1. Halpern, Lisa M. MSN, APRN, BC

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She was known to God by her Hebrew name, Baila bat Sarah. The tag on her toe identified her as Bessie Cohen, a resident-until that morning-of the Jewish Home. Her birth date, also on the tag, was January 7, 1921.

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That evening I was one of three women from my community's chevra kadisha (Jewish burial society) who had gathered at the Jewish mortuary to perform the tahara, the traditional purification ritual of preparing a body for burial. My experience as a nurse enhances my participation in this religious ritual.


Quietly, in observance of universal precautions, we gowned and gloved; softly, in observance of ritual traditions, we recited the introductory prayers asking Baila bat Sarah for her forgiveness for any indignities we might subject her to. We wanted to avoid any action that could cause a living person to feel disrespected-carelessly handling the limbs, for example, or having a mundane conversation during the purification ritual.


We prepared her for her final bath, gently removing gauze and IV tubing. On a paper towel, we gathered loose hairs and bits of bandage stained with her blood, preparing, according to religious requirement, to bury even these tiny bits of her body with her. As I performed these tasks, my mind was busily, unnecessarily, assessing the indicators of her clinical state in her final days and developing a differential diagnosis for the cause of her death. To still those thoughts, I wondered instead what joys she had known, whom she had loved, how she had struggled, who wept for her now.


We washed her body in sections, safeguarding her modesty with a bath towel, uncovering parts of her body only as we attended to them. Once, as we rolled her onto her side to wash her back, she slipped down the mortician's table. Bending my knees slightly to protect my back, I helped to reposition her. We cleaned beneath her fingernails and toenails, careful not to dislodge the onychomycotic toenails on her right foot. Using acetone, we removed her chipped pink fingernail polish, evidence of someone's loving attentions in recent weeks. One of us removed debris from her deeply indented umbilicus. Together we prepared to return her to the God who had created her, as clean and unadorned as she had arrived in this world.


Three times we poured water over her, from head to foot, as she lay propped on boards that allowed the water to flow over and around her. As we did so, we murmured in Hebrew a passage from the Book of Ezekiel: "I will pour upon you pure water and you will be purified of all your defilements, and from all your abominations I will purify you." She could no longer pray for herself, so by reciting these ritual passages we prayed on her behalf-just as nurses care for patients who are unable to care for themselves.


We dried her, tenderly, with clean white sheets. I noticed her hands-soft, white, competent-and wondered how many baths she had given. I thought about her mother, who might have bathed her first.


Plain white burial garments (tachrichim) awaited her on a stainless steel table. We shook them out. Taking turns, we helped one another pull on her trousers, shirt, and jacket, struggling a bit with her limbs stiffened by rigor mortis. Before tying the shroud's belts with the special knot representing the name of God, we cut open a tiny plastic packet of soil from the Holy Land and sprinkled the earth inside Baila bat Sarah's garments. As one of us cradled her head and another stood alongside to assist, the third arranged Baila bat Sarah's headdress and veil. According to ancient custom, her eyes and mouth were covered with shards of broken pottery, and the veil was pulled over her face.


Gathering at Baila bat Sarah's side, we again requested her forgiveness for errors we had committed or omissions we had made. We spoke in unison, two in an undertone, one of us aloud. Our activity ceased. My breathing was slow and even, my diagnostic mind stilled.


We summoned the morticians into the room to move Baila bat Sarah into her simple pine casket. They joined us, speaking in everyday voices that sharply contrasted with the hushed tones we had been using. The sudden glare of fluorescent bulbs seemed to overwhelm the faint glow of our ritual candle. The morticians worked with care but with less compassion than we of the chevra kadisha. We, and perhaps she, were jostled from our sanctified hour. We stood aside as the men lowered her body into the box cushioned with straw. The closing of the lid resonated throughout the room.