IT is yet another dark, wet winter afternoon. The wind is icy. The long driveway leading towards Our Lady's Hospice, Harold's Cross, in Dublin, is no more bleak than any other place on a grim day when sunlight appears to be little more than a distant memory. Two men are walking slowly away from the hospital buildings and seem exasperated more by the rain than the setting. But a small group leaving Caritas, the Palliative Care Unit which was opened in 1993, are cheerful. The gaunt faced elderly man sitting in a wheelchair being pushed by a young woman, probably his daughter, and accompanied by his wife, is leaving for home.
It is so easy to forget that many patients do go home from the hospice. Often a stay is a practical way to allow those caring for a patient at home have a rest.
Space and light are vital here. It is bright and warm inside the Caritas unit which has 36 beds, including four bed wards and large, private rooms which open onto the gardens. Decorated in plums and pinks, it is deliberately non institutionalised. There are no corridor discussions the doctors make a point of bringing relatives to a smart, restful sitting room. The happy, well equipped nursery room with its Disney themes and motifs may surprise the visitor, but children are welcome here. Many of the visits span several hours, at times family members and friends will stay over. Cashel, a large three year old golden labrador and failed guide dog "he got too excited at the traffic lights" pads about the corridors. Friendly and sweet natured, Cashel is a comforting presence as are the children who visit. The hospice is intended as a place of living, although many of the patients know that they are terminally ill, the emphasis is placed on quality of life and also on the idea of teams both among the staff and the patients participating in the various activities.
Art and craft sessions as well as poetry readings and workshops are organised daily and are also open, to patients attending day care. It seems a lively, busy atmosphere not like a place of death.
Founded in 1879, Our Lady's Hospice, known to generations of Dubliners as The Hospice for the Dying remained synonymous with death long after its name was changed and removed from the famous sign over the gate. Mother Mary Aikenhead founded the Sisters of Charity in Dublin in 1858, to serve the poor. The initial version behind the founding of the hospice 21 years after her death in 1858, was to provide care for the dying poor of Dublin. The woman who made the hospice a reality was Mother Mary John, who in her youth in Roscommon during the Famine had watched her own parents caring for the hungry. She had been a novice at Harold's Cross during, Mary Aikenhead's last, long illness. Of the pioneering Mother Mary John it is recorded "she naturally loved all that was bright and beautiful and her whole nature shrank from the gloom of death.
It is a philosophy still much in evidence in the hospice of today and is certainly shared by its Medical Director, Dr Michael Kearney, a consultant in palliative medicine there and also at St Vincent's Hospital. While still a medical student, Kearney became conscious of the need for a more caring approach to medicine, especially in the treatment of the terminally ill. This holistic view has become central to his own work and in his new book Mortally Wounded Stories of Soul Pain Death and Healing, a philosophical study in which he explains the theories and techniques of palliative care, as well as the system of inner care based on mythological and psychological models he has devised, he intended to confront and lessen the year of dying. Specific case histories are recorded in the book and their respective experiences illustrate the contrasting responses to death ranging from shock, anger and denial to eventual acceptance.
MICHAEL Kearney was born in May 1953, the second of a Cork family of seven. He has an elder sister and five grew up in a of brothers. Although I grew up in a medical family my father is a doctor, both of his brothers, my grandfathers and two of my mother's brothers there was no pressure to be a doctor. As a boy I was always interested in literature, cinema and nature. During the summer holidays I used to make short, Super 8 films with my brother. One of them was screened, it won a national film competition." The Between the story of a young man's search for meaning, was set partly in west Cork, in the Burren and on Inis Mor.
Kearney has always been interested in mythology as well and this influenced his fascination with tribal religions and the attitudes to death within various ancient cultures. Through mythology, he became interested in archaeology and the burial ground at Loughcrew in North Meath which is a special, spiritual place for him.
Despite the lack of family pressure, he nonetheless found himself moving towards medicine. Even so, as a student he was conscious of an ambivalence within himself. Faced with a career questionnaire during his third year in college, he realised he was unable to explain his reason for choosing medicine. Later when working on a ward, he had an unsettling, if rewarding, personal experience. One of my mother's friends was a patient, she was dying. I visited her every day and got to know her quite well. She knew a lot about music. I became conscious though, that there was no specialised outer or inner care for patients facing death." He says he always came away from speaking with her, "feeling as if I had got something from the experience and finding it very hard to think she could have got anything from my visits although she said she did."
All the while he felt a growing sense of outrage that there was so little being done to alleviate her various levels of distress. Suffering as opposed to being in pain are quite different suffering involves a total distress of both body and mind. In 1992, Kearney wrote "Early in my training in palliative medicine I was taught something about the nature of pain which might be paraphrased as while acute pain has meaning and is useful, chronic pain is both meaningless and useless. This description of chronic pain seems to fit a widely held view within palliative medicine of the suffering (be it physical, social, mental or spiritual) associated with the dying process. The attitude behind this view might be expressed in the phrase the suffering of dying is a problem to be solved. " Referring to the tension between the heroic stance and the medical model, and the idea of the doctor as a heroic figure coming in to do battle against illness, Kearney speaks of the wounded healer and offers the mythological figure, Chiron, as an image of such a figure.
