When a rabbi's heart fails during the High Holy Days, both medical and spiritual crises unfold simultaneously. Through autobiographical reflection, Rabbi Alexander M. Shapiro chronicles his second major cardiac event—occurring twelve years after his initial heart attack and bypass surgery—and its profound implications for religious leadership. The narrative traces his journey from the sudden onset of symptoms through hospitalization, treatment, and recovery, revealing the complex interplay between physical health and spiritual duties. As Shapiro observed Yom Kippur from his hospital bed, struggling with delirium and unexplained fever, he encountered unique challenges in maintaining religious observance while confronting mortality. His experience illuminates both the temporary effectiveness and ultimate limitations of cardiac bypass surgery, while demonstrating how interfaith community support and prayer became crucial elements of healing. The account details innovative adaptations of religious practices within the hospital setting and documents how congregational support enabled a transformative restructuring of pastoral responsibilities. Beyond personal narrative, the findings point to urgent systemic challenges within contemporary rabbinical practice, leading to specific recommendations for rabbinical organizations and synagogue leadership. Shapiro calls for institutional reforms to address occupational health risks, reduce clerical stress, prevent burnout, and improve work-life balance—changes essential to addressing the high rates of professional attrition and divorce within the rabbinate.