient.

Dementia creates complex family and community dynamics. Patients with dementia often deny their cognitive impairment even when it is obvious to relatives and caregivers. Afflicted with brain damage, these patients often forget many personal experiences that would lead them, if they could only remember them, to accept the limitations of their disease. At times they express anger at their caregivers and at times, they act inappropriately. If left alone, their ability to care for themselves could be compromised. The guardians of these patients, may God bless them, are forced to accept responsibilities for which they may be unprepared. They need our support, not our disregard. In this context, Rivkah acted with courage and loving determination as she guided Isaac’s blessing of Jacob even though it was against Isaac’s will.

Our society must constructively deal with the consequences of dementia without diminishing the dignity of its victims and their guardians. Our society should be encouraged to push aside its own denial of dementia and its societal implications, to alter family and cultural priorities so the aged with dementia are cared for in an honored manner, and to create healthy and supportive environments that nurture the lives of patients in need of much companionship and compassion.

If life with dementia were honored for life’s own sake, our culture would be more worthy of God’s blessing.