On Sunday, May 19 at 3 pm Eastern Time, L. Scott Sussman, M.D., and Debbie Dye, R.N. will join us for the last Casual Conversation before our 55thReunion in Hanover.  The topic is hospice care.


Scott is Physician Executive Director, Office of Chief Medical Officer, Yale New Haven Hospital.  He is my wife Shirley’s son, and he did his residency in internal medicine at Dartmouth-Hitchcock Medical Center, and specializes hospice and palliative care medicine.  His Yale School of Medicine page may be found here: L. Scott Sussman, MD, FHM, FACP < Yale School of Medicine .  Scott’s Yale Medicine page is here:https://www.yalemedicine.org/specialists/l-scott-sussman .  I have seen how gracious and comforting Scott is when he helped his grandmother (Shirley’s mother) in her final days in home hospice care.  (Rose Mantelmacher, a Holocaust survivor, was a guest in a Casual Conversation when she was 99 years old, just a few weeks before she died.  Her last words: “I am what I am.”  And she was.)


Nurse Dye comes to us courtesy of classmate Bruce Alpert, M.D.  She was the nurse who helped Bruce with his cardiology outreach clinic in Arkansas, and she is a professional pilot in her spare time.  Debbie has worked for ten years at St. Bernards, Flo and Phil Jones Hospice House, Jonesboro, Arkansas.  She must be an extraordinary caregiver to have lasted that long as a hospice care nurse, a profession with a notoriously short tenure.


In introducing this topic, it might be best to start with a book that Scott has recommended: The In-Between: Unforgettable encounters during life’s final moments by Hadley Vlahos, R.N. (Penguin Random House 2023) ISBN 978-0-593-49993-1.  Nurse Hadley was in ER medicine before she shifted to hospice care.  In the ER, patients are treated, but not in hospice care: patients are given comfort.  This is how she relates a conversation with the physician assigned to her hospice care company:


              So, I just do nothing? . . .


              No, you call her family and give them an update.  You get her favorite foods and let her do her favorite things.  You ask her again if she’s comfortable and when she isn’t you call me back so we can make sure she is, and you keep doing that until she is happy.  What you are doing is important, even if society doesn’t always see that.


And it doesn’t.  Hadley learned not to speak about what she does to her friends when they go out for a social hour.  And I had a lesson in that form of aversion and denial when I raised this topic as the next on the Casual Conversation agenda with the Class Executive Committee.  Several classmates commented on how much they would not look forward to this session, making jokes about how depressing a topic it is.


I hope they change their minds—and defy their fear--and join us.  And I hope they—and you—read the book Scott recommends.  It is beautifully written, integrating her own life with the stories of the hospice care she gave to a dozen men and women, rich and poor, young and old.  One of them was homeless who lived under a bridge on the beach, and who was protected by the community of men and women who lived there with him.  Another was her own mother-in-law who died from a glioblastoma and the last patient, a 35-year-old man who was dying of brain cancer.  Could she face this after her mother-in-law died of brain cancer?  Yes, she could, and she did.  She tells about a patient who gave her advice on how to deal with Hadley’s own eating disorder (which Hadley traces to a father who called her and her mother fat and walked out on them).  Her patient, who knew from whence she spoke, told Hadley:


“Eat the cake.”


And you will read about visitations that happen again and again, including a man who (in a “surge” close to death) was searching his room for his son who died from drowning decades before at age two.  Hadley got down on the floor with him to look under the bed.  Long-dead parents appear to counsel a patient.  Deceased husbands and wives.  And you don’t need to be religious to experience a visitation: Hadley recounts one determinedly atheist patient who had a visitation.


I dare you to read this without tearing up (and sobbing).  But whether you read this book or not, I urge you to be present for this Casual Conversation and to bring along your partners, children, and others.  You will learn about the Medicare guidelines and the technical aspects of obtaining hospice care.  And you will also learn what the care in “hospice care” means. 


And what life is.  I will let Hadley tell us:


[N]o matter what our different circumstances might be, death is a part of life for each and every one of us—there is no white picket fence we can build that’s strong enough to waylay the natural course of things.  When the time comes, we all want the same things: care, comfort, and connection.


Some of you, I hope, will remember that one of our classmates joined a Casual Conversation from his hospice bed.  He wanted connection and we, as a Class, could supply it.  That desire never ends.


Please join us.  If you want to, please let me know by close of business Friday, May 17 by emailing me at arthur.fergenson@ansalaw.com .


“Eat the cake.”


Arthur Fergenson

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