Friday, May 18, 2007

Clinical Innovation, Hospice - The Hospice Innovation

The High Touch Part of High Tech/High Touch Medicine

Death be not proud, though some have called thee"

DEATH be not proud, though some have called thee
Mighty and dreadfull, for, thou art not so,
For, those, whom thou think'st, thou dost overthrow,
Die not, poore death, nor yet canst thou kill me.
From rest and sleepe, which but thy pictures bee, 5
Much pleasure, then from thee, much more must flow,
And soonest our best men with thee doe goe,
Rest of their bones, and soules deliverie.
Thou art slave to Fate, Chance, kings, and desperate men,
And dost with poyson, warre, and sicknesse dwell, 10
And poppie, or charmes can make us sleepe as well,
And better then thy stroake; why swell'st thou then;
One short sleepe past, wee wake eternally,
And death shall be no more; death

John Dunne

Juno Beach,Florida -- Most of us die before we reach 100. That's the nature of the human genome. Some of us die of "natural causes" at home or work; others die from the big killers - heart disease, stroke, cancer, obstructive lung disease- in hospitals; all of us die no matter what medicine's high tech tools have to offer.

For every high tech innovation, a corresponding high touch innovation crops up, For every mainstream theray, there's an alternative therapy. For every disease, there's a support group. And for every failed therapy, every disease, with every death across the Great Divide, there's a hospice.

My son, Spencer, who lives here in Juno Beach, has made my wife and me proud of his role in the hospice movement. He's training to be a hospice chaplain, one of those saintly souls who visit the dying, listen to their stories, commiserate with their spouses and relatives, prepare them to die in peace, comfort them, and cater to their spiritual needs.

Yesterday, with our son, my wife, Loretta, a fomrer Massachusetts General Hospital nurse, and I attended a session of session of a group training to be hospice chaplains. It was led by Philip Kittle, PhD, senior chaplain of the Hospice of Palm Beach County. The mission of the hospice is "to serve the spiritual needs of Palm Beach County."

The session opened with a white paper on the theological nature and structure of "sin," and was followed by a verbatim presentation by one of the aspiring chaplains. The "verbatim" consisted of a three page case study, written and read by one of the chaplain want-to-bes. The case for the day concerned a Jewish woman whose spouse of 25 years was dying of cancer. Her problems were two-fold: one, difficulty in talking to her husband about his imminent death; and two, conflicts with her husband's three sons from a previous marriage. The discussion swirled around the trainee's intraction with the wife, her dying husband, and the three sons. In a separate meeting, I was told, an interdisciplinary team- the chaplain, nurses, and doctors - would lay out the plan for the patient.

Our session with the trainees inspired my wife and me. It made us realize we are in this thing called life and death together. All of us need compassion and comfort and coming to grips with our mortality at the end.

The hospice movement, now about 30 years old in the United States, has become a major force in U.S. health care. Hospice tends to the dying in freestanding hospice units, in hospice hospital wings, in long-term nursing facilities, and in patients' homes. It is an inspiring movement. It has inspired our son, who has decided to become an Episcopalian priest, ministering to the needs of the dying. We are proud of him.

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