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Compassion: Living, Loving, and Dying

Is it more difficult to be kind to those we love than to strangers and elderly?

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In a literal sense, compassion means to experience the suffering of another. Although this emotion compels us to reach out to strangers during tragic events, we have difficulty with compassion when those within our intimate circle anger us. Compassionate loving for people with dementia became key in the work of a professor at Stony Brook. And a case for compassionate care for the dying was made in a recent New England Journal of Medicine issue through a memoir as well as an article advocating palliative hospice training at nursing homes. In living, loving, and dying, compassion is the essence of our humanity.

The Greater Good Science Center at the University of California, Berkeley notes:

"While cynics may dismiss compassion as touchy-feely or irrational, scientists have started to map the biological basis of compassion, suggesting its deep evolutionary purpose. This research has shown that when we feel compassion, our heart rate slows down, we secrete the “bonding hormoneoxytocin, and regions of the brain linked to empathy, caregiving, and feelings of pleasure light up, which often results in our wanting to approach and care for other people."

Just why it is that even those with a compassionate nature can become enveloped in anger or disappointment is complicated. The Center research focuses on gratitude. Reseachers there have found that by turning to acts of kindness – even in the absence of feeling a gracious emotion – a positive response can be triggered. If you are at a difficult place, consider a three day gratitude plan to revitalize your love life.

Compassionate loving in hospitals, in nursing homes

Credit for the concept of compassionate loving often goes to Stephen Post, P.h.D, Founding Director of the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University, School of Medicine. Author of “The Moral Challenge of Alzheimer’s Disease: Ethical Issues from Diagnosis to Dying,” he was a voice for those whose minds had been hijacked by the memory thief. (1)

In a personal memoir, Robin Schoenthaler, M.D., portrayed how she became one with a dying patient. She depicted the humanity side of care in an NEJM issue which also discussed the dollars and cents spent on hospice care. (2)

Currently a radiation oncologist at the Massachusetts General Hospital, Department of Radiation, Dr. Schoenthaler talked of her internship at a Spanish-speaking hospital in southern California. She tells of a dying patient who taught her more than just "the nouns and verbs" of the language. She learned that by routinely translating word for word in her head, she found a new way of relating to patients. As such, she explained:

“It felt so much more graceful to say to a stranger, ‘You can redress yourself’ rather than, ‘Put your clothes back on.’ And I much preferred asking a rumpled patient, ‘How did you yourself sleep?’ rather than ‘How was your night?’”

In following a particular patient through life and then death, she was able to convey to the mother the simple words, ‘Se murio – She herself has died.’” Schoenthaler did not discuss how the daughter’s acute myeloid leukemia had returned nor did she attempt to translate what had taken place. Following the words, "Se murio," she added:

“And then I listened to the wailing of a woman in a village deep in Mexico who sounded as if her own marrow was being ripped from her bones, and it needed no translation at all.”

Such caring puts a different face on the dollars and cents of dying.

Nursing home hospice care

Despite the growing need for hospice care at nursing homes, the numbers do not add up to a savings in terms Medicare and Medicaid dollars. As such these entities do not provide incentives for nursing homes – at which it is reported that some 25 percent of the population will die – to make palliative end-of-life care a priority.

Mary Beth Hamel, M.D., Ph.D., in that same NEJM issue with Dr. Schoenthaler's perspective, wrote:

“Nursing homes must be able to provide excellent end-of-life care to all patients as an integral part of their mission, and all nursing, nursing assistants, social eory that with proper training such palliative care teams “would probably evolve to become more of a consultative role focusing on patients with the most challenging palliative care needs.”

The research interests of Dr. Hamel, Beth Israel Deaconess Medical Center, focus on end-of-life issues and decision-making. She points out that with proper training such palliative care teams “would probably evolve to become more of a consultative role focusing on patients with the most challenging palliative care needs.”

In essence as the population of elderly continues to grow, compassionate care should become the standard of care not just for the dying, but for all of the frail elderly -- even those with no family advocates. And for the “unbefriended” who are the lonely, the mentally challenged, demented, the social outcasts, in the absence of Mother Teresa, nursing homes will need fewer bean counters and more angels.

(Rita Watson, M.P.H., writes on issues affecting the elderly as a former recipient of the MetLife Foundation Journalist in Aging Award of the Gerontological Society of America and New America Media.)

References

The Moral Challenge of Alzheimer Disease: Ethical Issues from Diagnosis to Dying, Johns Hopkins University Press, 2000, Stephen G. Post PhD

Lessons in Medicine, Mortality, and Reflective Verbs, R, Schoenthaler, New England Journal of Medicine, Vol 372. No 19, 1787 - 89

Investing in Better Care for Patients Dying in Nursing Homes, M.B. Hamel, New England Journal of Medicine, Vol 372. No 19, 1858-59

Other articles on the elderly:

Copyright 2015 Rita Watson

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