Blood [is] Money

The Important Role of a Pidyon Nefesh in the Healing Process:

The Torah teaches us that when someone injures a fellow Jew, he is responsible for paying the doctors' bills (Shemot 21:19): אִם־יָקוּם וְהִתְהַלֵּךְ בַּחוּץ עַל־מִשְׁעַנְתּוֹ וְנִקָּה הַמַּכֶּה רַק שִׁבְתּוֹ יִתֵּן וְרַפֹּא יְרַפֵּא (If he gets up and is able to walk outside with his walking stick, then the one who hit him will be acquitted except that he is responsible for paying for his loss of employment and medical expenses [v'rapo y'rapei]). This is the basic p'shat. However, we also have the following mesorah (Berachot 60b): דְּתָנֵי דְּבֵי רַבִּי יִשְׁמָעֵאל: ״וְרַפֹּא יְרַפֵּא״ מִכָּאן שֶׁנִּיתְּנָה רְשׁוּת לָרוֹפֵא לְרַפּאוֹת (It was taught in the Torah School of R' Yishmael, [the pasuk says] v'rapo y'rapei ['and heal, he shall heal'], from here [we learn that] a doctor has been given permission to heal).

Huh? How could anyone come up with that just from the double wording v'rapo y'rapei? The topic being addressed is not the healing capabilities of doctors but rather the legal liabilities of a person who injures a fellow Jew. Yet, somehow, 'from here', i.e. from those two specific words, a Tanna from the School of R' Yishmael was able to derive this secondary teaching. How? It's not so clear, is it? On the one hand, the Tanna is telling us that there is a link between these two words and this secondary teaching about a doctor's capabilities to cure, but he didn't spell it out for us.

Not only that, but there's another obvious problem. If doctors were given permission to heal, then why aren't they using it? No offense to those of us in the medical profession, but our generation is, without a doubt, one of the sickest the world has ever seen. So, if doctors were given a blanket permission to heal, then why aren't we witnessing healing on a regular basis? There's lots of medications, lots of pills, lots of treatments, but very little actual healing. So how can we explain all of this?

The Gemara tells us that when R' Eliezer, the Gadol ha-Dor, fell sick, his talmidim came to visit him. Among them were the great sages, R' Akiva, R' Tarfon, R' Yehoshua and R' Elazar ben Azariah. R' Eliezer said to them (Sanhedrin 101a): חֵמָה עַזָּה יֵשׁ בָּעוֹלָם (There is fierce anger in the world). He said this because of the tremendous amount of idolatry in the world (Likutei Moharan 215): כִּי כָּל זְמַן שֶׁיֵּשׁ עַכּוּ"ם בָּעוֹלָם חֲרוֹן אַף בָּעוֹלָם (As long as there is avodah zarah in the world, there is wrath in the world). Each of his talmidim tried to console him with words of comfort but it was the words of R' Akiva that peeked his interest. What did R' Akiva say to him? He simply said, חֲבִיבִין יִסּוּרִין (Sufferings are precious).

Much has been written in an attempt to explain what R' Eliezer meant by his words and what R' Akiva was talking about, but R' Nachman provides us with a succinct answer in Likutei Moharan II:3: כִּי לֹא הָיָה אָז מִי שֶׁיּוּכַל לְהַמְתִּיק הַדִּין כִּי הָיָה צָרִיךְ לְפִדְיוֹן לְהַמְתִּיק הַדִּין וְלֹא נִמְצָא (For there was no one then who was able to mitigate the strict judgment [sweeten the din] for there needed to be a redemption [pidyon] to sweeten the din, but there was none). In short, R' Eliezer was the Tzaddik of their generation (as well as being the Gadol ha-Dor), and he took upon himself sufferings to atone for the generation. This is what is meant by sweetening the din. Under normal circumstances, the Tzaddik of the generation is able to perform a pidyonot to mitigate the din that by right should fall upon other individuals. However, who can perform a pidyon nefesh for the Tzaddik himself? No one. This is the meaning behind R' Eliezer saying that there was fierce anger in the world, i.e. there was much din from Heaven. And this explains why R' Akiva comforted him by telling him that his sufferings were precious in the eyes of Heaven. In essence, he was telling his Rabbi and Teacher, "Even though no one can perform a pidyon nefesh for you, know that your suffering is not in vain. It is precious in the eyes of Heaven and is accomplishing much."

So what exactly is a pidyon nefesh? The idea behind it is similar to the idea behind the kapparot ritual on Erev Yom Kippur. What do we say during this ritual? As we circle the chicken or the money around our heads, we say: זֶה חֲלִיפָתִי, זֶה תְּמוּרָתִי, זֶה כַּפָּרָתִי (This is my exchange, this is my substitute, this is my atonement). How can money, for example, be an exchange for one's life? The secret lies in the fact that the word for blood is דָם [dam] while one of the words for money is דָמִים [damim]. Money is damim because, sometimes, it feels as if one is literally pouring out his own tears, sweat and blood just to earn a living. In other words, since there is a direct relationship between one's money and one's life, one can be exchanged or substituted for the other.

