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Using Literature to Teach About Death and Dying

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Using Literature to Teach About Death and Dying Martin Donohoe Physician Responses to Death Meditative introspection: Richard Selzer ( In Praise of Senescence ... – PowerPoint PPT presentation

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Title: Using Literature to Teach About Death and Dying


1
Using Literature to Teach About Death and Dying
  • Martin Donohoe

2
Oliver St. John Gogarty
  • Turn back now if you are not prepared and
    resigned to devote your lives to the
    contemplation of pain, suffering and squalor. . .
    . Your outlook on life will have none of the
    deception that is the unconscious support of the
    layman to you all life will appear in transit. .
    . .

3
Oliver St. John Gogarty
  • You will see . . . the pull of the grave that
    never lets up for one moment, draw down the
    cheeks and the corners of the mouth and bend the
    back until you behold beauty abashed and life
    itself caricatured in the spectacle of the
    living, looking down on the sod as if to find a
    grave.

4
Oliver St. John Gogarty
  • . . . You can never retreat from the world, which
    is for you a battlefield on which you must engage
    in a relentless and unceasing war from which you
    know that you can never emerge victorious.

5
Illness and Death
  • Exposure
  • Loved ones, friends
  • Patients
  • Self (Lewis Thomas)
  • Responses
  • Own mortality

6
Somerset Maugham Of Human Bondage
  • Doctors see human nature taken by surprise, . .
    . The mask of custom torn off rudely, showing the
    soul all raw.

7
Death and Health Care
  • Changes in practice over last century
  • Home ? Hospital ? Home
  • Increased openness
  • Decreased stigmatization
  • Awareness of emotional, social, economic, and
    cultural factors
  • Clinical protocols to achieve a better death
    family involvement hospice etc.

8
Improvements in the Care of the Dying
  • Symptom management in the dying patient
  • End-of-life care discussions
  • Appropriately use of do-not-resuscitate orders

9
Improvements in the Care of the Dying
  • Managing conflicts regarding decisions to limit
    treatment
  • Withdrawing intensive life-sustaining treatment
    compassionately
  • Facing requests for physician-assisted suicide

10
Nevertheless
  • Studies show need and desire for further training
    in death and dying and end of life care among
    medical students and trainees

11
Need for Improvement
  • Physicians communication with patients about
    advance directives is less than ideal
  • Patients often leave routine advance directive
    discussions with serious misconceptions about
    life-sustaining treatments
  • Significant portion of patients misunderstand
    their options in end-of-life care

12
Need for Improvement
  • Physicians are frequently unaware of their
    patients preferences for site of terminal care
    and wishes regarding do-not-resuscitate status
  • Family members are troubled by the amount of pain
    that they perceive their dying loved ones
    experience in their last days.

13
Larry Churchill
  • Death is a non-technical solution problema
    problem of the human condition. It call less
    for the mystery of quantifiable factors in formal
    knowledge than for depth of insight, acuity of
    perception, and skills in communication, namely,
    the sort of expertise which is traditionally
    association with literature.

14
Physician Responses to Death
  • Sadness/Grief
  • Lewis Thomas, The Youngest Science
  • Intern weeps while presenting case at Morbidity
    and Mortality conference
  • William Carlos Williams, Dead Baby

15
William Carlos Williams Dead Baby
  • Describes a funereal scene in which the corpse,
    a curiosity/ lays surrounded by fresh flowers
    in a clean-swept home.
  • Apparent order only temporarily conceals the
    powerful emotions of the mourners

16
(No Transcript)
17
Physician Responses to Death
  • Fear
  • John Keats, When I Have Fears
  • Willliam Carlos Williams, Danse Pseudomacabre

18
John Keats When I Have Fears
  • When I have fears that I may cease to be Before
    my pen has gleaned my teeming brain
  • . . . then on the shore
  • Of the world I stand alone, and think
  • Till love and fame to nothingness do sink.

19
(No Transcript)
20
William Carlos Williams Danse Pseudomacabre
  • Christ, Christ! How could I bear to be
    separated from this my boon companion, to be
    annihilated, to have her annihilated? How can a
    man live in the face of this daily uncertainty?
    How can a man not go mad with grief, with
    apprehension.

21
Michel de Montaigne
  • It is not death that alarms me, but dying.

22
Physician Responses to Death
  • Anger
  • William Carlos Williams, Death

23
William Carlos Williams Death
  • Hes dead / the old bastard / . . . / a
    godforsaken curio / without / any breath in it /
    . . . / . . . Making love / an inside howl / of
    anguish and defeat.

