On Meeting Death; 1; When the Doctor Leaves

a doctor's concern for a patient who has faced hours taken was a critical or fatal illness must take into consideration the behavior and actions the various groups of individuals who may be directly associated with the problem more case in hand sometimes it is a relatively simple one perhaps involving two of three members of the family that nourished the minister while on other occasions the setting can be extremely complex including many family members important business associates valued friends lawyers perhaps even the press in either case team play is essential and the

doctors often called too soon leaky position and roe and so his first insert obviously relates to the patient not only must he determined to what extent he should exercise his scientific spill and clinical accurate in order to prolong life of justifiable it must make certain that his patient be kept comfortable from pain and from mental anguish he can only accomplish this by strengthening the doctor patient relationship a bond of mutual trust relief and confidence it as the headstone for the good works of a thoughtful and

conscientious physician he misspent much time in learning his patients character and personality only in this manner as he able to judge the metal fiber an attitude of his patient and thereby the chairman the proper and least injurious police traumatic approach and disclosing the nature of his patient's disease or illness some people insist upon knowing the whole truth and their wishes should certainly be respected others do not even desire to discuss the causal mechanism of their in fervently or disease still others larry of their fatal village by

simple logic and deductions they need not be told because you know that they know then there are some who prefer to be informed gently by intimidation over a period of time that's gradually arriving at their own correct conclusion some patients resort to a curious game in which both the patient and family know the truth yet each pretend they do not this may at times he's an otherwise tense own situation there are a small number of patients with such terror and fear of death in their hearts that knowledge of having a cancer or incurable condition only serves to hasten their death finally

one may encounter a patient who learning of his illness refuses to accept it and resorts to an attitude of pretense and make believe unnecessary prologue nation of life serves no useful or humane characters we do not permit animals to suffer why should we do so with a human being there may be rare exceptions such as the delayed arrival of a love number from some distant land also insistence to prolong and sustain life by every possible means maybe a family decision this is certainly true among certain groups and races and the doctor must comply or seriously consider

withdrawal from the case the doctor should protect his patient and the family from desperate grasping for straws an eleventh hour plea for an ill founded your own nostrand crow bison special diets healing warner's secret with missiles and their use only intensify disappointment and bitterness it requires infinite patience and persuasion to convince them that the so called years are unfounded yet the doctor must exercise great caution not to introduce a note of finality or that the door is irrevocably shot it is well to leave some vestige of hope because there is the occasional instance as

temporary spontaneous repression or temporary remission of course life to many of us is precious we cannot bear the thought of departure from our dearest once there is so much yet to be done our house is not in order and now lettuce tearing for a moment to the family of a patient in his terminal illness when a doctor concludes that is patient has taken by an incurable disease it is well for him to disclose this to at least one responsible member of the family this is his duty the latter perhaps with the advice of a doctor was then decide weather or no the patient should be told and also the other

members of the family should know should we inform a trench highly nervous unstable person or one affected was high blood pressure or serious heart trouble family conferences with with springs and shaking zones heads should never take place outside the patient's room how often they say don't tell he must not know as though the silences with going out of the room to speak to the doctor in the hole did not broadcast obvious revelations some families they react with a tremendous initial emotional impact please obtain the best possible consultant spare no expense letters obtained expert opinion and advice on dr so and so's

quote can secure and quote others will accept the situation with quiet courage and dignity a doctor can often suggest to the family certain avenues of approach to the patient their manner of behavior where tanner conversation and various attitudes to present but one thing is apparent and this is extremely important to remember if i can't it be decided to withhold part or the entire truth from the patient than a whole set of explanations needs to be instituted sooner or later someone will blunder and make an unintentional slip which

will arouse the patient's suspicions this will result in more explanations and deceptions eventually the patient will lose complete confidence in his family and trust in his doctor is disillusioned and they're resentful his integrity and self respect have been broken and shattered he has been done and he feels he is destroyed x marks the spot he has been that he has been denied the true cpu truth and the truth shall set you free and this is where our good spiritual advisors can play such a tremendous and helpful role if the patient desires it