However, only a tzaddik at a very high level of kedushah is able to perform an effective pidyon nefesh for other people. How come? As explained in many sources, there are 24 Heavenly courts; and therefore, the tzaddik performing a pidyon nefesh must know in which court a particular individual is being judged. Otherwise, he may end up attempting to intercede in one court while the individual is actually being judged in another court. In such a case, the pidyon would be totally ineffective. It's even more difficult than that because it could be that an individual is being judged in multiple courts simultaneously. If the tzaddik doesn't have access to all the courts, any pidyon that he would attempt to make on behalf of the individual would be, at best, only partially effective. Therefore, in truth, no one can perform a pidyon unless he has access to all 24 courts (Chayei Moharan 55): שֶׁאִי אֶפְשָׁר לַעֲשׂוֹת פִּדְיוֹן כִּי אִם כְּשֶׁיּוֹדְעִין כָּל הָעֶשְׂרִים וְאַרְבָּעָה מִינֵי פִּדְיוֹנוֹת לְהַמְתִּיק כָּל הָעֶשְׂרִים וְאַרְבָּעָה בָּתֵּי דִינִים (It is impossible to perform a pidyon unless one knows all the 24 pidyonot to mitigate [the judgments being issued by] the 24 courts). And to make things even more challenging, it is also brought down there: שֶׁמֵּאֵלּוּ הָעֶשְׂרִים וְאַרְבָּעָה פִּדְיוֹנוֹת אֵינוֹ יוֹדֵעַ כִּי־אִם חָד בְּדָרָא (There is only one person in a generation who knows how to perform all of these 24 pidyonot).

R' Nachman of Breslev testified about himself that he was that individual in his generation (Sichot ha-Ran 175): אֲנִי יוֹדֵעַ כָּל הָעֶשְׂרִים וְאַרְבָּעָה בָּתֵּי דִינִים (I know all the 24 courts). And this is why he stated there: אֵינִי יוֹדֵעַ אֵיךְ הַצַּדִּיקִים עוֹשִׂים פִּדְיוֹן (I do not understand how the tzaddikim can claim to do pidyonot). He was able to make such a claim because he had direct access to the 24 courts and knew firsthand which tzaddikim had access to which courts! Not only this, but he also revealed that there is a very high and elevated pidyon that is higher than all the 24 courts (Likutei Moharan 215): אַךְ דַּע, שֶׁיֵּשׁ פִּדְיוֹן אֶחָד שֶׁכּוֹלֵל אֶת כָּל הָעֶשְׂרִים וְאַרְבָּעָה בָּתֵּי דִּינִין, וְיָכוֹל לְהַמְתִּיק כָּל הָעֶשְׂרִים וְאַרְבָּעָה בָּתֵּי־דִינִים...אַךְ אֲפִלּוּ הַצַּדִּיקִים, לָאו כָּל אֶחָד יוֹדֵעַ זֶה הַפִּדְיוֹן, וְלֹא נִמְצָא כִּי־אִם חַד בְּדָרָא שֶׁיֵּדַע זֶה הַפִּדְיוֹן (But know that there is one pidyon that includes all the 24 courts, and it is possible to mitigate [the judgments issued by] the 24 courts...however, even among the tzaddikim, not everyone knows this pidyon, rather it is known to only one person in the generation).

Now that we know a little bit about a pidyon nefesh, let's return to the subject of healing. As we said above, R' Eliezer needed someone to perform a pidyon for him but there was no such individual with the credentials to do it. As R' Nachman explains (L.M. II:3): כִּי בֶּאֱמֶת אַחַר הַהַמְתָּקָה וְהַפִּדְיוֹן אָז דַיְקָא טוֹב לְרַפְּאוֹת הַחוֹלֶה עַל־יְדֵי רְפוּאוֹת כִּי אֲזַי דַיְקָא אַחַר הַפִּדְיוֹן וְהַהַמְתָּקָה יֵשׁ רְשׁוּת לְרוֹפֵא לְרַפְּאוֹת (In reality, only after the sweetening and the pidyon is it good to heal the sick through the pidyon, for only then, after the pidyon and the sweetening [of the din] is permission given to the doctor to heal). This is a very important principle which we need to explain more fully.

