Saturday, November 17, 2007

Dying a Secular Death; Hospice Documentary; Pal-Pourri

#1) Dying a Secular Death
The process of dying and the final result are often times that people reflect on some of the deeper religious issues. People of strong faith find great support or maybe difficult questions to their beliefs, people who never had a traditional belief go back to their family roots or adventure out to discover religions that they have never been exposed to. Whatever the experience near the end of life a common recurring theme is belief, religion, spirituality, whatever you want to call it.

Hospices and palliative care teams embrace this discovery of spirituality and are usually very open to all faiths. Most HPM practitioners I have worked with are eager to learn about different traditions and backgrounds and how those beliefs are important to their patients. But I have seen hospice and palliative care teams struggle occasionally when working with those without a traditional faith, specifically atheists and agnostics. Maybe it is the lack of a framework or belief in the afterlife that is common to so many religions, maybe it is the long-held negative yet erroneous view of atheists as people without morals, I am not sure what it is exactly. Without a common traditional religious structure to find common language care for the unbelieving patient can be more difficult for some. And I don't think the answer is as simple as, "Well at least they don't need to see a chaplain."

A reader tipped me off to a score of essays published in Free Inquiry magazine (Oct/Nov 2007) about experiencing the end-of life from a secular/atheist perspective. Most of the essays address the survivors issues such as how to have a ceremony without the religious infused language, or even whether to have one at all. I have read most of the essays and there are not many that give voice to the dying person's view on unbelief as they are dying, which is a shame, but understandably a hard task to do given that dying patients rarely write essays.

There are surely some to skip, such as the one on Cyronics, but others seem to give some good general advice from the bereaved. Some of the best quotes I think can be applied to all patients and families in general.

Janet Factor writes in "The Gift of A Wise Man":

"...the price of love is loss. No matter how happy, no matter how perfect and true the love, it will one day end in tears, for we cannot escape our own mortality."

"Without the understanding that we are mortal, we cannot appropriately value our own lives."
Richard T Hull in "Celebrate the Myriad Ways":
"We could have taken offense at much of what went on at the service and much of what was said to us before or afterwards. But it occurred to us that uncritically accepting the outpouring of others’ consolations was the essence of what it is to be a humanist: one who seeks to understand and celebrate the myriad ways in which humans try to deal with the tragedies and stresses of life."
Jean Kazaz in "People Don't Die, Do They?":
"Tolstoy’s terror of death did not subside until he underwent a religious conversion that convinced him that there really is more life after death. Nothing else would calm the panic that he so artfully projected into the character of Ivan Ilyich. My children were much more Tolstoyan three-year-olds than I ever dreamed I would have, but, in the end, they didn’t need Tolstoy’s solution. The subject simply went away."
The essays are all available free online, or you could possibly find Free Inquiry magazine in a large bookstore. (It took me going to three different bookstores to find this magazine.)

Also note the recent JPM article by Marilyn Smith-Stoner, RN on End-of-Life Preferences for Atheists for further info.

(Thanks for the tip Kathleen J)

#2) Hospice Documentary - 203 Days

Bailey Barash, a documentary filmmaker, has a great 30 minute documentary about the last 203 Days of Sarah Neider, a hospice patient. You can watch the film for free, but if you are involved in end-of-life education at any level, I highly recommend you pick up a DVD (Pallimed is getting no kickbacks, FYI). And you are supporting a filmmaker who is a hospice volunteer, and encourage others to focus on telling these great stories that we all see everyday. It is important to note the filmmaker has a lot of production experience including being an Executive Producer for CNN, so this is not just an amateur production.

After watching the film, it was easy to see how easily the short film could fit into hospice agency orientations, fellowship programs, Hospice 101 talks with medical/nursing students, whatever. The basic story live of a hospice patients last several months reviewed in under 30 minutes makes this a valuable resource to our field.

->AAHPM and HPNA have selected the 9 cases to be presented at the Annual Assembly by HPM practitioners in training (RN, DO, MD, etc.). It was a lot of fun reading the cases and there were a lot of good ones, so it was hard to select the final 9 (up from only 6 cases we were slotted for initially!) You can read more about the process at the unofficial AAHPM PIT-SIG Blog.

->Grand Rounds was recently covering pain issues at Counting Sheep (a nurse anesthetist blog)

->ERNursey and SICU Queen get into it about over-treatment in the hospital. Warning some language may not be suitable for all ages.

->Andy Billings, Susan Block and the faculty at Harvard are at it again. They have finished yet another year of PCEP, which is a great opportunity for HPM practitioners of all levels, and have now decided to tackle another working conference with the Harvard Medical School Palliative Medicine Leadership Forum for Junior Faculty Leadership Retreat. The deadline is December 7th, so get crackin'. The applications for PCEP are due January 15th, 2008 for the next session too. PCEP (Palliative Care in Education and Practice) is a great educational and networking resource. To show you how much fun it is I made a video after my experience in 2004.



Questions for readers:
1) Any revelatory experience in caring for atheists at the end of life?
2) Are you a alumni of the Harvard PCEP program, and if so, what would you want to tell others about it?

Feel free to leave some comments!

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