Sefer Tehillim, Chapter 41: "For the conductor, a psalm of David." As Ibn Ezra and following him the Malbim explain, King David composed this psalm when he was ill. At that time, says the Malbim, his enemies sought to kill David with deadly poison, as we saw in Chapter 38, and David pleads that Hashem save him. David also describes the constant Divine Providence watching over him - and not over him alone, but over anyone who is impoverished, anyone who is helpless.
אַשְׁרֵי מַשְׂכִּיל אֶל־דָּל בְּיוֹם רָעָה יְמַלְּטֵהוּ יְהֹוָה׃ - Praiseworthy is he who is thoughtful of the destitute; on the day of evil, Hashem will rescue him.
The Radak explains that "destitute" (dal) here refers to the sick person, just as it is said regarding Amnon: "Why are you looking so destitute, prince?" - dal, meaning sick. And praiseworthy is one who is "thoughtful" (maskil) toward him, meaning he pays attention, observes, comes to visit the sick person (bikur cholim), assists him, and speaks to his heart. It has been explained previously that the mitzvah of visiting the sick is not, as some mistakenly think, merely dropping by for a social visit: "I came to visit and then left." Rather, both here and in "to visit His sanctuary" (u-levaker be-heichalo), the root of bikur relates to inspection and assessment: inspecting to see what he lacks and what he needs. "To visit the sanctuary of Hashem" means to inspect and see what is needed in the sanctuary of Hashem. This is the very essence of the mitzvah of bikur cholim.
"On the day of evil" - when the illness weighs heavily upon the sick person and he is close to death, then "Hashem will rescue him." The Radak presents several possibilities for understanding this declaration. The first possibility is that David says this as a prayer: Please Hashem, on the day of evil, rescue him and save him. This also aligns with the subsequent verses: "Hashem will preserve him," "Hashem will sustain him on his bed of suffering," "and do not deliver him to the will of his enemies." From here we see that this is an expression of prayer, where he pleads: Do not surrender the sick person to the desire of his enemies; do not let him die.
A second possibility: this is not framed as a prayer, but as a description of reality. When the Holy One, blessed be He, sees the sick person's plight, on the day of evil Hashem rescues him. David is describing the reality: when the destitute person is in critical condition, when the patient is terminally ill, Hashem rescues him, Hashem sustains him, Hashem revives him - and not the doctors. His intent is to convey that healing depends entirely on the Creator, blessed be He, and even if one sees salvation coming through a doctor, it happens with the help of God. The doctor is an emissary, and one must never forget that. While it is probably not recommended to tell this to doctors - they do not like to hear it - we must know it: doctors are merely messengers. One must make every effort, the utmost hishtadlut possible, to provide medical care to the sick, but always remember that healing comes from Hashem. According to this interpretation, "and do not deliver him to the will of his enemies" is not a petition but a statement of fact: You, Hashem, sustain him, You rescue him, and You do not abandon him into the hands of his enemies.
A third approach is cited by the Radak in the name of his father - and as noted more than once, whenever an explanation is brought in the name of the Radak's father, one should listen with rapt attention, for his explanations are magnificent. He explains that these words are spoken by the one who is thoughtful of the destitute. The one "thoughtful of the destitute" is the visitor who comes to check on the sick person, observing and assessing what is happening with him in order to help, and then offering words of comfort to strengthen him so he will not fear the illness: "On the day of evil, Hashem will rescue him" - do not worry, Hashem will save you, Hashem will help you, Hashem will deliver you. These are words of encouragement and reassurance spoken by the visitor to the destitute patient. Thus, we have three explanations: either a prayer - please Hashem, rescue him; or a description of reality - Hashem rescues him and does not leave him solely in the hands of physicians, for salvation does not originate with them but with the Almighty; or words of encouragement and comfort spoken to the patient.
Rashi explains that "on the day of evil, Hashem will rescue him" refers to Gehinnom. Is there such a blanket guarantee for a sick person that Hashem will save him from Gehinnom? Rather, this verse does not speak of the patient, but of the one who is thoughtful of the destitute: you, who come to visit the sick person and perform an act of loving-kindness, on the day of evil Hashem will rescue you from Gehinnom in the merit of the kindness you performed.
The Metzudat David asks why the text specifically uses the word maskil [one who acts with discernment]. Seemingly, it could have said, "Fortunate is he who pays attention to the poor" - speaking of someone who visits the needy and comes to see what the sick person requires; why, then, maskil? Rather, it is because one must give charity with intellect and wisdom. He explains that dal here refers to an impoverished person in the literal sense, and giving charity requires wisdom and tact. For a person might come along, see someone begging, and enthusiastically say: "Come, I want to help you, you look terrible, I have an opportunity to do a kindness with you" - and in doing so, he has humiliated him, embarrassed him, and relegated him to the state of a public dependent while everyone watches him receive the handout. Such a person is foolish; he is a maskil spelled with a samech [from sachal, a fool] rather than a maskil with a shin [from sechel, wisdom]. "Fortunate is one who considers the poor" - give in an intelligent, tactful manner.
