“Footprints on the Sands of Time”

ABSTRACT

The author's reflections on Becky's legacy (see Werth, this issue) revolve around the idea that she can serve as a role model and that Becky's and Jim's experiences provide guidance to others who will inevitably go through the dying process. She also highlights several themes she saw in Werth's article: a cultural revolution around dying, the individuality of the dying experience, the need to expand the framework of care for the dying, and access to care and limits on access. She concludes by focusing on the need for communication between the dying person and loved ones.

Notes

¹In this country, doulas primarily function as assistants to pregnant women. A doula is a woman who gives continuous physical, emotional, and informational support during labor and birth. Doulas may also provide postpartum care services in the home. This concept has been adapted successfully by several programs for dying individuals. The Jewish Home and Hospital Lifecare System's (New York) program, “Doulas to Accompany the Dying,” is an award-winning example of such programs.

²In the early years of this century death was an accepted part of our culture. People died at home surrounded by loved ones, in peace and with dignity. But the medical miracles that flowed from the 1960s soon led us to the serious misconception that if physicians practiced their science correctly, they could conquer death or at very least postpone it indefinitely. Thus death was seen as a defeat—a defect of doctoring and a shortcoming in patients who failed to stay alive. Death became a source of shame and we successfully pushed it from sight, behind closed doors, into intensive care units, out of professional school curricula.

³See www.rallyingpoints.org

⁴ Clinical Practice Guidelines for Quality Palliative Care. National Consensus Project for Quality Palliative Care. Consortium Organizations: American Academy of Hospice and Palliative Medicine, Center to Advance Palliative Care, Hospice and Palliative Nurses Association, Last Acts Partnership, National Hospice and Palliative Care Organization. See www.nationalconsensusproject.org.

⁵As Jim Werth points out, death is not primarily a “medical event” and to provide for satisfactory completion of this life cycle event, trained providers should be available who can competently attend to the psycho-social and spiritual needs of patients and their families.