How We Roll, courtesy of Flickr user GorillaSushi

Many Openings: Confronting Inflammatory Bowel Disease and the Bathroom Prayer

Among the many odd things I found in my first days in Yeshiva in Israel in 1993 were my classmates who, upon exiting the bathroom, would close their eyes, and pray intently for about 15 seconds.  I soon learned they were saying “Asher Yatzar,” also known as the bathroom prayer. Other newbie Yeshiva bochers who did not know the words by heart would recite the words to the prayer, conveniently posted right outside the bathroom door:

“Blessed are You, Hashem our God, King of the universe, Who formed man with wisdom and created within him many openings and many cavities. It is obvious and known before Your Seat of Glory that if even one of them ruptures, or if even one of them becomes blocked, it would be impossible to survive and to stand before You (even for a short period). Blessed are You, Hashem, Who heals all flesh and acts wondrously.”

I did not grow up observant, but had a solid Jewish background consisting of a fairly common mix of Hebrew School and a heavy dose of Jewish camps and youth groups.  I was familiar with the main prayers in the  daily and Shabbat services and the brachot (blessings) over different types of food.  But, nobody ever told me that people say a bracha for going to the bathroom. Perhaps for good reason, since I don’t think that would have made me particularly excited to embrace my religion. I knew about Jewish legal concern with the bedroom, and I could see the argument for the holiness of intimacy. But, now the bathroom too? How much more intrusive could this religion get?
But, when I arrived at Yeshiva, I had committed to trying out what it was like to be “all in.” And so I started saying the bracha upon leaving the bathroom and also first thing in the morning, as the same prayer is also found in the beginning of the morning prayer service.   While a bit weird, it wasn’t altogether too hard to embrace the prayer  as I could get behind the overall message that our bodies are miraculous works of Divine engineering and that our physical as well of our spiritual selves are gifts from God.  It also resonated with  Walt Whitman’s “Song of Myself” which a few us were somewhat illicitly reading on the side, “Dead Poets Society” style.

“Welcome is every organ and attribute of me, and of any man
    hearty and clean,
Not an inch nor a particle of an inch is vile, and none shall be
    less familiar than the rest.”

“I do not press my fingers across my mouth,
I keep as delicate around the bowels as around the head and

“each part and tag
    of me is a miracle.

“Divine am I inside and out, and I make holy whatever I touch
    or am touch’d from,
The scent of these arm-pits aroma finer than prayer,
This head more than churches, bibles, and all the creeds.”

So for a few months I became one of those guys who would read the prayer off the bathroom door. Soon,  I memorized it and became one of the guys who would recite it silently to myself,  though not with as much kavannah (spiritual focus) as some of my classmates.
At the same time, as we studied the various laws concerning prayer, I also learned that Judaism has another streak that strictly separates out this particular bodily function from the spiritual realm. It is forbidden, for example, to pray while you feel the need move your bowels. It is forbidden to bring holy objects into the bathroom. It is forbidden to study Torah in the bathroom. It is forbidden to pray in a place that smells of defecation.
So there was a tension between the prayer embracing the holiness of the body and the actual laws of prayer. In fact, this was why, ironically,  you have to say the Asher Yatzar prayer after leaving the bathroom.  You are not supposed to recite prayers, even the bathroom prayer, while in the bathroom.
But I could live with that tension too. I understood both sides and it certainly wasn’t the issue I was going to worry about too much. There were much bigger conflicts to tackle in my religious journey.  And in a pinch, there was also more Whitman to rely upon:

“Do I contradict myself?
Very well then I contradict myself,
(I am large, I contain multitudes.)”

The following year, having returned to New York and landed my first job at age 23, I was steadfast in my observance.  Meanwhile, I started having what I thought of as merely persistent episodes of diarrhea. I didn’t have a primary care doctor, so I just lived with it for a long time even as it kept getting worse for many months.
The Asher Yatzar blessing becomes a bit tedious by about the eighth recitation in a two hour period. And during the worst times of day, I would run to the bathroom, do my business, think I was done, and barely have time to quickly recite Asher Yatzar, thanking God for the privilege, before having to run back in.
Besides the tedium and the practical problems of being able to complete the prayer, the meaning started to ring false.  My engineering was awry. God or my body–one or the other– was opening that which shouldn’t be opened.
In addition to affecting my work and life, I could barely say my morning prayers because of all those rules.  It is forbidden to pray while you feel the need move your bowels. I felt that all the time. It is forbidden to bring holy objects into the bathroom. I would start to pray, put on my Tallis and Tefillin and then have to take them off again,  finish in the bathroom and put them on again. This would happen three or four times, extending the otherwise thirty minute ritual into closer to sixty. And, completely wreck any possibility of kavannah. It was just an ordeal.
Then, I starting to see a strange, white pus-like liquid in my stool.  And then blood in my stool. Sometimes a lot of it. Soon after, I was moving only blood. The amount of time I could control my bowels was also getting shorter or shorter, often under a minute.   
Does one say Asher Yatzar thanking God  for excreting an unknown substance that clearly shouldn’t be there? Or for a toilet  full of  blood? Do you say the bathroom prayer when you didn’t quite make it to the bathroom? I did not know. I did not think so. And at the point it was hard to care. I certainly wasn’t going to ask a Rabbi.  I wasn’t feeling very blessed. It was hard to praise God on his “Seat of Glory” while tethered to the toilet seat.
The simple meaning of Asher Yatzar is that we would not be alive to stand before God if our opening and cavities are ruptured or blocked.  But, well  before that,  at least as a practical and ritual matter, it is very difficult to stand before God in prayer when worrying about one’s bowels.  In fact, this is probably why Jewish law forbids it.  

