Sunday, February 24, 2008

The Forest and the Trees - Table Talk for Vayakhel 5768

In my various visitations to areas hospitals to see shul members, I have often found a recurring frustration. In today's fractionated medical world, many patients find themselves under the care of numerous doctors for different specialties; they might have a cardiologist, endocrinologist, rheumatologist and internist all visiting them during their hospital stay. Each one makes recommendations, and each one might prescribe tests and medication, but these recommendations often treat one symptom while complicating others. You cannot treat the kidneys without affecting heart function. The kidneys don't live alone; they share the body with the heart, and while alleviating one symptom, a doctor can actually make another different problem worse. In modern vernacular we call this an inability to "see the forest for the trees."
Most important then, especially for older patients, is a comprehensive care specialist who can bring together the various doctors to decide the best course of action for the total patient, instead of treating each specialty individually. I have found it a matter of personal frustration that insurance companies refuse to pay for such a position, when this type of care could actually save these very companies oodles of money in unnecessary tests, drugs, procedures and reactions. Go figure. So the best we can do is ensure that a family member, friend, or even fellow shul member (as has happened) is there to help coordinate the maze of patient care.
This notion of seeing the "forest for the trees" plays a prominent role in the constuction of the mishkan. You may have noticed that Moshe seems to instruct the Jews to construct the mishkan several times over the course of the last five parshiot of Shemot. Ramban (36:8) notes that Moshe gives these instructions no less than five times. Why all this repetition?
Ramban explains that in Parshat Terumah, Moshe first describes in detail the specific attributes of each vessel and piece of the mishkan.
"After this, he mentioned all of them in general terms...The reason for this is that God commanded Moshe to tell Bezalel and Oholiav and all the skilled [craftsmen] the work in its totality, and afterwards they could begin the work. For they could not be prepared for the holy work until they heard all of the task, and they understood it and accepted upon themselves that they knew how to complete it."
In other words, while each individual specialized in a specific area or craft, Bezalel could only begin construction when each person understood how his or her work fit into the broader picture of the entire project. In this way, every artisan and craftsman worked together in the larger project, seeing his piece not as a "tree", but as a part of the larger "forest".
If only Moshe had tackled the health care system!