The following story is brought down in the Gemara (Avodah Zarah 55a). A Jew whose name was Zunin approached R' Akiva with a conundrum which he could not understand. He knew that there was nothing to avodah zarah; yet, he would see people go into their pagan temples with different kinds of ailments and come out having been healed. He asked R' Akiva to explain this. In short, R' Akiva said to him that at the very moment that a Heavenly court dispatches a judgment of Sufferings upon a person, for example, sickness (for whatever reason), it requires that the Sufferings swear an oath on three accounts: that they will leave the person on such and such a day, through such and such a doctor, and through such and such a treatment. R' Akiva then explained to Zunin the dilemma facing the Sufferings. What are they supposed to do if it just so happens that these three conditions come together when the person goes inside a pagan temple and prays to an idol? Perhaps the Sufferings should violate their oath so as not to give others the impression that the person was healed through avodah zarah. However, the Sufferings reject this option and say: וְכִי מִפְּנֵי שֶׁשּׁוֹטֶה זֶה עוֹשֶׂה שֶׁלֹּא כַּהוֹגֶן אָנוּ נְאַבֵּד שְׁבוּעָתֵנוּ (Just because this fool acted inappropriately, should we violate our oath?).

Therefore, as explained in L.M. II:3, even if a particular doctor is the doctor in the original oath, there is no way for him to know the day or the specific treatment that he should give in order to heal the patient. And because of the fact that he doesn't know what was decreed in Heaven, it is practically impossible for a doctor to heal a patient. He might be able to alleviate certain symptoms or delay the consequences of an underlying illness, but that's about it, unless he's fortunate like the man who went into the pagan temple and came out healed.

All of this is only operative when there is no pidyon nefesh. When the true Tzaddik of the generation, the one who knows all the 24 Heavenly courts, does a pidyon for the person, then everything changes. Let's read carefully (L.M. II:3): אֲבָל כְּשֶׁעוֹשִׂין פִּדְיוֹן וּמַמְתִּיקִין הַדִּין וַאֲזַי נִתְבַּטֵּל הַגְּזֵרָה אֲזַי קֹדֶם שֶׁגּוֹזְרִין דִּין אַחֵר כִּי כְּשֶׁנִּמְתָּק דִּין זֶה אֲזַי גּוֹזְרִין דִּין אַחֵר וּבֵין כָּךְ וּבֵין כָּךְ דְּהַיְנוּ אַחַר הַמְתָּקַת הַדִּין הָרִאשׁוֹן קֹדֶם שֶׁגּוֹזְרִין דִּין אַחֵר אֲזַי יָכוֹל הָרוֹפֵא לְרַפְּאוֹת הַחוֹלֶה עַל־יְדֵי סַמִּים כִּי אֲזַי אֵין דִּין וַאֲזַי יוּכַל לְהִתְרַפְּאוֹת עַל־יְדֵי אֵיזֶה סַם שֶׁיִּהְיֶה כִּי אֵין צָרִיךְ דַּוְקָא סַם פְּלוֹנִי וְכוּ' מֵאַחַר שֶׁאֵין דִּין כַּנַּ"ל (However, when we do a pidyon and sweeten the din, then the decree is canceled. Then, before the Heavenly court issues another decree, for when one din is sweetened another din could be decreed [especially if there is no real teshuvah], and in between this and that, i.e. after the sweetening of the first din and before they issue another decree, then a doctor can heal the sick person through a medicine, for then, there isn't any din, and then he's able to provide healing through any medicine that will be, for there is no need for a specific medicine, etc. since there is no din). Fascinating, no?

We see, therefore, that a pidyon is absolutely critical for a doctor to provide healing to his patient. And this is the meaning of what the Tanna taught when he said: ״וְרַפֹּא יְרַפֵּא״ מִכָּאן שֶׁנִּיתְּנָה רְשׁוּת לָרוֹפֵא לְרַפּאוֹת (v'rapo y'rapei, from here, a doctor has permission to heal). 'From here' – from where? As explained by R' Nachman in L.M. II:3, the gematria of וְרַפֹּא יְרַפֵּא [v'rapo y'rapei] plus 1 for each of the two words [287 + 291 + 2 = 580] is the same as the gematria for פִּדְיוֹן נֶפֶשׁ [pidyon nefesh], i.e. 150 + 430 = 580.

The secret that the Tanna did not reveal has now been revealed. When does a doctor have permission to heal? It is only after a pidyon nefesh took place on behalf of the patient. And this explains the perplexing double wording (v'rapo y'rapei) that many commentators have struggled to explain. The double wording is required to teach that a pidyon nefesh is required for healing.

As a bonus, do you want to know another secret? We bring this down because we recently wrote about the importance of waking up before midnight [chatzot lailah] and reciting the Tikkun Chatzot prayer to mourn over the exile of the Shechinah and the destruction of the Beit ha-Mikdash. Here's the secret (Likutei Moharan 149): חֲצוֹת הוּא מְסֻגָּל כְּמוֹ פִּדְיוֹן (Chatzot is effective like a pidyon). So if you don't yet know who the Tzaddik of our generation is (or you aren't quite prepared to give tzedakah for a pidyon), then you might want to start waking up before chatzot.