The power of moving from life to death
defined for seminarians and health professionals

Participants in a seminary program on hospice care were, from right, Dr. Maurice Gross, Medical Director for the Abington Memorial Hospital Hospice Team; Lynn Staples, team nurse; Seminary Professor Timothy Wengert, Chaplain Judith Meckling, Social Worker Carmella McDowell and moderator and seminarian Priscilla Hukki.

PHILADELPHIA, PA (April 8, 2003) – When it comes to talking about death, most people don't.

Members of the Abington Memorial Hospital Home Care Department's Hospice Team visited The Lutheran Theological Seminary at Philadelphia to help an audience come to terms with that reality today. Listening were seminarians, pastors, and a variety of health care workers. The presenting team included a Roman Catholic social worker, an Episcopal Chaplain, a Lutheran nurse and a Jewish physician. They were joined by an LTSP professor. The professor, the Rev. Dr. Timothy Wengert, teaches the Lutheran Confessions at the seminary. He poignantly described his recollections of benefiting from hospice during the events preceding the death two years ago of his spouse, Barbara. They journeyed together through hospice over the last four and one half months of Barbara's life.

The team defined how folks qualify for hospice care. People need to be attended to by a primary caregiver, who may be a family member or companion or friend. A doctor certifies that participants have six months or less to live, though the prognosis may not be correct. Participants and their families and caregivers need to focus on comfort-directed care, and they need to be covered by medical insurance.

Dr. Maurice Gross, Medical Director for the Abington program, described the value of serving on the multi-faceted team and described the benefits he receives from being a physician in the program. He's served as the medical director since 1986. "It's very fulfilling work," Gross said. "We do this work, many of us, because we want to do it right when it is our turn." Gross, who has taught at MCP Hahnemann, Drexel University and Temple University, described the team's role as serving as "midwives, moving people from living to dying. And he remarked at one point, "I have this image that when it is my turn, the people I have worked with will be waiting for me with open arms on the other side, saying, 'Come in. It's fine.'" He said many families who are uninsured and truly need hospice support in society can't have it now because they are not part of a reimbursement system. "Many intricacies of how we deliver health care are hampered by the rules and regulations health care entails."

Team Chaplain Judith Meckling, an Episcopalian, emphasized that it is important for hospice patients to have the freedom "to determine where they are" in their journey. "When I identify myself as a hospice chaplain, many hear that the word hospice means death or dead," she said. The word chaplain to many means "judgment….It is not a happy statement for them. We need to start where the person is and where family members are. They present different pictures, and we need to be open and listening. She said hospice patients truly appreciate someone who is an authentic, open and listening presence in their lives. She encouraged seminarians and professional church leaders to help parishioners deal with the reality of death throughout their life journey. "Dying persons need four things," she advised. "To be able to love and receive love, to give and receive forgiveness, to identify meaning and purpose for their remaining life and to feel hope for the future." She noted that it is hard for teams like the Abington group "to be invited to do reflections like this. People just don't want to talk about it."

Social worker Carmella McDowell, a Roman Catholic eucharistic minister in her congregation, said most hospice families think in the beginning a social worker wants to know "all about a family's business, its money and how they should change." She said the perception is a fallacy. "All I am is an advocate for the patient," she says. "I help people prepare a living will and advanced directives so that what the patient wishes will be done. I help people understand who makes the decisions and help patients find those around them who will support their decisions." She also helps connect patients and their families to a variety of community resources, including such services as pet therapy. "We try to normalize the idea of death. We work to keep everyone on board in a family situation. There is nothing backdoor or sneaky about hospice. And we try to be gentle. It is truly for me a humbling, accepting experience." She said one of the challenges is to support in-home caregivers not to feel their role is diminished when they cannot control developments, such as when a patrient can no longer eat. "We help people feel competent as caregivers, and we tell them to take care of themselves," she said.

Lynn Staples, left, offers remarks while Professor Timothy Wengert, center, and Dr. Maurice Gross look on.

Lutheran parish nurse Lynn Staples described how she became committed to hospice by what she observed over 12 years as an emergency room nurse and also as a nurse for Betak, a former Philadelphia hospice program for victims of AIDS. She said hospice nurses work to reassure patients and make sure their pain medication is adequate. Nurses also teach families how to administer care to loved ones, what remedies to apply and how to absorb stress themselves. "It is a real high for me to be there for them," she saysShe said her experience has "demystified death. Many who are dying are not frightened by it. They actually may sense the presence in the room of someone who has gone on before," she said. She described a recent experience in which a dying patient said he feared pain the most as part of the experience. "One thing I can promise them," Staples said, "is that they don't need to be in pain." She said she often prays with patients who invite her to do so, " and I always pray for my patients. I find that the whole experience is not depressing, but joyful."

Tim Wengert described the hospice journey with his wife, who died of cancer, as more peaceful because of the support the family received from a Chestnut Hill Hospital program. While acknowledging that much of society is in denial about death, he noted that his seminary training and parish experience in the Midwest had generally acknowledged death as a daily reality. He said a blessing of the final months was that pain management care made it possible even in the final weeks for the family to go to theater in New York and attend church together. "And our own pastor was just wonderful," he said. "We knew in advance the importance of having a living will and being open with our children," he said. He discussed a few concerns. "A lot of folks wait until late in the process to be involved with hospice," he said, "because they believe that bad thoughts ruin your health and you die sooner." He urged listeners to be honest about death. "It will not cause you to die sooner." Also, he said that "some Christians have a misapprehension that admitting that one is dying is a sign of weakness in your own faith. They fear that somehow this is a sign of not trusting enough in God to deliver a miracle." He ventured that honesty provides for the possibility of a more peaceful experience. Wengert said he is grateful that hospice care made it possible for Barbara to die at home "and that I was able to sleep with my wife until the day she died." He told how he and his two children also benefited from grief therapy they experienced both with his wife before she died, and after her death. "Without hospice," Wengert said, "Barbara's death would not have been as good as it was."

The hospice convocation stimulated much discussion after the presentations. The convocation was made possible by students. The key planner, Priscilla Hukki, was moved by a field work assignment that made her part of the Abington team this year. Sponsors along with the hospital and the seminary included the Southeastern Pennsylvania Synod of the Evangelical Lutheran Church in America and its initiative for health care professionals.

For further information, visit the website of the National Hospice Foundation