not only will they impart comfort and strength to the patient and family but they will help them realize that death can be an ennobling and dignified experience he will come to jerry news an acronym at the answer and as a completely at peace and reconcile to the will of god are ministers can be so very helpful in so many other ways but to sustain a patient as he comes to the lax carrying of the road is one of the finest acts of his noble calling i will skip over from discussion with the students and patients because they do directly relate to us here this

evening but then when we come to the doctor himself what attributes in his personality and character should be endeavor to portray in his relationship to the terminally ill patient you have already heard mentioned some of them compassion and sympathy or an understanding heart you should always present quiet simple yet dignified bearing you should be modest self effacing and professor deep sense of humility yet he should never be pessimistic or brooding on the contrary he showed in part a feeling of incur richmond of hope of a sincere desire to help to the utmost of his ability the most never show evidence of despair regardless of

the hopelessness of the situation through his experience and wisdom he must drive to create an atmosphere which is least a starting to his patients he was trying to conform to the wishes of the family and this is oftentimes difficult and calls for infinite patience and steadfastness so the doctor should be simple direct sincere forthright open minded walking humbly before his fellow man and before his those of you are anxious and medical really especially historical

standpoint might care to includes three books which describes the lives and times of three doctors and the first is by wilder penfield who wrote the torch and it tells the life of hippocrates dr penfield was a professor of neurosurgery at the far that aptly are neurological institute before he was called to take the chair at mcgill university montreal where he is now emeritus professor and he's written to history books and he spent one or two summers in greece and amongst the aisles where hippocrates live and he tried to write the story of hippocrates even fragmentary that as the others it might

be the second book which you will enjoy reading at his bar called will tailor their own glorious position describing life there say this book was her third attempt when she was still in sunday school she wrote an essay on st louis and a number of years later she picked it up again and grow further on the life of st louis and this did not satisfy or so finally he spent almost five years searching traveling on the mediterranean the holy land and the mere he's putting together as best she could and consulting with historians

and also very some members of the medical profession how best she could present the story the life story of this wonderful a possible and finely i think you'd like to read that a very short story written by humans learn that called a doctor of the old school and this is a clash in which we like to tell our own students that they must surely read because it describes the story of a country doctor back in the scottish highlands and the wonderful wonderful works he did and it will stir your innermost feelings was it look around

and observe some of you i think that a certain number of view belonged to my to my vintage mainly at ninety and those of us who a foreigner in that particular decade had a life expectancy of about fifty three or fifty five years so i think all of all we've done rather well and i think we have at least a dividend or fifteen years for which i know we're all thankful to our maker for giving it to us and i know you do as i do i'm grateful for every day that has given me to serve my friends my fellow beings my fellow man so in summary than doctors

concern of the top terminally ill patient is a deep and far reaching one that embraces not only the patient up the family the minister and nurses and of course that the patient was in the hospital various other staff members even sometimes the bees do his responsibility is often a heavily and sorrowful on what it is is his duty to shoulder it with courage and forty two he must manifest a constant desire to keep his patient as comfortable both physically and mentally as it is humanely possible it this can only be accomplished through teamwork and the most serious cooperation by the various individuals concern so in the last analysis it does rests largely upon the doctor and he must be gone and

also is dedicated wise humble and inspired by a now in closing i would like to read a a special favor coal mine and i hope you enjoy it as much as i do because it means to me more and more each time i read it because i like to think it pertains to all of you and hopefully to myself and his opponent and by thomas kaplan some four hundred years ago he was a physician and illusionist an opponent he must've been familiar ms karr says won't because this is home has the overtones of and together return i listen now to thomas

kaplan the matter of life upright whose guilt blessed life is free from all dishonesty does or thought about it the man whose silent days into harmless joyce are spent in hopes can not to move your sorrow discontent that man needs neither towers in armor for defense no secret vaults to fly from thunder violent he only ten the hold with other frightened eyes the harsh of the deep and turns less corning all the cares that fate of fortune brains he makes the heaven his book is wisdom heavenly things good

