No Place to Die

I only knew two people who died there. As a former employee, my daughter knew and saw many more. She cared for them and cleaned their bodies after death, and considered it an honor; and an honor to listen to their stories. That was the spirit of St. John's. It was a good place to live for a while before dying; if any place could be thus described. They took all comers, well, goers, turning no one away that needed them. The destitute could die with as much dignity there as anyone else. They had the highest percentage of uninsured and under insured patients in Colorado. After caring for more than 30,000 individuals living through their last days, weeks, or months, they are no longer able to take patients in (though they still provide home hospice services). It was the second oldest free-standing inpatient hospice in the country, and a model institution. According to the Denver Post the closing was a matter of  "federal sequestration cuts and thin health care margins."

I'll never forget the compassion and kindness with which I saw patients treated. I'll never forget the bar-on-wheels that made its rounds at cocktail hour. I'll never forget that a patient could unofficially smoke a joint for pleasure or pain in the courtyard--before medical weed. I'll never forget the way death was an accepted reality and up for open discussion. Joy and grief were both allowed. There was something peaceful and resigned about the place. Virtually no one was going back home, though some patients did. Some of the dying rallied when treated with such kindness, or lived much longer than expected. We are social creatures. Those who live and die alone live unhappier and die sooner; at St. John's there were some who began to enjoy life more even as they were leaving this world, so they stayed a little longer.

Where will they go now? There are other hospices, arms of HMOs and other large institutions. I've been in a few of them, too, and they aren't so bad, though they aren't as good either. I'm not aware that any receive the destitute. It is like the difference between a private restaurant that becomes an institution in a city and a chain, even a high-end chain like, say Magiano's or Morton's. There was something immediate and local about St. John's that the larger institutions, by their nature, can't capture. It's a genuine loss, though one that we don't have to consider until the human losses start piling up: when our parents face death, or us, or even our children. Assuming your death will be slower and expected, where do you want to die? My father died at home, under home hospice. His was an ideal and peaceful death, prematurely facilitated, I can't help but add, by the tobacco industry. Some of St. John's patients had no homes, or homes that had the support available that home hospice requires. Every destitute dying, in the words of Hank Williams, was

                       

                        . . . some mother's darlin, he was some mothers son

                        Once he was fair and once he was young

                        And some mother rocked him, her darlin to sleep

                        But they left him to die like a tramp on the street.

 

Maybe there's something about dying, no matter where we do it, that grants our lives dignity, even if our bodies are consigned to a mass grave. "Better is the end of a thing than its beginning," said the writer of Ecclesiastes. There's a deeper sense in which even those who die on the street, even those who die among many others in atrocities or plagues, die with dignity, even if the circumstances completely lack any. The dignity of death inheres in the extremely unlikely reality that one lived at all, and that each life is precious, no matter how or where it ends. Death brings a kind of honor even to the dishonorable, and far more to the honorable. Each of us is given one life, and, in the end, it is taken back. The hospice movement honors this reality by treating the dying under their care, rich or poor, with tangible dignity, honoring lives at their end with compassion, grace, openness, and palliative care.

If I were a very wealthy fellow, I like to think I'd have kept their doors open. When you see the beauty of a place like that you don't want it to die. If this ending is better than its beginning, it is exceedingly difficult to fathom how.