A Refresher Course on Bikkur Cholim

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Family being satisfied with the medical attendance.

(This is the fifth and final installment in the series of articles on things I learned from my recent back surgery.)

After my procedure, I was in the hospital for three days. While I was there, I didn’t entertain much. The first day was the day of the operation itself, so I spent the entire afternoon in recovery, flat on my back as I described in a previous article. The second day, I slept about 30 minutes of every hour. My wife said that some friends asked about visiting but that I said I wasn’t up to receiving. I have no recollection of this incident but it makes sense given how groggy I was. The third day was Friday so (a) I was hoping to be released (which finally happened) and (b) there’s Shabbos for which to prepare.

Once I was released, I recuperated at home for two weeks. For the first several days, I couldn’t stand unaided, so I spent my days (and nights) in an easy chair. I walked with the assistance of a walker for a week before I could transition back to my cane. My time was occupied with working remotely on my laptop, with occasional breaks for visiting nurses and in-home PT. A few friends texted to see how I was doing but I wasn’t expecting anyone so it didn’t strike me as strange not to receive visitors.

And then, two neighbors from my shul came for a visit and the lightbulb went off over my head: “Oh, yeah! I’m a choleh (sick person) and bikkur cholim (visiting the sick) is a mitzvah!” It seems that we may be so far removed from being invested in this mitzvah that, not only did most people not perform it, I wasn’t expecting anyone and was surprised when someone actually showed up!

It’s odd that most of us don’t think about bikkur cholim because, as a rule, we’re generally pretty good at being menachem aveil (comforting mourners by making a shiva call). These two mitzvos are not only very similar thematically, they are performed virtually identically, i.e., by paying a visit. Not only that, there’s far more Biblical precedent for bikkur cholim than there is for nichum aveilim:

There’s much less nichum aveilim in Tanach. David sent a contingent to visit the bereaved king of Ammon in II Kings 10 (it didn’t go well). As far as the visit of Job’s three friends, that is used as the paradigm for nichum aveilim but remember that Job wasn’t only in mourning, he was also afflicted bodily, so it was bikkur cholim as well.

I think the difference between the two mitzvos is that the parameters for nichum aveilim are clearly delineated: e.g., “the family will be sitting from 7:30 AM until 9:00 PM at 123 Fake Street until Thursday morning.” When it comes to bikkur cholim, we don’t have the clearly-defined times and ticking clock to motivate us. We may also be concerned that patients recuperating at home may be otherwise occupied and our visits may pose an intrusion. This is something that doesn’t concern us too much when it comes to visiting people in the hospital or making a shiva call, where our expectation is that the patient or the mourner has nothing better to do and will surely welcome a visit.

A friend of mine was melamed z’chus that nowadays we practice bikkur cholim by visiting patients in the hospital rather than at home. (To be melamed z’chus means to find a reason to justify what appears to be wrong behavior.) That may reflect the reality of what most of us do but differentiating between patients in the hospital and those at home is an artificial distinction. Hospitalization as we practice it today is a modern phenomenon that started in the late 19th century thanks to such medical advancements as anesthesia, more sterile environments, and advanced diagnostic techniques like X-rays. Before that, it was safer for all but the most critical patients to try their luck at home. In halacha, hospitalization is not a defining criterion for performing the mitzvah of bikkur cholim.

And so, without further ado, I would like to offer a refresher course on the mitzvah of bikkur cholim. The following is adapted from the Chofetz Chaim’s classic work Ahavas Chesed:

Bikkur cholim is a form of chesed (kindness) for which one is paid interest in this world, while the principle is held for him in the Next World (Shabbos 127a). The Sages (Sotah 14a) are emphatic that we should perform this mitzvah as an aspect of emulating God (Deut. 13:5). Just as God visited the recuperating Avraham (Genesis 18:1), so should we visit the sick.

The mitzvah of visiting the sick has no fixed parameters; even important people are to visit their subordinates. This mitzvah should be performed even several times a day, unless doing so is a burden on the patient (Yoreh Deah 335). In the case of a regular illness, family members and close friends should visit as soon as a person takes ill, while others should wait until the third day; in the event of a serious illness, one need not wait. The Shulchan Aruch says that we should not visit those suffering from intestinal distress (which could cause the patient embarrassment), nor those with eye or head ailments (since talking will cause them pain). In such cases, the visitor should stay in the hall and inquire as to whether the patient requires anything that he might be able to provide. In this way, he will still see the patient and be motivated to pray that God alleviate his suffering. Asking that God help the patient is an inherent part of bikkur cholim; if one neglects to do so, he has not fulfilled the mitzvah.

When one prays for the patient, he should include all the ill of Israel in his prayer, similar to the way we include all the bereaved of Israel when comforting a mourner. The formula is “HaMakom yeracheim alecha b’soch shaar cholei Yisroel” (May the Omnipresent have mercy on you, among all the sick of Israel). On Shabbos we say, “Shabbos hi m’lizok u’refuah kerova lavo” (It is forbidden to cry out on Shabbos but healing will come soon). On yom tov, one uses the same formula as on Shabbos, substituting “yom tov” for “Shabbos.”

The Gemara in Nedarim (40a) says that the mitzvah of bikkur cholim saves a person from the punishments of Gehinnom. (This conclusion is reached by expounding on a verse from Tehillim; see there for details.) Conversely, failure to perform this mitzvah is a grave transgression and one who neglects it is compared to a murderer. One of Rabbi Akiva’s students got sick and no one came to visit him. Rabbi Akiva visited the patient and, while he was there, he instructed his other students to clean up the room. When the patient recovered, he told Rabbi Akiva that the teacher had literally saved his life.

This does not reflect a full overview of the laws of bikkur cholim, nor is that all that the Chofetz Chaim has to say on the subject. Notably, he laments the laxity of his generation in performing this mitzvah, an oversight for which he can see no justification. (Ahavas Chesed was published in 1888, so that’s 130 years ago as of this writing!) Among other criticisms for neglecting bikkur cholim, he cites Leviticus 19:16, the prohibition against standing idly by while another person is in danger. If this was the case in the Chofetz Chaim’s day, I can’t imagine our generation is much better!

For all its Biblical and Talmudic precedent, we seem to have lost sight of this mitzvah. As noted, the Chofetz Chaim was already at a loss to explain the general indifference towards this mitzvah over a century ago, so I’m not even going to try. All I can say is, now that I’m aware of a general shortcoming in this area, I’m going to review the halachos of bikkur cholim and resolve, bli neder, to try to do better. Whoever feels likewise is invited to join me in this endeavor.

Rabbi Jack Abramowitz is Torah Content Editor at the Orthodox Union. He is the author of six books, including The Tzniyus Book and The Taryag Companion. His latest work, The God Book, is available from OU Press as well as on Amazon.

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.