And what constitutes giving with discernment? For example, one gives his friend a loan, knowing the man is destitute, intending from the outset that this loan will ultimately be a gift. But saying, "Take a grant, you poor thing," compromises the recipient's dignity. Therefore, he tells him: "I understand you are facing a temporary squeeze; I can arrange a loan for you, as I have funds that I do not urgently need right now." He hands him the money, and the recipient feels at ease - he has taken a loan, not accepted an impoverished person's handout. Even tycoons take loans, only they receive debt haircuts; at any rate, he merely took a loan. Afterward, you convert the loan into a gift and decide never to collect it from him - which was your intention all along when you gave it. Through this, the money becomes tzedakah for him, and it turns out that the giver gave charity with wisdom and discretion, in a manner that caused no offense to the recipient.
The Malbim explains: "Fortunate is one who considers the poor" - fortunate is the person who contemplates, examines, inspects, and discerns the affairs of the destitute. Notice that according to the Malbim, this does not mean one who acts wisely to help the poor or do something for him, but rather fortunate is one who studies and reflects on what happens with the destitute, from which he will learn emunah. For through the very survival of the impoverished in the world, a person is preserved from hazards - and whoever contemplates the state of the poor clearly sees the Divine Providence of the Holy One, blessed be He, over the poor, the weak, and the downtrodden.
A wealthy person gives the impression that he is saved through natural means: here he has assistants, there he has helpers, here he paid someone to rescue him. All his deliverance appears to us as a natural salvation, as though not through Supreme Providence, for he trusts in his wealth, as it says, "A rich man's wealth is his strong city." But the destitute person possesses no means by which to be saved from the hazards of the world - by what power does his salvation come? By virtue of the individual Divine Providence that Hashem exercises over him. From here onward, the Malbim presents several examples of how Hashem saves the destitute, and fortunate is the discerning person who observes and reflects upon this, thereby recognizing the Providence of Hashem.
The first hazard: perils that arise from the harshness of the climate and season, which is the meaning of "on the day of evil" - a harsh day. What is the harshness of the season? For example, a winter day when, according to the calendar, torrential rains fall; or conversely, a day burning like a furnace, during the scorching days of summer. From this, "Hashem will deliver him" - he is saved through Hashem's Providence and not through natural means. You see that the Holy One, blessed be He, protects and saves him from all kinds of harm, and the first example is the harsh day, days of adversity, yet Hashem guards and saves the destitute. Subsequently, the Malbim explains each verse as an expression of an additional peril from which Hashem rescues the poor, and through this, your faith is fortified.
The Alshich connects this entire verse to the story related in the Gemara in Shabbat 156b. Astrologers told Rabbi Akiva regarding his daughter that on her wedding day she would die; this was what they foresaw. The Gemara recounts that on that wedding night, a poor man arrived, and no one noticed him, cared for him, or did anything on his behalf. Rabbi Akiva's daughter gave him charity; she stepped away from everything - the celebration, the music, the entire event - and went to care for that poor man, and through this her life was spared. The Gemara relates that Rabbi Akiva arose in the morning not knowing if his daughter was among the living, knocked on their door, and saw that, thank God, she was healthy and all was well. He asked them to look around; they looked and saw a snake in the wall with a hairpin thrust between its eyes. How had this happened? In those days, walls were not plastered as they are today, but constructed of bare bricks; she had removed the pin from her hair and stuck it between the bricks - straight into the eyes of the snake, which had already been primed to strike. In the merit of the mitzvah of kindness she performed, she was saved. Rabbi Akiva went out and expounded: "Tzedakah saves from death." The Gemara asks: Could this mean only from an unnatural death? The verse teaches: from death itself. That is, do not think tzedakah saves only from an unnatural death, God forbid from a traffic accident, but even from what is called a natural death - tzedakah saves even from that.
He comes to tell us here: Come and see, "Fortunate is one who considers the poor" - like the daughter of Rabbi Akiva, who set aside all her affairs to look after the needs of the destitute, to assist him and serve him a generous portion at the wedding. And not only is there salvation for a person when the merit preceded the danger - having performed the deed two days or a week prior - but know that even on the "day of evil" itself, when the decree is already active and the snake is already lurking right here, if you performed tzedakah on that very day, "Hashem will deliver him." It is not only through prior merits, but even if performed in the moment, as seen with Rabbi Akiva's daughter. This is also called a "day of evil", the day on which a harsh decree had been sealed according to the astrological sign of the day seen by the stargazers; yet despite all this, Hashem will deliver him and save him, for Hashem possesses the power to overturn the celestial constellations.