Finally, mercifully, I found and saw a doctor.  It took him about three minutes–not counting my bathroom break–to make a preliminary diagnosis of Ulcerative Colitis.  This diagnosis was quickly confirmed by a same day referral to a gastroenterology specialist.
Ulcerative Colitis (UC) is a chronic , abnormal  immune response condition. In people with UC,  too many white blood cells are sent to the colon.  This causes inflammation and ulcers and leads to the diarrhea and other symptoms  (pus, blood) that I was experiencing.
In retrospect, it seems strange that I had never heard of Colitis or its cousin, Crohn’s Disease. The two conditions are collectively known as inflammatory bowel disease (IBD).  Not only does the disease affect about 1.6 million Americans, it is a largely Ashkenazi Jewish disease. According to the Crohn’s and Colitis Foundation of America (CCFA), American Jews of Ashkenazi descent (that would be me)  have the highest likelihood of any group to have IBD. We are four to five times more likely to have IBD than the general population.  The precise reason for the high prevalence among Ashkenazi Jews is unknown. Beside genetic explanations, some researchers have suggested a  link to kashrut and cleansing rituals. (See here. )
Besides the high prevalence among Jews, it is also most commonly first diagnosed between ages 15 and 35. I started experiencing my symptoms at 23.  So, there I was a ground zero of risk for IBD, but totally oblivious to the possibility, and suffered longer and worse than was necessary. This reflects a lack of willingness to confront gross, taboo subjects, both nationally and in the Jewish community. Just as there are laws forbidding the mixing of Jewish ritual with the bodily functions, parallel unwritten rules apply to what we teach and talk about in polite company.  We don’t often talk of our wondrous openings and cavities.
Once diagnosed and under medical care, I soon achieved remission.  Did I appreciate my working body more, like a blind person who regained his sight? Did I recite Asher Yatzar with more feeling? Not really. Not at the time.  First, it wasn’t God that healed me miraculously.  It was doctors and a cocktail of pills and not-so-spiritually-inspiring enemas. And, frankly the last thing I wanted to do was concentrate more on my bowels than I had to.
That was 21 years ago. Mentally adjusting to having a chronic disease is not easy. IBD comes in flares. Over the last 21 years,  I have been blessed with long periods of remission, as well as cursed with years when I could not confidently leave the house, drive my kids to school, conduct a business meeting, without risk of a very unpleasant and embarrassing episode of incontinence. And yet I also know that my case is more moderate than those of many others.
Over the same period, otherwise known as my adult life, my religiosity has generally waned, and occasionally flared, often in response to the High Holiday season.  While I have consistently kept Shabbat and other central tenets of Jewish life, for most of this time I have not said blessings regularly throughout the day, including Asher Yatzar. Much of the decline has more to do with the regular busyness and distraction of work and three children than either disease or ideology.  
Until recently, there has not been a connection between my observance cycles and disease cycles, one way or the other.  But in response to my latest extended flare, my doctor put me on medication that have been very effective for achieving at least temporary remission, but also has a lot of side effects. Among these side effects for me have been high anxiety and waking up extremely early. While many people recommend meditation in the morning to fight the anxiety, I chose to start davening again, as regularly as I used to back in my spiritual glory days. It also happens to be coming up on High Holiday season, so the cycles are aligned. 
So, for the last few months, every morning I wake up earlier than I should, I use the bathroom, in a manner similar to a normal person, thanks to the meds.  Then, as Jewish ritual prescribes, I wash my hands, focus,  and say Asher Yatzar, now with kavannah.  And, again, thanks to the remission, I can usually make it through the ritual with at most one bathroom break.
Once I taper off my current medication, I am hopeful that another medicine regime will sustain the remission. I am also hopeful that I will be able to keep davening every day in the absence of insomnia and after the High Holiday season recedes. I don’t know If either hope will come true.
But, Asher Yatzar has a little parenthetical clause that does not appear in all versions. Without a working body, the prayer says,

“it would be impossible to survive and to stand before You (even for a short period).”

“Even for a short period.”
The parenthetical reminds us that we should be grateful for even a short period where our souls and bodies–which is to say, our lives–are lined up well enough to stand before God.  And so, if only for this short period, I am.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

The reCAPTCHA verification period has expired. Please reload the page.

This site uses Akismet to reduce spam. Learn how your comment data is processed.