Not only did hospitals entice with medicine and procedure; they also offered a welcome respite to families and community members saddled with the burden of caring for the sick and dying.Page 82
My patient Diana died in the hospital but still experienced and art of dying, an ars moriendi. She outlived her prognosis by years and thus had ample time to consider what preparations would be necessary for dying in her own home. Despite the best planning, she ultimately found the hospital a more hospitable place to die.Pages 85-86
Despite this, there exist many sound reasons to avoid hospital dying.Page 86
Figuring out how to die at home requires planning.Page 90
Dr. Dugdale helpfully considers many of the pluses and minuses of dying at home and dying in a hospital. Several of your comments on last week’s discussion post brought up difficulties and challenges that can make dying at home undesirable both for dying persons and family members. In the first passage I quoted above, Dr. Dugdale recognizes how such difficulties partly explain why more and more people die in hospitals. This development, as Chris pointed out in a comment in last week’s post, is similar to modern trend of more and more people being born in hospitals. I found that to be a fascinating comparison. I think most of us who, with Dr. Dugdale, find the trend toward hospital deaths somewhat troubling, do not find the trend toward hospital births troubling in the same way. I think there are good reasons for that that which we have discussed and will further discuss as we read through this book. I think that comparison is fascinating because it invites us to consider how those two phenomena are the same and how they are different. One way they are different is that hospitals have labor and delivery units to assist those who are birthing, but they don’t have units to assist those who are dying. Or do they?
It strikes me as curious that Dr. Dugdale gives much consideration to the pluses and minuses of dying at home and dying in a hospital, but does not consider the merits dying in a hospice facility. She mentions home hospice in this chapter, but makes no mention of hospice facilities. Dr. Dugdale and I have both lived in New Haven, CT and New York City and are familiar with many health care facilities in both places (albeit in different ways as a physician and a priest). I am aware of several excellent hospice facilities in those areas: Connecticut Hospice near New Haven, Rosary Hill in Hawthorne, NY, and Calvary in the Bronx. I’m sure Dr. Dugdale has at least some familiarity with these places and others like them. I don’t know why she doesn’t consider this option in her book.
It seems to me that hospice facilities provide dying persons and their families many of the desirable features of both the home and the hospital. They are more welcoming to visitors than hospitals and focus of comfort rather than cure. At the same time, they provide the expert medical care, adequate space, and equipment that may be lacking at a dying person’s home. I’m sure the expense is often considerable (though Rosary Hill is free for the cancerous poor), but they are surely less expensive than most hospitals. I don’t know how the expenses of hospice facilities compare to the costs of outfitting a home to meet a dying person’s needs. I have a fair amount of experience ministering to people in hospice facilities, and more experience with terminally ill patients in hospitals who are considering discharge to a hospice facility. That seems to be a good alternative for many people. But perhaps that is a particular characteristic of urban areas with high populations. Maybe hospice facilities are not an option for dying people and their families in most parts of the country?
I said (self-questioningly) that hospitals don’t have units to assist the dying. I do not know of any hospice facility that is part of a hospital or attached to one. Mary Manning Walsh, the nursing home where I and my brother Dominicans provide pastoral care, has a hospice floor that is connected with Calvary. And many hospitals do provide palliative care, which aims to relieve symptoms and stresses associated with serious illness. The goals of palliative care are similar to hospice care, but palliative care in a hospital can coincide with curative treatment. For that reason, palliative care in a hospital may do little to insulate patients from the problems associated with what Dr. Dugdale calls the “rescue fantasy.”
Several weeks before he died, Jesse taught a master class from the hospital bed in his living room. He recognized that this would be the last opportunity to gather his students together, and in true ars moriendi fashion he used the occasion to exhort them.Page 88
This aspect of the ars moriendi, the final exhortation, teaching, or imparting of wisdom, is one we have not yet considered. I would be curious to know if you have experienced some form of this at the death of your loved ones? I have not experienced that personally, but I do experience it as a Dominican. We recite a prayer every week called the Spem Miram, which refers to St. Dominic’s death-bed promise:
V. O Wonderful hope which you gave to those who wept for you at the hour of your death, promising that after your death you would be helpful to your brothers. R. Fulfill Father what you have said and help us by your prayers.