Jean Vanier founder of the L'Arche communities, within which people with and without handicaps live communally whom Kearney had met at a conference in UCD in 1975, became a mentor of sorts for the young student. Suggesting that Kearney visit St Christopher's Hospice in London, Vanier described it as a place of healing. Kearney spent a week there in 1976 in final Med and immediately realised it was the approach to patient care he wanted to adopt. Before moving as a junior doctor to St Christopher's Hospice in 1980 for two years, he had worked for three years in a Cork hospital. After spending a year's sabbatical in France in 1982, working with the mentally handicapped, he returned to London and joined the staff of St Thomas's, one of London's oldest teaching hospitals. He stayed there for three years.
From 1986 to 1989, he was back at St Christopher's as a consultant before returning to this country with his wife and Mary, Anna, Claire and Ruth the daughters, whose visits of curiosity, distraction and humour while I was wrestling with my word processor in the basement" are acknowledged in the opening pages of Mortally Wounded.
After almost 10 years in England, he was back in Ireland, but it was Dublin, not Cork, so it was not quite home. "I think I was conscious of coming back to somewhere that was similar, in that it was Ireland, but different, in that it was not home. I always liked the anonymity of London, I quite like being an outsider. Kearney is a quiet man philosophical, sympathetic, thoughtful, deliberate and weary, a bit otherworldly. Being interviewed is clearly an ordeal for him, he does not enjoy speaking about himself. "It's something I don't find easy, I'm quite introverted. But I think it is so important to explain what palliative care is and its value. I feel passionate a out that."
AWARE that the word hospice carries an instant image of death, he says, "death is still very much a taboo subject, despite the 25 years of the hospice movement and that hear of death is the cause of so much distress in the dying." In his book he reports the angry reaction of Ann, one of his hospital patients, a young separated wife and mother, to another doctor's suggestion that she consider a move to the hospice. She was angered by the tactlessness of the suggestion it implied she was dying. In many minds, hospice is still equated with death.
Fear, according to Kearney, cuts so many dying people off from a time which should be a period of deepening, of healing and of living. "I don't want to make out that dying is easy, it's not. It's a time of suffering, of separation." It is true. Kearney has no false bonhomie, he is involved in sad, serious, real life business. "But what makes it an awful lot more difficult is fear and this is where palliative care has so much to offer in lessening the fear for the person and their family." By reducing the Thar, the environment around the person changes the family and friends are less frightened. "Part of what I want to say in the book is about the value of palliative care, and also to highlight that point made by Marie Louise Von Franz, the Jungian when she says that nature, through dreams, prepares us for death."
According to Kearney "within us as persons there is an unconscious desire to bring us towards psychological healing before death." He also stresses the healing power of the imagination. Fear can cut a person off from their own inner depths and fear can also devalue the imagination and the healing power of the imagination. "By lessening the fear, we are also allowing nature to do her work" to be told that you are dying immediately shatters a person's view of the world and their role in it. It pushes the individual into an acute grief situation. The initial reaction is usually one of shock, numbness, disbelief denial, bargaining and later resignation, hopelessness and fatalism. Spirituality is also important. "I would say spirituality rather than religion with a capital R or as a system of belief. To me spirituality is far broader, it is part of our humanity."
Unlike many doctors, he is not detached and stresses that there is a powerful sense of emotional engagement with patients. "You can't work with people in this situation. You can't get to know them, to learn about their specific histories and not become deeply involved. An intense closeness is created." Working with the terminally ill causes a tight merging of the medical and psychological, the roles of doctor, psychotherapist and priest become much closer. Admitting to sometimes feeling depressed because of the intensity of the work, he agrees "Of course there is a sense of grief of tragedy of rage at the unfairness of it all, but that's far from the full story. In the hospice, there is death, but there is also life and that's my personal experience also."
Dying is potentially a time of healing for the person who is dying. But that healing can also be shared by the friends and family who often learn through their loss. A year after the death of Bairbre whose story is told in his book, her sister Louise wrote to Kearney. He quotes a passage from that letter. "Bairbre's illness, dying and death" wrote Louise, "were among the most important things that have ever happened to me and although I still grieve, I look back on the last few months of her life as being a time of enormous growth for both of us. She told me that I had given her permission to die and I know that I was able to help her to die well, as she wanted to. She in her turn gave me the incredible experience of soul to soul communication at a level I will always treasure." Responses such as these are what Kearney says keeps me going."
His book is extremely philosophical and plots various journeys towards self acceptance and self understanding. "I think it is important to see life in the midst of death, by looking at death. It is about confronting the fear of death by seeing life. If people live well with their dying, they eventually die well, which means dying in their own way.
