Medical Update: Second Immunotherapy

Update & Some Ideas in the Merit of Michal Chava bas Feiga Aviva

Second Immunotherapy — A Step Forward

Today, my wife is undergoing her second round of immunotherapy. Like many cancer treatments, this one carries both hope — and risk. Statistically, the immediate dangers aren’t overwhelming, but they also can’t be ignored.

To those in this Tehillim group: please continue davening.That she responds to the immunotherapy. That Hashem protects her from the risks and the harsher side effects. That she exceeds all expectations — and that we see healing.

Recently, someone pointed me to a powerful teshuva (halachic responsum) by Rav Moshe Feinstein zt”l. He was asked a question that now feels deeply personal:

Is a person allowed to undergo a potentially risky medical procedure today, if there’s a chance — not even a guarantee — that it might extend their life in the future?

Before sharing Rav Moshe’s answer, I want to introduce one of the surprising sources he draws from — a brief but powerful story in Sefer Melachim (Kings).

👣 The Four Metzoraim (Lepers) — Melachim II 7:3–4

וְאַרְבָּעָה אֲנָשִׁים הָיוּ מְצֹרָעִים פֶּתַח הַשָּׁעַר וַיֹאמְרוּ אִישׁ אֶל רֵעֵהוּ מָה אֲנַחְנוּ יֹשְׁבִים פֹה עַד מוּתֵנוּ׃אִם נֹאמַר נָבוֹא הָעִיר וְהָרָעָב בָּעִיר וָמָתְנוּ שָׁם; וְיָשַׁבְנוּ פֹה וָמָתְנוּ; וְעַתָּה לְכוּ וְנִפְּלָה אֶל מַחֲנֵה אֲרָם; אִם יְחַיּוּנוּ נִחְיֶה, וְאִם יְמִיתוּנוּ וָמָתְנוּ׃

— מלכים ב׳ ז: ג–ד

“Now there were four men with tzara’at at the entrance of the gate. They said to one another:‘Why should we sit here until we die? If we say, let us enter the city — the famine is in the city, and we shall die there. If we stay here, we die also. So now, come, let us go over to the camp of Aram. If they spare us, we live; if they kill us, we shall but die.’”— Melachim II 7:3–4

🔍 Historical and Narrative Context

This moment occurs during the siege of Shomron (Samaria) by the Aramean army. The city is facing an extreme famine. The economic and humanitarian collapse is so severe that people are paying silver for animal carcasses — and even turning to cannibalism.

Melachim II 6:25–29:

וַיְהִי רָעָב גָּדוֹל בְּשֹׁמְרוֹן וְהִנֵּה צָרִים עָלֶיהָ עַד הֱיוֹת רֹאשׁ חֲמוֹר בִּשְׁמוֹנִים כֶסֶף, וְרֹבַע הַקַּב חִרְיֵי יוֹנִים בַּחֲמִשָּׁה כֶסֶף...וַתֹּאמֶר הָאִשָּׁה: הָאִשָּׁה הַזֹּאת אָמְרָה אֵלַי, תְּנִי אֶת בְּנֵךְ וְנֹאכְלֶנּוּ הַיּוֹם וְאֶת בְּנִי נֹאכַל מָחָר.וַנְּבַשֵּׁל אֶת בְּנִי וַנֹּאכְלֵהוּ; וָאֹמַר אֵלֶיהָ בַּיּוֹם הָאַחֵר, תְּנִי אֶת בְּנֵךְ וְנֹאכְלֶנּוּ — וַתַּחְבִּא אֶת בְּנָהּ.— מלכים ב׳ ו: כה–כט

“And there was a great famine in Samaria, and behold, they besieged it until a donkey’s head was sold for eighty silver pieces, and a fourth of a kav of dove’s dung for five silver pieces... Then the king of Israel was passing on the wall, and a woman cried out to him, saying, ‘Help, my lord, O king!’… And the woman said, ‘This woman said to me, “Give your son and we will eat him today, and my son we will eat tomorrow.” So we cooked my son and ate him…’”

This is the desperate backdrop against which the story of the four metzoraim unfolds.

Their reasoning is simple, painful, and familiar:

• Stay where we are → die soon (from starvation).

• Go to the Aramean camp → may be killed immediately.

Basically: If we sit still, we die. If we move, we might live.

And so, Rav Moshe Feinstein draws from this story in Igros Moshe, Choshen Mishpat II:73:

"מותר להכנס לסכנה מיד כדי להאריך ימים"“

It is permitted to enter immediate danger in order to possibly extend one’s life.”

This is not halachic recklessness. It’s halachic hope — a validation that sometimes, the courageous choice is the uncertain one.

So we go into the immunotherapy with that mindset: that staying still is not an option. That even a risky step forward is still a step forward.

And we go in armed with emunah, tefillah — and, perhaps most surprisingly — gratitude.

🙏 Why Gratitude? A New Kind of Gratitude

About ten weeks ago, we sat together in the oncology waiting room for the first time. It was quiet — the kind of quiet that hums with fluorescent lights and unspoken fear. My wife looked around, took in the faces, and said softly:

“I’m the only one here in my thirties.”

It wasn’t said for effect. There was no bitterness or drama. Just a quiet observation that landed like a punch. She was right — and it felt deeply, painfully unfair.

Everyone else in the waiting room looked like they were in their sixties, seventies, maybe even eighties. People with grown children and probably grandchildren and grey hair. People who’d had a full adult life before this.

And then there was her — young, vibrant, in the thick of motherhood. And yet, sitting in the same room.

A few weeks later, I came to visit her after her biopsy. I was trying to find the surgical ICU, wandering through the endless, impersonal maze of hospital corridors. I took a wrong turn and ended up outside paediatric oncology.