יְהֹוָה יִשְׁמְרֵהוּ וִיחַיֵּהוּ וְאֻשַּׁר בָּאָרֶץ וְאַל־תִּתְּנֵהוּ בְּנֶפֶשׁ אֹיְבָיו׃ - Hashem will preserve him and keep him alive, and he will be blessed in the land, and do not deliver him to the desire of his enemies.
The Radak explains: "Hashem will preserve him" - not only from an unnatural death, but even from death itself; even for a person whose time has come to die, additional life will be granted to him, and Hashem will preserve him from that death. "And keep him alive" - He will grant him yet more life. Furthermore, an additional blessing awaits him: "and he will be blessed in the land" - beyond the reward in the World to Come, he will receive the reward of a good life here in this world, and as a reward for giving charity, he will be fortunate even in this world.
Some offer a playful interpretation: A poor person comes to someone asking for charity and begins pouring out his dire situation, and the man responds: "Listen to me, sir, a person must have bitachon (trust) in Hashem. Know that despite the terrible situation you describe, if a person trusts in Hashem, Hashem will save him." He begins quoting Chovot HaLevavot and who knows what else, all to bolster the pauper's bitachon, yet he does not take a single penny out of his pocket! They say to you: Sir, when a poor man arrives, do not lecture him on faith; give him gelt, pull money out of your pocket and give it to him! And who were the heretics? The Maskilim, the Enlightenment movement. Therefore, it is said homiletically: Praiseworthy is the one who, when a poor person approaches him, becomes a "maskil" - he does not start preaching to him about trust in Hashem, but rather acts like a person without faith: "If I do not help him, who will?" Take out money and give it to him! Not that he should actually lose his faith, God forbid, but rather that he must not shower him with sermons of faith instead of helping him and providing what he needs.
Another homiletic explanation is brought in the book Shaarei Parnassah Tovah in the name of the Maharam Loanz: Chazal say, "The reward of a fast is the charity given" (Agra detanita tzidkata) - meaning the primary reward for a fast day comes from the charity distributed on it, and that is the simple meaning. Homiletically, this can also be explained as follows: a person who fasts physically experiences what an indigent person feels. Today we are unfamiliar with this, but in the past, an impoverished person was literally starving - not merely lacking delicacies, but lacking even a single slice of bread; he could literally be among those swollen with hunger, his stomach swollen from starvation. When does a person notice how the hungry feel? On a fast day, when he fasts and realizes what it means to go without breakfast and without lunch. Therefore, "The reward of a fast is charity": because a person fasts, he senses the poor man's hunger, and because of this he gives him charity, and in the merit of that charity he will be rescued from harm. This is what is written, "Praiseworthy is the one who considers the poor; on the day of evil [Hashem will deliver him]" - when is a person praiseworthy for considering the poor, gaining insight and understanding what the pauper is going through? "On the day of evil," meaning on a fast day, as Chazal expound on the phrase "to do evil or to do good" - a festive day or an "evil" day, which is a fast day. Such a person, who on a fast day considers the poor and empathizes with his plight, Hashem will deliver him, and he will merit that the Holy One, blessed be He, rescues him from all misfortune.
Rashi explains that "Hashem will preserve him and keep him alive" refers to the one who visits the sick: in this world too, Hashem will protect him and keep him alive, and not only rescue him from Gehinnom as Rashi explained on the previous verse. Radak, followed by Metzudat David, explains that "and he shall be praised in the land" (ve'ushar ba'aretz) is read like ye'ushar - since the written text has a yud and the reading tradition has a vav - meaning he will be praised throughout the land: everyone who witnesses the deeds of the one who considers the poor, who aids and assists the needy person, will proclaim how fortunate he is.
The Malbim continues along the same line: Praiseworthy is the one who reflects and learns from the individual Divine providence (hashgachah pratit) with which Hashem watches over the indigent, recognizing through this how intensely the Holy One, blessed be He, watches over His creations. Consider another form of misfortune - the hardships that surround the poor person regarding basic necessities: a person needs clothing, a person needs food. In this as well, "Hashem will preserve him and keep him alive": even though he seemingly lacks food and should have perished, you see that "I have not seen a righteous person forsaken, nor his seed begging for bread" - the Holy One, blessed be He, provides sustenance for all His creations and keeps even the destitute alive; although he lacks food, he still lives, Hashem still "keeps him alive."
