Title: Using Literature to Teach About Death and Dying
1Using Literature to Teach About Death and Dying
2Hector Berlioz(upon first visiting the
dissecting room as a medical student)
- At the sight of that terrible charnel-house
the fragments of limbs, the grinning faces and
gaping skulls, the bloody quagmire underfoot and
the atrocious smell it gave off, the swarms of
sparrows wrangling over scraps of lung, the rats
in their corner gnawing the bleeding vertebrae
3Hector Berlioz(upon first visiting the
dissecting room as a medical student)
- such a feeling of revulsion possessed me that I
leapt through the window of the dissecting room
and fled for home as though Death and all his
hideous train were at my heels.
4Oliver 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. .
. .
5Oliver 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.
6Oliver 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.
7Illness and Death
- Exposure
- Loved ones, friends
- Patients
- Self (Lewis Thomas)
- Responses
- Own mortality
8Somerset MaughamOf Human Bondage
- Doctors see human nature taken by surprise, . .
. The mask of custom torn off rudely, showing the
soul all raw.
9Death 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.
10Improvements in the Care of the Dying
- Symptom management in the dying patient
- End-of-life care discussions
- More appropriate use of do-not-resuscitate orders
11Improvements 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
12Nevertheless
- Studies show need and desire for further training
in death and dying and end of life care among
medical students and trainees
13Need 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
14Need 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.
15(No Transcript)
16Larry 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.
17Physician 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
18William Carlos WilliamsDead 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
19Physician Responses to Death
- Fear
- John Keats, When I Have Fears
- Willliam Carlos Williams, Danse Pseudomacabre
20John KeatsWhen 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.
21(No Transcript)
22William Carlos WilliamsDanse 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.
23Michel de Montaigne
- It is not death that alarms me, but dying.
24Physician Responses to Death
- Anger
- William Carlos Williams, Death
25William Carlos WilliamsDeath
- Hes dead / the old bastard / . . . / a
godforsaken curio / without / any breath in it /
. . . / . . . Making love / an inside howl / of
anguish and defeat.
26Physician Responses to Death
- Recognition, Acceptance
- Anton Chekhov, Ward Number Six
- W. Somerset Maugham, Sanatorium
27Anton ChekhovWard 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.
28W. 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.
29Physician Responses to Death
- Humor
- Samuel Shem, House of God
30Samuel ShemHouse 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.
31Woody Allen
- I'm not afraid to die, I just don't want to be
there when it happens.
32Clarence Darrow
- I never wanted to see anybody die, but there
are a few obituary notices I have read with
pleasure.
33Physician Responses to Death
- Frustration, Futility
- John Stone, Answering the Phone
34John StoneAnswering 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?
35Physician 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.
36Physician 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.
37Physician 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.
38Responses to Death
- Comfort from belief in afterlife
- John Donne, Death be not Proud
39John DonneDeath 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.
40John Donne
- When one man dies, one chapter is not torn out
of the book, but translated into a better
language.
41Woody Allen
- I don't believe in an after life, although I am
bringing a change of underwear.
42Physician Responses to Death
- Surprise
- John Stone, Death
43John StoneDeath
- 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.
44(No Transcript)
45Other 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.
46Other 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.
47Other 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.
48English Proverb
- Death always comes too early or too late.
49Samuel Johnson
- It matters not how a man dies, but how he
lives.
50Mark Twain
- Let us endeavor so to live that when we come to
die even the undertaker will be sorry.
51References
- 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
52Public Health and Social Justice Website
- http//www.publichealthandsocialjustice.org
- http//www.phsj.org
- Contact Info
- martindonohoe_at_phsj.org