Through the glass, I saw them: small children — four, six, maybe eight years old — hooked up to the same kinds of machines she was. Some lying still. Some sitting up with thin smiles. All wearing gowns far too big for their tiny frames. Heads shaved. Eyes tired.

And something in me broke.

Because they’re fighting the same illness as my wife. But they haven’t lived long enough to understand what they’re even fighting. They haven’t had time to build a life they can miss. No childhood memories to fall back on. No before to compare the after to.

And in that moment, everything shifted.

Suddenly, being in our thirties feels like a gift. Having known love, marriage, and motherhood feels like a privilege.

That accidental detour to the wrong ward gave me a new perspective. And that is a kind of gratitude — not the easy, Instagrammable kind. The raw, unexpected kind that hurts as it heals. The kind that doesn’t erase the fear, but makes space for perspective alongside it.

It reminded me of something I once read in Orchot Tzaddikim — in the Shaar HaHakarat Hatov (Gate of Gratitude). The entire section explores how we owe gratitude not only for tangible blessings, but for the sheer gift of existence itself.

“And if a person were to reflect on the multitude of Hashem’s kindnesses to him… he would see that even if he were afflicted all his life, he could not repay the Creator for even one kindness.”

That’s not abstract mussar. It’s painfully real. Even when life is stripped down to its hardest version — even then — the fact that we’re alive is already more kindness than we could ever repay.

And we carry that with us now — into every treatment, every scan, every quiet moment in the waiting room.

📜 The 13 Middot — And a Deeper Kind of Mercy

Let's look at something else — a comment from the Rosh on the י״ג מידות הרחמים (13 Attributes of Mercy):

ה׳ ה׳ אֵ־ל רַחוּם וְחַנּוּן

(שמות ל״ד:ו)

“Hashem, Hashem, Kel Rachum Vechanun…”

According to the Rosh, the first two of the thirteen attributes of G-d's mercy are the repetition of Hashem’s name:

• The first “Hashem” represents G-d’s mercy before a person sins.

• The second “Hashem” is His mercy after they sin and do teshuva.

But why do we need mercy before we’ve done anything wrong?

The Maharal answers:

Because life itself is mercy. Before we speak. Before we act. Before we sin. Even our very existence is not deserved. It’s not payment. It’s not earned. It’s not a reward.

It’s a gift. That’s the first Hashem — the mercy of being. The chessed of existence itself.

Rav Chaim Friedlander zt”l, in Siftei Chaim – Emunah uBechira (Vol. 1), expresses this idea with beautiful clarity. He writes that life is a matnat chinam — an unearned gift, rooted in Hashem’s will to bestow good:

“The very fact that we exist is only because Hashem willed to create us, without us deserving it. Our continued existence is similarly undeserved — every breath is a renewed expression of His will.”

That means every morning we wake up, every moment we get to be together, is not just a continuation — it's a brand-new act of Divine generosity.

If we think life is fair or unfair, we’ve misunderstood it completely.

🙏 From "Why Me?" to "Thank You"

That insight reshaped everything.

Instead of asking, “Why should a woman in her thirties be here?”, I began thinking, “What a chessed it is that she got to be in her thirties at all.”

She got to grow up.

To laugh with friends.

To fall in love.

To get married.

To become a mother.

To raise children.

To know them.

To hold them.

And yes — this is hard. Unbearably hard.

But walking past those children in the oncology ward — too young to even understand what cancer is — forced something into focus.

You can cry and still be grateful. You can break and still bless. You can mourn what’s lost and still thank Hashem for what was — and what still is.

The verse says:

מַה־יִּתְאוֹנֵן אָדָם חָי גֶּבֶר עַל־חֲטָאָיו

(איכה ג׳:ל״ט)

“Why should a living man complain? Let a man reflect on his sins.” (Eichah 3:39)

Chazal read it this way: As long as you’re chai — alive — you have no right to complain.

Even in pain. Even in crisis. Even in the waiting room.

Because life, at its core, is a gift we were never owed.

And when you understand that, you stop asking “Why me?” And you start whispering, “Thank You.”

What Are We Grateful For?

We are grateful that she’s in her thirties. We are grateful that our children know her voice. That she was able to teach them Shema. To sit with them on the couch. To pack a school lunch.

We are grateful for:

• A treatment plan

• Access to doctors, specialists, and medication

• Everyone who is saying Tehillim, day and night, in her merit

• Every message of support

• A night without nausea

• A normal supper

• The chance to say “Good morning”

Gratitude Doesn’t End Suffering — But It Transforms It

Gratitude doesn’t erase pain. But it gives it a frame. It doesn’t pretend everything is fine. It says: Even in the not-fine, Hashem is here.

And so, today, as we begin the second round of immunotherapy, we do so with the mindset of the four metzoraim: We don’t know what lies ahead. But staying still isn’t an option. So we walk. We try. We pray.

And we thank Hashem — not only for what we’re asking for, but for what we already have.

To every single person who has held us — physically, emotionally, and spiritually — thank you.Thank you for the chessed. For the tefillot. For the mitzvot you’ve taken on in her merit.For lifting us with your love.

Please continue davening for מיכל חוה בת פייגא אביבה.

There are stories — real stories — of people with this exact diagnosis who have defied every medical expectation. Who weren’t supposed to make it — but did. And I am convinced, with every fibre of my being, that in the merit of the thousands of Tehillim being said, and the countless acts of kindness being done, she too will be among them.

May we soon share a besorah tovah, a good report, filled with hope and healing.

With love and unwavering gratitude,

Yaacov