Another dimension of providence: there are hardships caused by location. Even a wealthy person whose financial situation is sound often has to travel across the seas to earn his livelihood - sailing on ships, flying on planes, journeying to distant lands; the wealthy frequently bring their bread from afar. In contrast, observe the poor person: "and he shall be sustained in the land." He does not need to wander to the ends of the earth to search for food in foreign countries; rather, the Holy One, blessed be He, provides for him right here. In that very land he will be sustained and blessed through Hashem's providence.
And the fourth aspect: there are evils that surround a person due to enemies and adversaries who seek his harm, and concerning this it is said of this indigent person, "and do not deliver him to the will of his enemies" - You, Hashem, do not deliver him to the nefesh of his enemies, meaning You do not surrender his life to his foes. Radak explains that nefesh here means desire or will, as in "if it is your desire (im yesh et nafshechem)," which means "if it is your will"; "do not deliver him to the nefesh of his enemies" means do not fulfill the desire of his enemies. And what is the desire of his enemies? To kill him. Do not allow their wish to be fulfilled, for they long for his demise.
יְהֹוָה יִסְעָדֶנּוּ עַל־עֶרֶשׂ דְּוָי כָּל־מִשְׁכָּבוֹ הָפַכְתָּ בְחָלְיוֹ׃ - Hashem will sustain him on the sickbed; You overturn his entire bed in his illness.
What is "devai"? It is an expression of madveh, severe illness. A woman during her period of ritual impurity - the Gemara notes that this is a type of illness, which is why scripture states "the uncleanness of her illness (niddat devotah)" and "she who is sick in her impurity (hadavah benidatah)," which are expressions of illness; similarly, "and my heart is faint (ve-libi davai)," meaning my heart is sick. And what is the "bed of illness (eres devai)" in its most critical state? Rashi explains in the name of the Aggadat Tehillim: this refers to the seventh day of the illness, when it is intensely severe. Even so, Hashem will sustain him even on the most critical day of his sickness.
"You overturned all his lying down in his illness" - there are many explanations for this. Rashi explains: even at a time when his illness is severe and all his calm and rest have been overturned. In a normal, healthy state, a person is at rest; whereas when he is ill, it is as if his bed is overturned, for he no longer rests peacefully in his bed. This is what the verse tells you, "You overturned all his lying down in his illness": the illness has overturned his bed, so that he does not lie in peace, but rather lies upon a bed of suffering, pained by his distress.
And the Radak explains: ostensibly, the verse seems contradictory, since "Hashem will sustain him on the sickbed" is a benefit, while "You overturned all his lying down in his illness" sounds negative, posing a difficulty. Therefore, the meaning is: You will sustain him on the sickbed after You overturned all his lying down in his illness - after You transformed his bed from the bed of a person resting peacefully into a bed of illness, pain, and suffering, then Hashem will sustain him on the sickbed. He further explains that this is framed as a prayer: Master of the Universe, may Hashem sustain him on the sickbed, and please, "You overturned all his lying down in his illness" - overturn his bed from illness to health. According to this, the meaning of "overturning" is the opposite of the first explanation: not that You transformed his rest into illness, but rather please overturn his illness and bed into health.
The Malbim explains that here the verse comes to address the fifth danger: afflictions that surround a person due to his bodily constitution - illness and physical ailments; and from this too Hashem protects him: "Hashem will sustain him on the sickbed." Even though there is no one else to support him: a wealthy man has an entire hospital wing where everyone caters to his needs, he can buy out the entire hospital and has no problem having someone look after him; but this destitute man does not even have enough money to pay for basic healthcare, so who will watch over him? The verse tells you: Hashem will sustain him.
Likewise, "You overturned all his lying down in his illness" - when a person lies ill, often the sheets become soiled and soaked with sweat, and sometimes bedsores and pus develop, requiring someone to overturn his bed: turning the mattress over to the drier side and placing another blanket underneath him. A wealthy person has someone to do this for him, but the destitute man - who will attend to him? Therefore, You, Hashem, as it were, overturn his bed in his illness. The intention is not that Hashem literally comes to flip his mattress, but that Hashem watches over him so that this condition does not harm him - as if someone had made up and overturned his bed, Hashem provides even this for him.
The psalm was uttered during David's illness, when his enemies sought his life, and it opens with praise of one who is "thoughtful of the destitute": one who visits the sick and inquires what he lacks, one who gives charity with wisdom and dignity, and one who reflects upon Hashem's providence over the poor and draws faith from it. In the hardships of the era, in lack of sustenance, in the burden of displacement, against enemies, and in bodily ailments - in all of these, the destitute man lacks means, and in all of these it is revealed that he is saved solely through Divine providence. From here we learn that healing also comes from Hashem and the physician is merely an emissary, and that even the harshest decree is averted through the merit of kindness - as in the story of Rabbi Akiva's daughter, where even on the very day of calamity, "charity rescues from death."