thoughts is where the friends his wealth and well spent a huge the earth is sober and am happy pilgrimage thank you the peak thank you dr schillinger the question that's on my mind but doctor showing years to ask you if you had a family the family of a patient and the patient was sought obviously at and are approaching terminal illness stage would you advise the family to keep the patient in the home even though this mine maina an indefinite length of time and a great debt burden for all concerned would you recommend that the patient they sent to a nursing home or would

you suggest that the patient should be sent to the hospital now these are the possibilities and the perhaps you'd like to start off by giving us some answer to that question this question depends somewhat on the members of the family i think if there are one or more children in the family this often the stress is not only the children but also the dying individual because he sometimes or she sometimes feel that they want to be remembered by their grandchildren or by their younger ones

as they were when they were in in good health i i must be prejudiced in answering this question because i think when my own time comes i would prefer to die at home in my own bed nearest my loved ones home how many many people die by accident or catastrophe or in strange surroundings comparatively few die in their home and so i can only add says this question from pre judicial point of view than i personally would prefer

to die at home even though i might be denied oh certainly find months in treatment and administration of special drugs in addition those in the hospital or in the nourishing home does does actor answer your question a lot and it does so after all this is a matter that depends largely on the situation in the circumstances of course and i think i wanted to get just the kind of comment that you offered to us to find out your own personal feelings about it now there are number of questions here that have to do with day attitude of they doctor and the doctor telling the patient or telling the family one of eight questioners since buffet like most doctors would advise

against telling a patient how ill he is would you think that's true and if so what you think i think in general this is wrong i think a patient feels hurt feels injured athlete later comes to the realization that you hold the truth from him he feels that you let him down that he hasn't been sufficient moral fiber or intellectual capacity to accept the truth i can only say that in those instances where the truth has been withheld there's almost always follow a period of regret and remorse on the part of

those who insisted on keeping the truth from such an individual there are occasional exceptions to be sure and this is where it's so important to try and exercise the best possible judgment and wisdom based on one's experience but i come back to tell the truth dr joiner there are several people who are concerned about the various aspects of the same question really they have to do is the question of prolonging life work just for the sake of keeping the

patient breathing and the heart going and so on one question says he spoke as if doctors do not attempt to prolong life when there's no hope of recovery is this true and hospitals about the hippocratic oath is it appropriate to request once dr in advance not to prolong one's life another person says do believe in euthanasia another says given a firm diagnosis of terminal illness under what circumstances with a doctor sick to prolong life and wouldn't ever be justifiable to casey death to limit the duration of suffering this is our whole area of concern is you can say oh well it's so covers considerable area thought i think that i think that in recent years the

family families in general have realized that it does not serve any useful purpose too i'm necessarily prolong life as doctors were not really violating the hippocratic oath i think are our first duty is to is to try and keep the patient comfortable in his free from pain as possible and i i think there is even a half a year at a packed old bull two years ago a pronounced by pope john that life that once the responsibility of the patients' physical wellbeing that had been had become the responsibility of the doctor it

was the doctor's decision as to as to the policy in the matter of a prolongation of life i think they're in the present day at least a doctor and usually speak perfectly frankly and freely with the family and give his own and his own thoughts and in the matter of handling the patient and the family and they often subscribe to what our may offer some modification and not infrequently the patient who knows what his condition is will request the doctor not to not to keep him alive just

for the sake of living a few days a few hours longer and as i said before this is not true inserting in certain areas and certain races where there is a very strong insistence that the patient should be sustained to be very very good last moment of breathing are ours heartbeat and was a reference to euthanasia we will never those of us here will never live to see this take place that it will come and it will come very very slowly and cautiously it will have to consist of a group

of people of the highest integrity it would have to consistently of a rather large group of at least two ministers to judges two lawyers and probably other individuals as well because as you might imagine there might be very serious show undertones of very serious shirt design show which might otherwise take place and then you may remember that mentioned was also made that occasionally perhaps rarely a patient who seems to be coming close to the end of its