24
Physician Responses to Death
  • Recognition, Acceptance
  • Anton Chekhov, Ward Number Six
  • W. Somerset Maugham, Sanatorium

25
Anton Chekhov Ward Number Six
  • Dr. Andrew Yefimych accepts suffering and death
    as inextricable, even ennobling, aspects of the
    human condition
  • To despise suffering and death would mean to
    despise ones own life.

26
W. Somerset Maugham Sanatorium
  • The tuberculous Mr. Chester grows to accept the
    nurturing companionship of his wife, whom he had
    alienated out of resentment for the fact that she
    would live while he must die. At the tales
    conclusion, he says
  • I dont mind dying any more. I dont think
    deaths very important, not so important as love.

27
Physician Responses to Death
  • Humor
  • Samuel Shem, House of God

28
Samuel Shem House of God
  • Exhausted interns use sick humor as a defense
    mechanism against the tragic and unexplainable
    deaths they encounter.
  • Serves a protective function, allowing them to
    laugh at whatwhen seen in normal, rather than
    grotesque termsmight make them quake or cry.

29
Woody Allen
  • I'm not afraid to die, I just don't want to be
    there when it happens.

30
Clarence Darrow
  • I never wanted to see anybody die, but there
    are a few obituary notices I have read with
    pleasure.

31
Physician Responses to Death
  • Frustration, Futility
  • John Stone, Answering the Phone

32
John Stone Answering the Phone
  • Worn down by the death of neighbors, patients and
    friends, expresses his frustration and feelings
    of futility, he picks up the receiver / and
    say(s) not hello but / now what / now what?

33
Physician Responses to Death
  • Meditative introspection
  • Montaigne To learn philosophy is to learn to
    die
  • Rainer Maria Rilke Each man bears Death within
    himself, just as a fruit enfolds a stone.

34
Physician Responses to Death
  • Meditative introspection
  • Richard Selzer (In Praise of Senescence)
  • One way to confront death is to think about
    it, to philosophize, and thereby to peel away the
    fruit to discover the stone within ourselves.

35
Physician Responses to Death
  • Denial Insecurity
  • Richard Selzer (The Exact Location of the
    Soul)
  • Describes a physician who, uncertain of his
    ability to heal, pretend(s) . . . that there is
    nothing to fear, that death will not come so long
    as people depend on his authority. Yet later,
    after his patients have left, he closet(s)
    himself in his darkened office, sweating and
    afraid.

36
Responses to Death
  • Comfort from belief in afterlife
  • John Donne, Death be not Proud

37
John Donne Death be not Proud
  • Death be not proud, though some have called
    thee Mighty and dreadful, for thou art not so.
    For, those, whom thou think'st thou dost
    overthrow. Die not, poor death, nor yet canst
    thou kill me.

38
John Donne
  • When one man dies, one chapter is not torn out
    of the book, but translated into a better
    language.

39
Woody Allen
  • I don't believe in an after life, although I am
    bringing a change of underwear.

40
Physician Responses to Death
  • Surprise
  • John Stone, Death

41
John Stone Death
  • Death / I have seen / come on / slowly as rust
    / sand / or suddenly / as when / someone leaving
    / a room / finds the doorknob / come loose in his
    hand.

42
(No Transcript)
43
Other Recommended Readings
  • The Giftby Allan L. Kennedy
  • Brief story of physician duped by angry wife who
    requests continued aggressive care of her
    moribund husband in order to prolong his
    suffering
  • Medicine, by Alice Walker
  • Poem on marital devotion and love as palliative
    medicine.

44
Other Recommended Readings
  • Man is only a reed (from Pensées), by Blaise
    Pascal
  • Cognition and awareness of death ennobles man.
  • In the room where my father died, by Joan I.
    Siegel
  • Death in the context of the modern intensive care
    unit.

45
Other Recommended Readings
  • Confluence at lifes extremes, by David A.
    Silverman
  • Short tale on the rewards of geriatrics.
  • Essays by Roger Bone
  • Well-known intensivist, who wrote searchingly and
    poignantly of his own death from cancer.

46
English Proverb
  • Death always comes too early or too late.

47
Samuel Johnson
  • It matters not how a man dies, but how he
    lives.

48
Mark Twain
  • Let us endeavor so to live that when we come to
    die even the undertaker will be sorry.

49
References
  • Donohoe MT. Reflections of physician-authors on
    death literary selections appropriate for
    teaching rounds, J Palliative Med
    20025(6)843-8.
  • Numerous open-access slide shows, articles,
    syllabi, and links available on phsj website

50
Public Health and Social Justice Website
  • http//www.publichealthandsocialjustice.org
  • http//www.phsj.org
  • Contact Info
  • martindonohoe_at_phsj.org
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