Medical update; 31 july 2025

Dear friends,

It has now been two weeks since Michal’s most recent treatment. The pain in her liver persists. The nausea has not lifted. It has not worsened — for that, we are deeply grateful — but it has also not significantly improved. We are suspended in that most difficult of places: the in-between, where nothing is certain and hope must be chosen, again and again, without confirmation. I will continue the medical update below, but first let’s get some perspective from Tanach:

It was only matter of time before I started quoting Sefer Iyov. Of all the voices in Tanach, his may be the most hauntingly honest about suffering, and perhaps the most instructive

Introducing the Book of Iyov

Sefer Iyov is one of the most enigmatic and emotionally charged books in all of Tanach. It tells the story of a man described as blameless, upright, God-fearing, and distant from evil — a paradigm of righteousness. The verses linger over his prosperity, almost inviting us to admire the fullness of his life:

“Seven sons and three daughters were born to him. His possessions were seven thousand sheep, three thousand camels, five hundred yoke of oxen, and five hundred she-donkeys, and a very large household. That man was wealthier than anyone in the East” (Iyov 1:2–3).

Then comes the challenge. The Satan — identified by Chazal as the yetzer hara, the prosecuting angel in the heavenly court, and even the Angel of Death — approaches Hashem with a piercing argument: It is easy to serve God when one is surrounded by comfort and blessing. But take it all away, and see what remains. In response, Hashem grants permission for the Satan to strip Iyov of everything.

In rapid succession, Iyov is subjected to devastating suffering: the loss of his vast wealth, the sudden death of all his children, and a collapse of his world as he knew it. And yet, Iyov's faith remains remarkably intact. His first reaction is not bitterness, but surrender and praise:

“Naked I came from my mother’s womb, and naked shall I return there. Hashem has given, and Hashem has taken;

יְהִ֛י שֵׁ֥ם יְהֹוָ֖ה מְבֹרָֽךְ

Blessed be the name of Hashem.” (Iyov 1:21)

And the text affirms:

בְּכׇל־זֹ֖את לֹא־חָטָ֣א אִיּ֑וֹב וְלֹא־נָתַ֥ן תִּפְלָ֖ה לֵאלֹהִֽים

For all that, Iyov did not sin, nor did he cast reproach upon God.” (Iyov 1:22)

Still unsatisfied, the Satan reappears before Hashem with a further claim: material loss is one thing — but let a person suffer in their own body, let them lose their health, and then see if they continue to bless God. And again, Hashem grants permission — this time to afflict Iyov’s very flesh.

Iyov is struck with a terrible disease that covers his entire body in painful boils—from the soles of his feet to the crown of his head. He sits in ashes, scraping himself with a shard of pottery, consumed by both physical torment and emotional desolation. It is at this point that his wife, unable to bear the sight of his suffering, urges him to abandon his faith altogether:

“Are you still holding on to your integrity? Curse God and die.” (Iyov 2:9)

But Iyov’s response is as startling as it is steadfast:

“Shall we accept the good from God, and not also accept the bad?” (Iyov 2:10)

It is easy to believe when the world is functioning in our favour. The real test of faith is whether we can continue to believe when the world appears to have turned against us—when Hashem feels distant, when His ways feel incomprehensible, when suffering eclipses understanding.

Iyov’s most powerful declaration —

“Even if He slays me, I will hope to Him” (Iyov 13:15)

is not uttered from a place of comfort, but from the depths of despair. His hope is not born of clarity. It is not the result of understanding. It is the fierce, trembling choice to anchor himself to the One from whom all things come—even when that same One feels like the source of his pain.

Iyov’s friends arrive with the intent to console him, but their comfort quickly turns to confrontation. They insist that his suffering must be the result of some hidden sin, invoking a worldview where divine justice is always proportional and deserved. Iyov, however, refuses this logic. He maintains his integrity and demands an explanation from God, voicing some of the most anguished and poetic challenges to divine justice in all of Tanach.

After a long and unresolved dialogue, Hashem finally responds — not with direct answers, but with a series of overwhelming questions that lay bare the vastness of creation and the limits of human understanding. In the closing verses, Iyov is restored materially, but the spiritual tension of the book remains: not all suffering is understood, and not all questions receive answers.

Was Iyov Real? What Chazal Disagree On — and Why It Doesn’t Matter

Chazal themselves are divided on whether Iyov was a real historical figure or a parable crafted to teach profound truths. Some Sages held that Iyov never existed and that the entire narrative is a mashal — a metaphor for the human condition. Others firmly maintained that he lived and suffered, and debated when: some placed him in the time of Avraham, others in the days of Moshe, and some as late as the Babylonian exile.

But in truth, the question of historicity is secondary. The enduring power of Sefer Iyov lies not in when — or even whether — it happened, but in what it teaches us. Iyov is less a biography and more a mirror. His story shifts the focus away from why we suffer, and instead demands that we confront a more important question: how do we respond to suffering when understanding eludes us? The book of Iyov does not resolve the mystery of divine justice — it sanctifies the struggle, and in doing so, offers us a language for pain that still clings to faith.

Faith in the Fire: The Verses That Define Iyov’s Legacy

Among the most arresting elements of Sefer Iyov are the verses that give voice to a faith that persists even when no clarity is offered. Iyov does not receive answers. What he receives is a confrontation with the magnitude of Hashem’s world — a divine voice that reminds him how small a portion of reality any human being can truly grasp.

“Where were you when I laid the foundations of the earth?” (Iyov 38:4)

is not a rebuke, but a recalibration. Iyov sees only a handsbreadth — Hashem sees from one end of time to the other. And perhaps this is why Iyov remains, at his core, a man of faith. Not because he understands, but because he acknowledges that he does not.

