BIKUR CHOLIM

The gemara in Sotah 14a tells us that when Hashem came to Avraham in Elonei Mamrei (Bereishit 18:1), He was in fact visiting Avraham, who was recovering from the painful surgery of having had a circumcision at age ninety-nine. The gemara there tells us that just as Hashem visits the sick, so too is it incumbent upon us in our attempts to imitate God to visit the sick as well.

The gemara in Nedarim 39b-40a delves deeper into the idea of visiting the sick. The gemara there cites a baraita that says that there is no measure to bikur cholim, which is explained by Rava as meaning that a person can fulfill this commandment countless times during the day (we should note that although bikur cholim is listed among the things that a person does for which he reaps some reward in this world and the full reward in the world-to-come, it does not appear in the actual list of those things in the gemara in Shabbat 127; rather, various siddurim have created a composite list based on that gemara and various lines in the gemara elsewhere). The gemara continues and notes the efficacy of this commandment, namely that one who visits a sick person removes one-sixtieth of that person's illness. If that is the case, then why not visit a person sixty times and heal them? To this the gemara replies that each visit removes one-sixtieth of what remains. That being the case, the gemara goes on to stress the importance of one who visits the sick to pray for the health of the patient.

There is another factor to this mitzva that is also included in the gemara in Nedarim. A student of Rabi Akiva fell ill, and none of the other students went to visit him. Thus, Rabi Akiva himself went to visit the student, and cleaned up his room and tended to his needs. The student told Rabi Akiva that he had given him strength (literally, "caused me to live"), after which Rabi Akiva taught that anyone who fails to visit the sick causes him to die. Rav Dimi offers a similar statement, and the gemara explains that a person who fails to visit the sick also fails to ask for mercy on his behalf and thus by not aiding in his recovery allows him to plunge further towards death. Ran proves the efficacy of prayer from a fascinating case in Ketubot where the maidservant of Rabi Yehuda HaNasi prayed for his death after his illness had become so horrible as to render him in a constant state of pain. Since her prayer worked, Ran claims that certainly prayers for life should find some favor in the heavenly spheres.

Rambam (Hilchot Avel 14:4-6) lays out the basic procedural obligations of this commandment (most of what Rambam codifies is codified as well by the Tur and Shulchan Aruch Y.D. 335). He notes that it is something that is incumbent on everyone to do, even a great person visiting a person of lesser stature. As per the view of Rava, a person may make multiple visits to one who is sick, so long as the visits due not become burdensome to the patient. This detail highlights the guiding principle behind this law it is a law about respect for others. That being the case, Rambam also codifies the fact that one may not visit a person who has an intestinal disease or severe headaches. As various commentaries on both Rambam and the Shulchan Aruch note, intestinal diseases can be embarrassing, and a person would not want others to see him in such a state. With regard to severe headaches, they note that people in such states prefer silence so as not to aggravate their condition, and thus the talking of a visitor would prove to be more detrimental than beneficial to one who has such a condition.

Rambam also notes that there are good times and bad times to visit one who has fallen ill. A person should not pay a visit to one who is sick during the first three or the last three hours of the day. He claims that it is because those are the times when people are tending to the patient, although the gemara and others note that during the first three hours of the day people tend to be feeling better, and thus a visitor will not feel compelled to pray for them. In a similar yet opposite vein, people tend to feel worse near the end of the day, and thus a visitor might perceive that prayers will not help them at all and thus refrain from doing so. Rambam also writes that no one should visit one who has taken ill until the third day of their sickness unless they are severely ill. The Kesef Mishna notes that Rambam is ignoring the Yerushalmi in Pe'ah 3 which notes that friends and relative may visit immediately, and others must wait until day three. Bach explains that by visiting a person right away, he is designated as "a sick person" and thus his luck is against him. However, one who is very ill is already considered to be in that category and visiting him can only help.

We are told that when Yoseif came to visit his father Yaakov before his death, Yaakov straightened himself up on his bed. Chazal there comment that he sat up because the divine presence rests over the head of the sick. With this in mind, the gemara states that one who visits the sick should not sit on a couch or a chair, since he should not be higher than the divine presence. However, Tosafot notes that this is only when the sick person is lying on the floor (as was apparently the practice), and thus if the sick person is on a bed there is no issue. The Beit Hillel 9a (a commentary to the Shulchan Aruch) cites the Zohar that says that regardless of the elevation of the patient, a person should not sit parallel to the head of the sick individual because the divine presence is there, and should not sit parallel to his feet because the angel of death is there.

What should one do when visiting one who is ill? The Poskim more or less uniformly suggest speaking to the patient about his daily affairs, trying to keep his mind away from more morbid thoughts. This notion is probably best exemplified by the law that rules that if a person who is sick loses a relative we do not inform them of the loss until they themselves are healed, lest the distress of the situation cause them to take a turn for the worse (and thus the non-uncommon phenomenon of two married elderly people dying in close proximity to one another). Once again, the purpose of the visit is to raise the person's spirits and thus hopefully help to make them better, a cause-effect relationship that is borne out to some degree by modern psychology.

The Darchei Moshe raises an interesting issue. He cites a responsum of Maharil who rules that one may visit his enemy if he falls ill. The Darchei Moshe opposes this view, based on the fact that the gemara in Sanhedrin 19a says that one may not comfort his enemy for the loss of a relative. The Shach takes a more moderate approach, saying that it all depends on the people and the nature of the antagonism. It would seem that while part of this commandment is to foster good relations among people, there is a time when one has to realize that his best intentions can backfire. As the mishna in Avot 4:18 tells us, one should not try to appease his friend while he (the friend) is still angry. As important as bikur cholim is, the Darchei Moshe and the Shach, to different degrees, warn against performing it when it is doomed to failure.

Finally, we mention a more modern issue. Can a person fulfill this mitzva via telephone. Both Rav Moshe Feinstein (Igrot Moshe Y.D. 1:223) and Rav Ovadiah Yoseif (Yechaveh Da'at 3:83) deal with question, and both conclude that a telephone only suffices in cases when a person will be otherwise unable to visit the patient. However, if a person has the chance to pay a live visit, they may not discharge they obligation via the best that modern technology has to offer, since visiting allows one to help the patient in any way necessary. Furthermore, the Tur and Shulchan Aruch note that when one visits a sick person they may pray for them in any language, since the divine presence is there, which understand all languages (as opposed to angels who otherwise will receive prayers and only understand Hebrew according to the Tur). This being the case, by appearing in person a visitor has the chance to maximize their prayers, something that cannot be done over the telephone. Rav Feinstein also notes that even though we usually rule that a person can have a messenger fulfill a commandment for him, such a principle does not apply here and the one who sent the messenger would have to appear in person in order to receive credit for fulfilling this commandment.


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