HOSPICE CARE 

   Relative to the contemporary hospice care-giver, the psychopomp serves as an escort or bridge into the otherworld of death.  The modern medical staff delivers ultimate attempts to increase and maintain the patient's life-force.  When the patient is no longer viable the attending physician will dispense with the news of impending death, and may suggest hospice care.  Many hospital based physicians are ill prepared in the relinquishment of life, and the hospice system relocates the patient to an environment conducive to a respectful and dignified death.  The dying who are in hospice programs receive palliative (pain management through controlled drug  administration) and spiritual care.  The dying often acquire a beautiful and resolute closure to life because the care-giver  helped to make their transition tolerable, perhaps welcomed.

    The hospice atmosphere is one of an interdisciplinary team approach focused on the quality of the dying patient's life.  The dying patient is urged to be involved in decision making concerning their final hours unlike the technological control in hospitals.  Hospice care extends to the support of family members and the care givers, during the final days of the patient, and the bereavement period post-mortem.  Reestablishing a more traditional way of handling death the hospice serves as holistic branches of the medical models.

    The ritual of death care is an ancient one and psychopomps and Egyptian embalmers were the first to become distinguish with the vocation of certifying the dead.  The responsibility now lies with the intern tern society:

    You cover the floor while everyone else sleeps; you
    must wake the son in Teanneck or Brooklyn and tell him. 
    Not much is worse than calling a man you've never met
    to tell him his mother has died.  The groan.  The long,
    half awake silence.  The oh, no.  The Oh, what shall I do  
    now?...

   From the beginning of medical training, students are taught to have coolness and presence of mind, and to refrain from showing indecision and worry.  The founder of the hospice program at Camellia Cottage, Dr. E.J. Watson-Williams, made the following comments to a National Hospice Organization meeting in 1979:

    The physician in the modern Western civilization ...has
    been told by medical school admission committees that
    they are intellectually superior and inspirationally
    devoted to the service of others, to whom they are
    irreplaceable, ethically irreproachable, and never
    wrong....[The physician] works in a tradition that
    regards illness as a manifestation of a bad something,
    either from within or without the patient.  It is his 
    job to find out what is bad and then to remove it or
    destroy it. He has learned to treat the illness  rather
    than to care for the patient.

    Like a Master gardener who must know about the genus of the plant, its diseases, predators, fertilization requirements, ground surface, temperature, and location; the care-giver must know about the human body, medicine, and the patient's psycho-social world.  The hospice serves to reestablish traditional ways of handling death as holistic branches of the medical model.  The hospice care-giver attempts to circumvent the feelings of failure of the medical model, through becoming an integral unit.  The approach to the modern organization of dying is summarized by Paul Dubois, The Hospice Way of Death:

    1. The aim is to manage physical symptoms and offer as much comfort as possible.
    2. The unit of care is not a single individual but a community that includes the dying person,
        immediate relatives, and significant others.
    3. After the death of a patient, support services are offered to bereaving families.
    4. Institutionalized care is provided, with concern and support for the hospice staff.
    5. Staff members are selected with close attention paid to the ability to provide strong support to
        dying patients and their loved ones.
    6. The physical setting is designed to provide for privacy and offers the possibility of communal
        gatherings at the bedside.
    7. The presence of children is encouraged.
    8. Interaction among patients is encouraged.
    9. An interdisciplinary care team includes doctors, nurses, clergy, volunteers, and others.

    Robert Kaselbaum, Ph. D., coined the term "death system" in the early 1970's to describe a total range system which includes people; patients, families, staff, funeral directors, and sometimes police.
It also comprises places; hospitals, hospices, funeral homes, morgues, and churches as well as related behaviors such as sending flowers, attending memorial services, and publishing obituaries.  The death system is influenced by exposure to death, by life expectancy, and by one's views of individuality and reality.

    One hospice group in particular, Camellia Cottage, depicts the epitome of this specialized type of care.  Camellia Cottage is a small hospice on the grounds of Sacramento University of California at Davis Medical Center (UCDMC), opened in 1989.  This hospice was in fact a community of care-givers, a place of support and nurturing for staff, patients, and their families.  Employee faces were cheerful, and the aroma of coffee met one  upon entering the facility.  Cubicle furnishings were bright and colorful, and attractive pictures, photos, and bulletin boards could be found throughout the building.

    The hospice team cared for the patients, while the counselors assisted the hospice team.  Therefore, the health care professionals were also taking care of the health care professionals.  Weekly, the staff (including volunteers) met for a support group conference.  Trust was consciously maintained and was an expression of spiritual, emotional, and practical concerns.  An annual retreat was held for the hospice, continuing its support for members.  During the first retreat, a contract of commitment was written by the members pledging honesty; to regard compassion; to remain flexible; to actively listen; to be non-judgmental; to risk vulnerability through self disclosure which would demonstrate trust; and to let go of expectations regarding the outcome of the patients.    

   Recognition of the many psychological, sociological, and religious dimensions in living and dying confirmed the realization that dying patients are living human beings.  Hospice care celebrates the patient's spiritual values yet does not impose a particular religion.  The hospice members foster opportunities to actualize spiritual values whether the patient is an atheist, agnostic, Buddhist, Islamic, Catholic, or any of a variety of religions.  Universal spiritual aspects encouraged in a compassionate environment formulate hope for the dying, and offer a sense of wholeness.

