The miracle of birth and the mystery of death are pivots for all religions. But while most people openly discuss birth, death is another matter. We recoil from its mention; we send our dying to acute-care hospitals, where medical practice focuses on curing.
Ultimately, of course, death is inevitable, and though it is a phenomenon experienced by every living organism, most people are wary of facing its realities.Hospice workers face death every day. The confrontation both requires and bestows spiritual strength.
The goal of the Salt Lake Community Nursing Program's hospice is to enhance the quality of life through the process of dying. Not coincidentally, local hospice nurses say, their own lives and spirituality are equally enhanced.
"It isn't such a downer as you might think," said hospice nurse Judy Elkins, "because you see beautiful things when people die."
Elkins says she believes everyone is religious on some level, and says she has had dying clients whose faith is so strong it suffuses the rooms in which they lie.
And Sharon Whitmer, another of the county's hospice nurses, says her strong Christian faith supports her in her work because she knows people are going somewhere else and will be released from their suffering.
"To attend a person's death," Whitmer said, "is as special as attending a person's birth. I always feel privileged because I am able to be with them."
For a while, though, Whitmer steered clear of hospice work because of her belief in heaven and hell. She believed that some of the people she eased out of earthly life would not be "going to their reward," she said.
She came to grips with that by not looking beyond her own role. "The difference was I had the ability to be Christ right now for people," she said. "I can still be Christ to them - minister and help them - and that's what makes me love this job. I can minister to the whole person, and I couldn't do that in other jobs."
Hospice care is voluntary. Most hospice clients die within six months, though some die much sooner. While many cities have residential hospices where the terminally ill live out their final days, hospice care in the Salt Lake Valley means a dying person goes home.
Once admitted to the hospice program, dying clients are visited regularly by nurses and volunteers, who guide and counsel family caregivers.
Standout hospice workers, says hospice nurse Kara Pinell, are those whose faith - whatever it is - is strong enough to cope with the demands of a normal full-time client load of 10 to 13 people, all of whom are going to die soon.
"It's `hello, I love you, goodbye,' " Pinell said. "You can be totally exhausted from the inside out, totally fulfilled from the inside out and totally empty from the inside out, all at the same moment."
But it's not the patients' deaths that wring her out emotionally, she said. "It's the reaching out to the family. It's like a sacred witnessing we get to do."
Sometimes that witnessing requires the nurses to re-educate the dying person's family. They see their loved ones dehydrating because they refuse to eat. Their skin becomes so delicate it tears irreparably when bandages are removed. It is hard for families to accept such deterioration as a natural process at the end of life.
Pinell said adults, children and physicians all need to re-evaluate their concepts of death. But when she broaches the subject socially, even when she simply tells people what she does for a living, they often pull back from her.
Sometimes, she said, facing death is hardest for those who have strong, conventional religious beliefs, because they fear what is going to happen to them after they die. Others, particularly American Indians or those who have studied American Indian religious systems, "have it easiest," she said.
Pinell shares her spiritual beliefs with her clients, telling them about others' death experiences and explaining the cycles of life as described in the mythology of diverse cultures. Again and again, she said, she has seen people change profoundly at the ends of their lives as they consider their own beliefs and listen to hers.
Every week, the hospice team of doctors, nurses, volunteers and support people get together for a team meeting. They are also required to have counseling sessions.
The weekly team meetings are a time for the hospice workers to discuss the realities of death by discussing their clients. Much of the discussion centers on physical problems, including the most basic human functions. But there is also plenty of time for venting through humor or sadness, either at the team meetings or at the mandatory counseling sessions.
The meetings are invaluable, Pinell said, adding that the tone of the meetings is set by Dr. Perry Fine, the team's lead physician.
Fine decries the direction of modern medicine and says that unless priorities change, dying people - and by extension, the hospice workers - will be blocked from their spiritual needs by their physical pain.
"The ethos of modern medical practice is on cure. It is not on care," Fine said. "Fifty to 70 percent of cancer patients die in pain, from moderate to totally out of control."
Ironically, religious beliefs themselves can exacerbate pain if the religion prohibits drug use, or causes dying people to fear drugs or feel guilty for accepting drug therapy, Fine said.
"We want people to be free to find themselves," he said. "But suffering is not useful. It's a matter of priorities. How can people whose basic needs aren't being met get into philosophy? If you don't deal with this primary stuff - with palliative care - you can't get to the rest."