lifespan may suddenly show a repression or in remission i might live for another few weeks or even longer so the matter of euthanasia it will take many many years to to formulate and two crystallize out as a doctor treat this situation of a patient who knows he's dying but refuses to have his family go well they're not telling patients what things it's been we're really picking my brain is the ceiling and here again i think it depends upon the circumstances i can think of i i separated husband or wife who's resentful of partner who has no other relations and who

who requested dr not to not to inform his or her partner and then there are probably other similar situations but by and large i think the doctor may be open to very very serious censure and criticism if he does not disclose this to at least one member of the family and i'd like to make one closing remarks and will you forgive me if i do so to those of you who entertain any doubts and misgivings about death and life everlasting at and if those of you have the stock argument to

appreciation music sit down quietly shunned time and listen to the first movement of the brandenburg concerto in d made and toward the end of this first movement there is a piano passion and i'm sure this is box praise an exhortation to his maker and the other musical passage which i think will dispel your fears and misgivings is to listen to the b minor mass thank you dr joiner oh when the doctor leaves when when we know that that

this is the end there is about to be the end there isn't a long time in which to make up their minds about these questions for many families they question that then comes into their minds is so if that nobody thought about it was the undertaker that on that we'll get in touch with us or have we made up our minds that we do want their you know where do we want the cremation or what is it that we want if we got any arrangements made for cemetery for well what we expected you know or if you wait until the eleventh hour and fifty nine minutes and fifty nine seconds before you even think about these questions you can't possibly answer them with poison and with reflection because isn't

any time for that therefore it's important that we as we seek to know some of these facts now tonight for the second session we have asked mr john paul ryan who is a vice president of frankie campbell incorporated to come and speak to us remember i played mr o'brien that we were destined to come get into a debate we were asking him to come out and defend himself against charges that he's not guilty of ari we hear words asking him not to come and defend a lot of people he doesn't know and some of whom he probably doesn't approve of or ask them to do is can you tell us what he knows what he can tell us in a very practical way about the kind of arrangements that maybe

made them they're commonly are made and no doubt if he doesn't tell us something about the matter of cost and so on your allow undoubtedly given an opportunity to do so in the question period and these are matters of very great concern and we want to know a quarter attention the fact that next week we're going to continue with this question of what happened what he does has arrived what's going to be done or some people who say they don't want to have the conventional kind of fuel so there will be a discussion of what some of the other possibilities are next week but in the meantime they hear probably is the most common thing that is done with families when that arrives is get in touch with the undertaker and so mr o'brien we

want to get in touch with you right now a few years ago or i would probably have been facing empty streets after being introduced as a funeral director or years ago through ridges used to be viewed with all around they were given it will shutter as he would wont buy they all dressed in black are very somberly or long faces beards and sometimes and really were more feared feared because only a time of distress or loss or they called the community had no other contact with them and they were expected to be gloomy about everything broader education and that the basis it is done away with much of this fear but there's still a mystery about funeral directors and the fear i hope a small part of a mystery

my understanding of the purpose of this series of seminars is that the church which is which is the church families to learn to face life's final reality with a sense of christian confidence and composure the church which is to help members make appropriate and properly thought out arrangements in advance of events the old always come unexpectedly now i can i cannot prepare anyone the face that only our church can prepare you for your death in the death of song when you love my function is the carol lee a secular regimes of a funeral and to see that they are carried out in accordance with the family's wishes my question tonight is

to help you understand the funeral and what you can do to repair for this you should be german in your own mind and heart what type of you know you want and what you can afford to pay for their funeral this you can do in advance i worked like you have you know you want it you can afford is dictated not only by the present state but long history is as far back as recorded history and you come back into pre recorded history channel's of always been an important part of life and joe says chapters in forty nine of fifty we we really do and jaws of command of his servants the physicians to embalm his father and the physicians and beyond israel

