The 1,500-pound gorilla in the room

“Am I going to die?” a congregant in her late 40s, married and with a young daughter, asked me. We were in the oncology ward of a local hospital, and, according to her husband, the prognosis was bleak. She was acknowledging the 1,500-pound gorilla in the middle of her room.

What’s a 1,500-pound gorilla, you ask? It’s a health issue, usually an issue of life and death that you don’t want to deal with, even though you know it’s real. It could be someone you love who has been diagnosed with a terminal illness. It could be someone you love who is young and being kept alive by artificial means, even though there is little or no hope of recovery, and the patient’s organs could save lives.

I remember when my dad was diagnosed with lymphoma.

It was 1967, I was all of 20 years old, and the doctor told my father to get his affairs in order because he had six months to a year to live.

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My father looked at the doctor and said, “When you become God, you can make that statement, but until then, treat what I’ve got or find me a doctor that knows what he’s doing.”

He ended by throwing that doctor out of his room and found a wonderful oncologist connected with Memorial Sloan Kettering.

The long and the short of it is that my dad, A”H, died in 1994, 27 years after his diagnosis.

Back to my congregant. I struggled with my answer — what do I say to her?

My response is irrelevant now because she died two days later, but I still struggle with how to deal with that 1,500-pound gorilla that I see all the time, and even though families see that gorilla as well, many just walk around it or through it as if it didn’t exist.

There are myriad stories of the 1,500-pound gorilla being ignored that ended miraculously. Sadly, this story isn’t among them.

It was June 4, 2024, my first day at Overlook Medical Center in Summit. We had a Jewish patient in the ICU; I’m going to call her Malkeh.

I walked into her room.

She’d had a tracheostomy — a tube was placed in her neck so she could breathe through it, instead of through her nose or mouth — and was hooked up to more machines than I’d ever seen. A friend of hers was sitting at her bedside, with tears streaming down her face.

Malkeh was about 30 years old, and the friend told me that the family was in the ICU waiting room next door, so after saying a few prayers at her bedside, I went to meet them.

There must have been 20 people sitting there. I introduced myself and asked who was there for her. It seemed like all of them; her parents, her husband, her brother, her in-laws, and many friends. They all were there praying for her and just being there for her and for her family.

They told me Malkeh had taken the dog for a walk and suffered a heart attack. No one had any idea how long she had been deprived of oxygen. Tests didn’t reveal much either.

I visit all our Jewish patients, spending various amounts of time with each, but I made sure that I made a Mi Shebeirach, recited the priestly blessing, and repeated the words Moses used to ask God to heal his sister, Miriam, El na refah na la, at Malkeh’s bedside, and then I spent a lot of time with the family.

She was transferred from the ICU to a private room and was weaned off the breathing tube. Even though she showed little or no reaction to most stimuli, I kept praying for her and with the family.

Do you think that God hears all prayers? her mom asked.

I smiled. You’re not going to like the first word of my answer, I said, but if there is a God, and if God is omnipotent, omniscient and omnipresent, then yes, God hears every prayer. (Sadly, I said, sometimes God’s answer is no.)

If, on the other hand, there is no God, my prayers are sending good energy out into the universe; that, in and of itself, is a huge win.

Her mother jumped up and gave me a big hug. You’re my rabbi for life, she said.

It was mid-September, three and a half months after Malkeh was admitted to the hospital. She wasn’t showing much improvement, and I was alone with her in-laws.

She’s young, and with the exception of her heart, all her other organs were functioning. So I asked the family if it was considering the alternative to Malkeh remaining there. I was talking about the 1,500-pound gorilla in the room. Organ donation.

We are, they said, but her parents and her husband believe that miracles take time, and because of her age, and because she had been so healthy, they felt that she could pull out of it.

Since our hospital didn’t have the equipment to try to bring her to another level, her mother and her husband researched various programs from Boston to Texas and ended up moving her to a hospital in Central Jersey.

I texted her mother every couple of weeks. There still wasn’t much improvement, and although I felt that I should drive down and discuss that gorilla with her face to face, I couldn’t and didn’t.

On Tuesday, February 12, I was officiating at the funeral of a congregant’s father when I got a text from Malkeh’s mom.

“We saw you at Beth El cemetery today, and we realized that nothing is coincidence,” she wrote. “You were always so warm, and gentle, you made us feel so safe and your prayers were so comforting, you will always be part of our family.”

I didn’t have to ask why they would be in the chapel at Beth El. I knew the answer.

Tears streamed down my cheeks when her mother told me that Malkeh had an MRI the week before and the doctors said that she would never speak, walk, or see again. I knew that the 1,500-pound gorilla that we never spoke about had come to life in that moment.

I went to her memorial service and was greeted by many non-family members who had visited her and her family in the hospital. “Wow, rabbi, you were wonderful to the family in the hospital, and it’s so nice of you to come today.”

I’d never seen her out of bed, but the rooms at the memorial were filled with pictures of Malkeh. There were hundreds of pictures. Every one of them showed that Malkeh was all about life, all about joy, all about family and friends, and I realized that her immediate family would never even consider that there was a 1,500-pound gorilla anywhere near her room.

Malkeh’s mother saw me and came running over. We hugged and hugged some more; her husband saw me and did the same.

I’ve worked with sick and dying people for decades, and I am honest (even if my honesty is done softly), but in this case I felt that her family would always choose life, and always choose hope, so addressing that gorilla had no point.

There comes a moment when each and every one of us will have that gorilla in the middle of the room for somebody that we love.

I pray that we can deal with it with grace, compassion, and the understanding that all the choices we make in life involve obstacles.

Cantor/Rabbi Lenny Mandel, who left the wilds of Manhattan almost 50 years ago and lives in West Orange, has been the chazan at Congregation B’nai Israel in Emerson for the past quarter century.