The exchange between Iyov and his wife, following his affliction with disease, embodies two opposing responses to suffering. On one side is despair — the impulse to give up, to curse God, to declare the world unjust and rage against it. On the other is Iyov’s defiant faith, captured in his words: “Even if He slays me, I will hope to Him” (Iyov 13:15). It is the recognition that everything — both blessing and pain — comes from Hashem, and that even what we cannot understand may ultimately serve a higher good. This is the eternal tension in the wake of tragedy: some turn away in anger, others turn toward in faith. Suffering, it seems, creates either atheists and believers. Some people turn away forever — and some clung tighter than ever before.

That is the challenge Iyov places before us: to live with faith not because we understand, but precisely because we know that we don’t. To remain anchored not in clarity, but in the acceptance that the full picture is hidden from us — and to believe anyway.

Medical Update Continued:

And that, in many ways, is where we find ourselves right now. We are not standing at the edge of clarity. We are not yet seeing signs that the treatment is working. We are somewhere in between — suspended in the early weeks of immunotherapy, where the greatest unknown is the question that cannot yet be answered: Is it working? Will it work?

In these initial stages, even scans and bloodwork offer no clear reassurance. There is a well-documented phenomenon known as pseudoprogression, where tumours may temporarily enlarge and biomarkers like AFP may rise — not because the disease is advancing, but because the immune system is beginning to respond. It creates a cruel optical illusion: what looks worse on paper may, in fact, be the first sign of healing.

And that’s the impossible gamble doctors must make. Immunotherapy doesn’t reveal its hand early. The standard approach is to administer three full cycles before evaluating whether it’s having any effect. That means committing to a course of treatment — side effects, hope, risk and all — with no way of knowing until weeks later if it’s helping or not.

So we sit in that uncertainty. With no data we can truly trust yet. Just a silence filled with questions we cannot answer, and hopes we dare not let go of. Because the only way forward — the only way through — is to wait, to hope, and to believe that underneath the surface, healing might be beginning, even if we can’t see it yet.

This isn’t a place where strength flows naturally. It is a place where strength must be chosen — sometimes minute by minute — in the absence of certainty or signs. Where each day without worsening symptoms is received as a gift, even as pain persists. And where hope isn’t propped up by medical updates, but by emunah — by the stubborn, trembling insistence that we are still in Hashem’s hands, especially when we cannot see how.

Closing THOUGHTS

The Gemara in Berachot teaches:

רְפוּאָה בָּאָה מְעַט מְעַט 

“Healing comes little by little.”

Even when healing has been decreed from Above, it often arrives slowly — in quiet, almost imperceptible increments that don’t feel like progress until, one day, you look back and realize you’re no longer where you began.

We are trying to believe that. To hold onto it. To live inside it.

And so, as we enter this coming week — one step closer to the next infusion, and one step deeper into the unknown — we draw strength not from answers, but from our willingness to remain in relationship with Hashem, even in the dark.

Like Iyov, we’ve learned that we don’t need to understand in order to hope.

saying tehillim on tisha b'av

On a halachic note: I’ve been advised by my Rav — who is familiar with both Mikki’s condition and the halachic framework — that it is permitted and encouraged to continue reciting Tehillim on Tisha B’Av.

She falls under the ruling of the Mishna Berura (O.C. 554:7), which permits Tehillim when recited as bakashat rachamim — a personal plea for compassion — rather than Torah study.

With that in mind, I humbly ask you to please continue davening for my wife:

Michal Chava bat Feiga Aviva

Every chapter matters. Every whisper counts. And if all we can offer this Tisha B’Av is broken-hearted prayer — then perhaps that is the korban Hashem most desires.

Thank you — deeply, sincerely, endlessly — for walking this road with us. For your prayers, your messages, your quiet whispers of Tehillim in the dark. We do not take it for granted. Every kapitel, every name mentioned in a minyan, every amein whispered with kavanah — it all sustains us in ways we can’t always put into words.

We are not going through this alone. And that, in itself, is a kind of healing.

May Hashem repay your kindness a thousandfold.

Tisha B’Av: Feeling vs. Knowing

As we approach Tisha B’Av — a day drenched in loss and longing — it feels appropriate to reflect not only on what we grieve, but why we grieve it.

The Gemara in Nedarim (81a) asks the chilling question:

עַל מָה אָבְדָה הָאָרֶץ?

— Why was the land lost?“

Because they did not bless over the Torah first.”

Not that they didn’t learn. But that they didn’t bless — they didn’t feel it as a privilege. Torah became routine. Cultural. Detached from the heart.

The Ran explains that they still studied Torah, but not lishmah — not out of reverence or love. The Maharal adds that Torah is the soul of Eretz Yisrael — and when it’s studied without soul, the land itself becomes desolate.

It is a deeply psychological idea: that destruction came not from doing wrong, but from feeling nothing. From letting the fire of Torah become cold.

And that is why Iyov’s story feels especially resonant right now.

Because Iyov refuses to become numb. His is a faith that feels. He never stops engaging, even when his questions go unanswered. Even when Hashem feels hidden. Even when everything falls apart.

If Tisha B’Av warns us of what happens when we stop feeling Torah as a blessing, Iyov reminds us of what it means to feel anything as a blessing — even pain, even breath, even the unanswered silence.

Perhaps that’s what it means to recite Birkat HaTorah techilah — to bless from the beginning. Not just before study, but before understanding. Before clarity. Before certainty.

To say: This, too, is sacred. This, too, is from Hashem.

And perhaps that is the very faith that can rebuild a world.

Wishing you all a meaningful, gentle, and redemptive fast.

Yaacov