and forty days were fulfilled for him four so we for fill in the days of those which are alarmed many egyptians mourn him for three score and ten days and when the days of his morning work has joseph's they conclude house of pharaohs saying is now i have found grace in your eyes speak i pray you in the euro pharaoh saying my father made nice were saying hello i die in mind grave which i have big for me in the land of canaan their shelves they'll bury me now therefore let me go up my pretty and very my father and i will come again and pharaoh said go up and very very father according to according as he may be slow and joseph runup to

bury his father and with him on all the series and the pharaohs the elders in the house of his house and all the owners of the land of egypt and although house of joseph and his brother and his father's house only they're little ones in their flocks were left in the land abortion and their own wang shares an abortion and it was a great company and his sons didn't do him according to his command when for his songs carry him to the land of canaan and bury him in the grave and the field and the bill which alan abraham bought for the purpose of their employers and joseph returned to egypt he and his brother and on all that went with him to bury his father after they had various and joseph tobin of other children of israel saying god will surely visit you and you shall carry out my bones from hence so joseph biden

been a hundred and ten years old and they want him and they put him in a coffin in egypt ice it is architecture from real person to indicate their funerals and bombing the shipment the remains of purchasing a burial plots before in the uk and earlier yes even for agents by firm basis in our duo christian tradition is the violence occurred between be at the thirteenth centuries bc five to five years before they were written down today's funeral and burial customs go back at least twenty five thousand years city of custom a customer has nothing to do with fumaroles your figure why a bird's wonder why soldier we start

marching in his left foot left right left or is the right left goes back to the greek greek myth of jason and the golden fleece you remember jason had a single standalone his left foot this show that he was a warrior the right foot on the weapons side was barely give them a foothold on me soft ground left foot on the shield side remained shut in order for him to step forth and the battle to because of the surgery that the celestial it was a war fought so with the war for his part of the march another superstition that goes along with its custom is a little less sort of the first thought it was an step into the house members of the war full it was in bad taste so that the ancient policing costumes are still very much a part of our modern life

that has always felt the need for a few went to french priest in the last century founders of two koreas military man they've also actually they felt like with these people for evidence in the grave show and a belief in the afterlife and indeed by the suppliers for a formal hearing ancient civilization have a few more games or strenuous this was following of you know strenuous tiring and often violent games this was an emotional safety valve for the family today we also need a safety valve courting from reverend that your age actions book a funeral must face the reality of death not avoid it if you know must provide a setting where in the religious needs of the reader may be

satisfied if you know most of our faith says is to sustain your spirit if you know must help free you from guilt and self condemnation a few enormous help you express your feelings if you know most direct you'll be on the death of a loved one of the responsibilities of like a film us in a personal way up you are facing crises with dignity encourage it sunil must above all provide an environment where loving friends and relatives can give you the help you need to face the future with strength and courage but we know that you know there's two purposes a religious and an emotional religious aspect to return unsold the godly and the body to the earth once again and commanding the body to earth there are certain basic costs of transportation for the

solitary an opening and closing of the grave unsatisfying emotional needs the fuel becomes a focal point and recognizing the effects of that the end of life for one and a continuance of life for the survivors family can often not except without the catalyst of an emotional ritual and i'm sure you remember the repatriation of the war to dead the government spent billions of dollars to bring the boy back for a season of the families might have the opportunity to have a a funeral service and a factual burial where the family can actually see the informant i know we haven't experiences with family or a close friend of

ours now like my soul blues killed over a season was not brought back and the family didn't want to realize that this boy was that it so i have they were given all the verification from the state department from washington but they still don't believe that they in fact checked susan sharon's becoming but i think one member of the family the mother did die before filing because she couldn't get this brief power there was no factual funeral would not be the point to say yes this person is dead heat yes we have made a very ill in the family plot what

