Nuns Teach One Another, Us, As They Lay Dying

The nuns at the Sisters of St. Joseph convent near Rochester are — like many compatriots — aging and dying. But how they're choosing to do so could provide a model of live, and death, for the rest of us.

Rather than separating out the simply elderly from the truly infirm, the nuns continue to live together not for financial necessity but because they feel that their deaths should not be conducted separately from their lives.

"There is a time to die and a way to do that with reverence," said Sister Mary Lou, 56, a former nurse. "Hospitals should not be meccas for dying. Dying belongs at home, in the community. We built this place with that in mind."

This is, after all, the model for modern-day hospice care, but even within the strictures of hospice, dying in one's home is less and less of an option for some people.

There are positive effects to the surroundings and the patient-care philosophy behind the convent, which is focused on allowing patients to make empowering decisions and living the ends of their lives without a fear of death. They're cared for mostly by one geriatric specialist, Dr. Robert McCann, who is able to bill Medicare for some of their costs but goes largely unreimbursed. He says:

...through a combination of philosophy and happenstance, "they have better deaths than any I've ever seen."

Dr. McCann's long relationship with the sisters gives him the time and opportunity, impossible in the hurly-burly of an intensive-care unit, to clarify goals of care long before a crisis: Whether feeding tubes or ventilators make sense. If pain control is more important than alertness. That studies show that CPR is rarely effective and often dangerous in the elderly.

"It is much easier to guide people to better choices here than in a hospital," he said, "and you don't get a lot of pushback when you suggest that more treatment is not better treatment."

There are more tangible benefits to the philosophy behind the convent: no one can recall a resident dying in a hospital; the nuns seem to enjoya lack of anxiety about death that the doctor believes comes from their religious faith. More substantively, McCann says he need only use one-third of the narcotics he uses on his other geriatric patients to manage the nuns' pain at the end of their lives. And the nurse practioner at the convent, Barbara Cocilova, has seen other benefits, too.

Among those with Alzheimer's, Ms. Cocilova said, diagnostic tests tend to produce better-than-expected results among those who are further along in the disease process, a possible result of mental stimulation.

Dr. McCann and others say that the sisters benefit from advanced education, and new ventures in retirement that keep them active.

Geriatric medicine pracitioners often emphasize the need to stay active mentally in order to maintain mental capacity; but the setting also shows that stimulation from being part of an ongoing community is also important.

McCann, who provides end-of-life-care to laypeople as well, adds another layer of thought to the community the nuns have created.

Some days, Dr. McCann said, he arrives with his "head spinning," from hospitals and intensive-care units where death can be tortured, impersonal and wastefully expensive, only to find himself in a "different world where it's really possible to focus on what's important for people" and, he adds, "what's exportable, what we can learn from an ideal environment like this."

The story is accompanied by an oral slideshow (have your tissues ready, trust me) of the nuns, McCann and some of the staff at the convent speaking. What stands out to anyone who has watched a loved one die in an institutional setting is the amount of physical contact between the sisters and their caregivers. In a hospital, there's a lot of pulse-taking and blood-drawing and all the myriad ways of touching a person that medical care requires. But in the slide show, there's hand-holding, and face-touching, hugs and singing and smiles on not just the faces of the healthy, but on those of the ill. There are no gloves, no gowns, no bits of minute physical distance to separate the dying from the sick from the healthy at the convent, in no small part because they don't believe that those things help cushion one's death as much as they hurt the sense of still belonging to the world that the nuns think they need at the end of their lives. Let's hope McCann and the nuns he treats can find a way to make that exportable.

Sisters Face Death With Dignity and Reverence [NY Times]
A Gentle Death [NY Times]