GetWellness Online Health Interview
Edited version, English version, Ava (UK)
"In our Western culture we are so focused
on creating things and keeping our lives busy
that we really don't give ourselves time to
contemplate death and other deep issues,"
says Pam Kircher, MD.
Dr. Pam Kircher is a board-certified family
physician and a board-certified hospice and
palliative care physician. She serves as the
Medical Director of the Wellness Center at Mercy
Medical Center. She has her counselling practice
in Durango, Colorado, USA and is the secretary
of the board of the International Association
of Near-Death Studies. In 1995, Dr. Kircher
published Love is the Link: A Hospice Physician
Shares Her Experience of Near-Death and Dying.
Since that time, she has spoken locally and
nationally about near-death experiences and
end-of-life issues.
GetWellness Online Health: Whether we
accept it or not, one day we will all die. Why
is there no preparation for death in our culture?
Dr. Kircher: In the Western culture,
we really emphasize doing or making things.
This is in great contrast to the Eastern cultures
where people contemplate death as a way of seeing
how to live. In our Western culture we are so
focused on creating things and keeping our lives
busy that we really don't give ourselves time
to contemplate death and other deep issues.
GWOH: Many people think that you are
negative or even morbid to talk about death,
although the Swiss physician, Elizabeth Kübler-Ross
has made many in the West more aware of that
subject. Yet why do most people always seem
to avoid any talk about death and dying?
Dr. Kircher: I think it's primarily
because of a fear of death, and this fear becomes
more intense when we don't talk to one another
about it. I think there has been great progress
since Dr. Kübler-Ross first began her work
with dying people in Chicago in the 1960's.
At that time the tradition among doctors was
that it was a bad idea to tell people they were
terminally ill. Medical students were taught
that if they talked to their patients about
the possibility that they might die in the near
future, they would hasten their deaths. When
Kübler-Ross first began talking to dying
patients, many doctors thought she was unkind.
It's amazing that she was even able to stay
in practice. Nowadays, many US medical schools
have courses on death and dying, and spirituality.
While that is a great improvement over medical
education in the 1960s, I feel that we still
have a long way to go in educating the medical
community about being with people who are dying.
GWOH: You mentioned fear earlier. How
do we deal with it?
Dr. Kircher: I think a lot of this fear
is a result of a strong emphasis on our bodies
to the exclusion of our minds and spirits. In
Western culture, many of us have come to see
ourselves as bodies only. Consequently, we feel
that when our bodies are gone, we are gone.
In contrast to this viewpoint, religious philosophy
strongly emphasizes Spirit. People who focus
on the spiritual aspects of themselves often
approach death in a more peaceful manner than
people who have only focused on their bodies.
Eastern culture generally concentrates on the
spiritual aspects of life and people in that
culture are not so fearful of death as we tend
to be in the Western culture.
GWOH: Please explain to us what death
implies, how does it differ from dying?
Dr. Kircher: I think of dying as a process
of approaching death. A lot of people are afraid
of the dying process itself because they are
afraid of the pain that might be involved. I
believe the hospice movement has been a great
step forward in helping to control symptoms
that are intolerable like pain or persistent
nausea. Today hospice care is providing much
better symptom management than dying people
have received in the acute care setting in the
past. The other difficult part of the dying
process is the necessity of learning to let
go. It begins when people can no longer do the
work by which they may have defined themselves.
It is difficult to say goodbye to activities
that one used to do, to the people in your life
and to everything you have known. As someone
who has experienced near-death, I have no fear
of death itself. I feel secure that when I die
that's not the end of everything about me. I
feel that my spirit will live on. A common theme
among people who have had a near-death experience
is an absence of fear about death. However,
there is still sadness about having to say goodbye
to every person and every thing we have known
on earth.
GWOH: Many like to hide the fact from
the ill person that he or she is actually dying.
What's the right approach?
Dr. Kircher: I have found that when
the family and the dying person can be totally
open and honest with each other, the last few
weeks of life can be the most powerful time
in life. This is when one can make sense of
relationships, say the things that need to be
said, and forgive one another for things that
have happened. Almost invariably, the person
who is dying knows it. I invite people to think
about how lonely it must feel not to be able
to talk about your own dying if that is the
one thing on your mind. Please do honor and
respect your loved ones by allowing them to
be open and honest about what is on their minds
when they are dying.
GWOH: But on the other hand, we have
the medical community that seems to treat death
or dying as a failure.
Dr. Kircher: I think that's something
doctors pick up in medical schools, though it's
never actually said. There is this thought that
we have so much technology that if we just know
enough we can do more procedures to save the
dying person. The truth is that every patient
will die at some point, but there is this sense
that 'Well, not while I am in charge, they won't
die.' Doctors tend to think they can make you
live another week by doing another procedure.
The patients may be able to live another week
or month, but how miserable will they be? Is
that something the patient really wants to do?
Or maybe the patient would rather not have another
procedure, but prefers symptom management only,
so that he or she can be comfortable enough
to focus on what they would like to say and
do before they die? So we need to be honest
about what we are offering.
GWOH: What kind of environment would
you consider to be the most conducive for someone
who is dying?
Dr. Kircher: The most conducive environment
is home. If people can get plenty of support
from a hospice, they are most comfortable in
their own home where their family can come and
go. Family members are often afraid of caring
for a loved one at home because they have no
experience in providing nursing care. But if
they have the help of a hospice that comes in
with nurses, volunteers and social support,
life is made easier for all. Most people I have
talked with who have cared for loved ones at
home have found it to be one of the most powerful
and truly wonderful experiences of their lives.
GWOH: Many elderly people live in nursing
homes. Which care facilities most closely approximate
a proper home environment?
Dr. Kircher: I think the best thing
is the in-patient unit of a hospice. These in-patient
units may be a wing of a hospital or a free
standing unit. Also, nursing homes often have
a special section for hospice care. In those
settings dying people can have hospice care
that includes music therapy and volunteer visits.
The goal is to make these environments as home-like
as possible.
GWOH: What sort of changes would you
like to see in the way death is dealt with in
our culture?
Dr. Kircher: I would like to see more
of an awareness of the ephemeral nature of how
long we are going to be in our bodies. I would
like to see people being more conscious of how
they are living their lives so that when they
are near the end of their lives they can look
back and say, 'This was the life I wanted to
live.' When I have been with dying people they
didn't dwell on what they had accomplished,
but they spoke of how they had related to their
loved ones and how they had connected with their
children. They spoke of the uselessness of long-held
grudges. They contemplated whether or not they
had honored their own deep inner needs. They
spoke of the need to respect mind, body and
spirit in daily life. I would like us to learn
from these people who were kind enough to tell
us what they were thinking at the time of death.
If we know that those are the issues that we
will be contemplating as we approach death,
then I would like us to develop a culture that
supports those values.
GWOH: How will a better understanding
of death and dying affect the way we live our
life or the quality of life we will live?
Dr. Kircher: The more we are aware of
the spirit world the less we grasp onto material
possessions. Life is much larger than our awareness
of the purely physical aspects. Keeping this
in mind on a daily basis has a profound impact
on how we live our lives. If each of us lives
a life that is fully aware of mind and spirit,
death will not be so feared. If we live a life
of peace, relationships will be positive, and
forgiveness will not be such an issue as we
approach death. And, most importantly, if we
live a life based on the values that we have
learned from people who are approaching death,
I believe that each day of our lives will be
fuller and richer and happier than we have ever
dreamed of!
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