might be proper and fitting a problem for the funeral for one family might be inadequate or too much for another the sensible thing to do is to confer with your funeral director and speaking frankly he has a wider range of prices for complete funeral services was the family can shoot them perform with his religious emotional and economic needs i didn't understand the reasons were a family should have to spend one and a more than they feel like a fort the other side a remorseless air like you first quote from gladstone the great british political philosopher and prime minister will observe show me the manner in which a nation cares for its dead and i will measure with modern mathematical exactness the tender

mercies of its people and secondly queen elizabeth's message to the house of commons is the future of days ago i know that it will be the wish of all my people but the losses which we have sustained by the death of the right honorable sir winston churchill should be met and the most fitting matter and that ensured that they should be given the opportunity of expressing their sorrow at the loss and the veneration of the memory of that outstanding men mr ryan in looking at these questions cursory way i find that at least two that i've looked at ask questions concerning cremation gerson so one question is from a

someone who so i say that suzanne by saying is in remission in every way more desirable but then now there also is the question that they ask so in the case of commissioned op is there a law which requires embalming abbey for cremation it's a very easy question to answer no there was no other states that you are following the death of the remains are cremated or buried within a five day period according to the new york state department health there's no necessity for one i don't know what also in connection with the cremation of one desires cremation and desires not because of economic necessity but because of personal conviction that have the least expense

possible in caring for the remains how busy perceive and what is the cost and this is an exclusive of day expenses a memorial service if one is hell well as i said before the best way to do any of these is anyone wishes to do is to speak your funeral director and rearrange your mechanism to do these things now when you know what you want and you can pull on paper and folded in literature what to do when a vote for cremation it is compulsory that an affidavit from the next of kin would be signed or another they would sign by you prior to that but the seventh ever be on file under be given to the bomb of health on a case where there is no next of can buy a nevada so stipulated in your world the jewish promotion and that there is also stability in your world you have an executive order executive rich why this person can sign a

necessary papers for promotion as to the cost the cost of cremation is again anything to the family on a play in the farm and i do not mean this is legally from nothing and taught everyone apply be a person who is collecting social security rules say the maximum benefit for so security is two hundred and fifty five dollars this can cover your funeral services burials or permission a veteran is entitled to and fifty are still nevada is an illustration of you as an honorable discharge the steubenville expenses of funeral or burial corporation a salmonella person were to wish that after death is body should be cremated and should wish that there not be here at the expense of a burial plot and the things they had read the memo the

expense but what is done with the ashes after a cremation the military has a home space in the cemetery merges into a temporary dam where the remains can be inferred the voice is fifteen dollars built to the family to read from the grand assemblies that yes as you can tell what mr ryan they got economics of this whole problem is very much on the minds of the people i just looked for it has something to do with this but probably the people she was writing about have something to do with it to an here's a question they're several little more less like it if cremation is desired and the body's not to be viewed by anyone is an embalming required by

law you said no what's the minimum cost for a casket for years moving the body to agreement are you do not move the body image as the children the torrent and then returned it has been through the film director there is nothing in the lawless says you must have the container port in history was to go for a new for cremation but there is no credibility in the city of new york or elsewhere that would set the remains without a casket of some type the least expensive way of life we have and i think the best way to say this is to actually tell you that in the selection with it camels we have a eminem service that if the family is in the day we'll hear from nothing that if

we in ministers contact us and tells me the family is in the way of lippy the minister of the family themselves put a price only a service that they want they never turn anyone away we never will that's the best thing i can do for crossing for price is where you're spending that's the way to go i think that's very helpful answers for what ryan would you please discuss what arrangements ought to be made for a funeral by cremation especially for persons who are all along and what kind of arrangement i suppose they'd have to get somebody to make these arrangements on this album well they themselves familiar items than they would have to have before that they should have a will if they aren't sure they do other well it should be so stipulated in their will agree with the nation and there as an executor and executor its name in the world would be able to follow

these arrangements out to vote for the moderate you know just imagine this ms litvin foreign believe in that way as for the first time been given the opportunity to talk about our profession this certainly strikes despite reading over some remarkable than they're held at it not been for most arab book and i think it's very healthy i think that i'm learning more about you moore thank you very much it's been