    Any model of coping with the dying must provide a descriptive, theoretical framework for understanding, empowering, sharing with, and helping individuals who are coping with dying.  Models must leave individuals free to live out their own experiences during the living/dying interval and not falsify or distort the experiences they represent.

    Anthony Lee (1978) discovered that Near-Death Experiencers bore consequences from the NDE, and needed emotional care as a result of the Lazarus Syndrome or returning from the dead.   Lee's research was the result of investigations of NDE cardiac arrest patients, who after resuscitation reported the episode from an out-of-body situation.  The result was the following guidelines for cardiopulmonary resuscitation (CPR) patient care:

I.   When patient is in arrest and apparently unconscious:
    1. Avoid threatening language and subliminal suggestions;
    2. Assure the patient that care is being given as if he were fully conscious;
    3. Use comforting touch even during painful procedures.

II.  When the patient becomes conscious:
    1. Continue reassurance and support as the patient regains consciousness;
    2. Begin reality orientation as soon as the patient is lucid;
    3. Prepare the patient for transfer to the ICU/CCU or for any change in the personnel taking care of
        him.

III. Structure the environment to minimize stress in the ICU/CCU:
    1. Provide an environment of personal care;
    2. Provide as much privacy as possible;
    3. Give patients in proximity to the code [the 
       emergency area] immediate support;
    4. Prepare the patient and the family for the first visit;
    5. Give the patient an opportunity to express his fears
        and anxieties and to ask questions of concern to him.

IV. How to manage post-CPR reports of death experiences:
    1. Listen attentively to any report and allow the
       patient to complete the story;
    2. Be non-judgmental of what you hear no          
       matter how incredible it may seem;
    3. Give assistance in reconstructing the         
       events that confuse and worry the patient;
    4. Chart the experience and, if indicated, call a
       conference on the care plan.

 V. Follow-up care:
    1. Assess the impact of the experience on the patient's
       immediate behavior and evaluate what could have been
       done better;
    2. Intervention with the family;
    3. Assess the impact of the experience on long-term
       behavior of the patient;
    4. A final caution.  NDE'ers who are absorbed in the
       NDE are potential suicide risks, and should be
       monitored for prevention;
    5. Nursing programs to learn more about CPR patient
       care.  In service conferences were called on NDE, to            
       enable the staff to become more aware of the phenomenon.    

    The thanatologist is equipped with more data then ever before, regarding care-giving to the dying, which is inclusive of the terminally ill, and Near-death survivors.  In the case of the NDE, the patient has been given a reprieve from death.

    Cases of spontaneous remission from terminal disease are rare and are usually called miracles.  Brenden O'Regan, vice-president for research at the Institute of Noetic Science in Sausalito, California, analyzed data on miracles from all over the world.  After reviewing more than 3,000 individual articles and 860 medical journals in May of 1987, O'Regan established the legitimacy and commonplace of miracles, and advised, "It is not determination toward a specific goal, but rather acceptance of cosmic life laws and a desire to experience all sides of living to its fullest that sets the stage for miracle making.

    Three Semitic religions, Judaism, Christianity, and Islam formed the foundation of monotheism for contemporary western culture.  The return to life from the NDE and parapsychological events involving departure from what the Western religion calls events, are being studied by various educational disciplines to determine patterns and truths regarding the survivors' allegations.

    NDE survivors, however, have continued to reveal their flights from life into temporary death and back, with scrutinized documentation, as Thanatology and compassionate treatment become more pronounced.  Survivors are taken more seriously as they remarkably define the attitudes and atmosphere of the people and the area in which their bodies lay in transition.  The survivors who vividly recall the death scene and relate how they spoke with the dead, and interact from another plane with the living, appears to have legitimized dignity for the dying in the Western world.

    The first thanatologists to pioneer death studies were Herman Feifel and Cicely Saunders in the 1950's.  Jacques Choron, Robert Fulton, C.S. Lewis, John Hinton, Barney G. Glaser and Anselm L. Strauss, Jeanne Quint Benoliel, and Elizabeth Kubler-Ross, presented their research in the 1960's.

    Near-death studies in America, had their origin in the early 1970's with the work of psychiatrist Russell Noyes.  Significantly Noyes's work had two tendencies:

     1) the shift from the dominance of parapsychology to
         that of medicine in investigating near-death phenomena and;
     2) the attempt to study the experience of dying by                 
         interviewing near-death survivors directly.

     Kubler-Ross gained much prestige in the early 1970's as she aroused both public and professional awareness on the subject of the NDE.  Psychiatrist Raymond Moody, informed the world of the NDE in 1975 with his book Life After Death" (Atlanta: Mockingbird), which established elements common to the NDE. In 1977, Karlis Osis and Erlinder Haraldsson published, "the Hour of Death    (Mamaroneck, NY: Hastings House), an investigation of visions of the dying as reported by physicians and nurses.

    Researchers were brought together in Charlottesville, Virginia, in November 1977, by Moody and John Audette, a medical sociologist.  This meeting began the second phase of NDE research and the founding of a professional society called the Association for the Scientific Study of Near-Death Phenomena.   In 1980, Psychologist Kenneth Ring (1982) compared the NDE's of 102 persons who were ill, accident victims, and those who had attempted suicide.  Ring's research contained statistical analyses of his data, and was supplemented by extensive qualitative materials.  The following year the University of Connecticut established the International Association for Near-Death Studies. 

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