Caring for the body of the dead

Nurses, the Dying, and the Newly Dead by Elayne Kornblatt Phillips & Beth Epstein


[Ed. Note: The following is a reprise from January of 2015. — JB]

 “On my way home I stopped and picked up some things for her, like baby shampoo and stuff…because I wanted to give her a little something extra because it was her last day.”

–Neonatal Intensive Care Nurse, discussing the imminent death of her tiny patient.

For nurses, caring for the dead and the dying is a privilege and an obligation. Sitting with families, holding patients’ hands, closing patients’ eyes, washing bodies—all of this is in a day’s work. Many times, the quiet moments of last breaths and family gatherings are preceded by rapid-fire, aggressive resuscitation—the last, futile attempts at preserving life. The transition from noise, drugs, commands, and physical action to quiet is stark and often jarring.

For hundreds of years, nurses have cared for the dying and the dead. Still, knowledge about how to care for patients as they are dying and after death comes largely from personal intuition. Education in caring for a dying patient is now available (e.g., ELNEC), but caring for a dead patient is often an afterthought. It is assumed that a nurse will know how to care for a dead patient and his family. But assuming is a risky proposition. If the knowledge is not simply “known” but can be taught, then what might we teach and how might we teach it?

For thousands of years, Jews have practiced and taught the ritual of taharah. Perhaps by exploring what nursing and Jewish practices have in common and what is different, we can learn how each can enhance the other. Here we consider how the practice of taharah can inform nursing practice in caring for the dead.

We conducted focus group discussions with nurse attendees at the Kavod v’Nichum 2013 annual conference and with our local Chevrah Kaddisha members to identify key themes that could inform nursing practice. We identified two themes that may help nurses frame their practice— acknowledging a transitional period and creating sacred space.

Acknowledging the transitional moment was described in terms of recognizing that the soul may still reside in the body at the time of the taharah, and that the hands and eyes of the Chevrah Kadisha members would be the last to touch the patient.  It is understood that a significant period exists for both the dead person (meyt(ah)) and the caretaker immediately after the end of the physical status we label “life” and the emptying of the body as vessel of the “soul.”

Creating sacred space for taharah involves focusing solely on the meyt(ah), working in silence or quietly singing or humming psalms and prayers, and maintaining calm even under difficult circumstances. It also calls for respect and modesty, moving the meyt(ah) only as necessary and then as gently as possible and exposing only parts of the body being washed or dressed. There is a recognition that although the body is forever damaged, there is still respect due to the value of the person who has died. Although these activities and modifications are grounded in respect for the meyt(ah), they infuse the Chevrah members with a spiritual sense that this is a profound and pivotal time in the person’s “life” and reminds us that we are doing holy work. It also reminds us that one day we will be cared for in this way. We are honored to perform this mitzvah.

In the hectic healthcare environment where the time to spend caring for a patient who has recently died is often short and nurses are aware that there are competing obligations to other patients, it is easy to make short shrift of the tasks necessary to prepare the patient for family visitation or to be transported from the hospital. Working efficiently need not require the nurse to separate emotionally from the patient. Nurses’ level of comfort with the practice of caring for the dead is largely dependent on past experience, culture and upbringing, and an intuitive sense of maintaining dignity. An awareness of the body in transition—recognition that this may be the last bath, the last time the family sees the patient—and setting a sacred space of quiet, calm, and competence may be helpful to those nurses looking for guidance in fulfilling the professional obligation of caring for the dying patient and family before and after death.

 

Elayne Kornblatt Phillips, RN, PhD, FAAN

Elayne Kornblatt Phillips, RN, PhD, FAAN

Elayne Kornblatt Phillips RN, MPH, PhD, FAAN, is a Clinical Associate Professor of Nursing at the University of Virginia School of Nursing, and former Director of Research at the International Healthcare Worker Safety Center in the School of Medicine.  She is a founder and chair of the Women’s Chevrah Kadisha at Congregation Beth Israel, Charlottesville, VA. She has been a student at the Gamliel Institute.

Beth Epstein, PhD, RN

Beth Epstein, PhD, RN

Beth Epstein, PhD, RN is an Associate Professor at the University of Virginia School of Nursing. She conducts research in ethics and pediatrics and is a member of the Ethics Consult Service for the UVA Health System. Beth currently serves as President of Congregation Beth Israel in Charlottesville, Virginia and is a member of Congregation Beth Israel’s Chevrah Kadisha.

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GAMLIEL INSTITUTE COURSES

LOOKING FORWARD: UPCOMING COURSE

The Gamliel Institute will be offering course 2, Chevrah Kadisha: Taharah & Shmirah, online, afternoons/evenings, in the Fall semester, starting September 5th, 2017. This is the core course focusing on Taharah and Shmirah ritual, liturgy, practical matters, how-to, and what it means.

CLASS SESSIONS

The course will meet online for twelve Tuesdays (the day will be adjusted in any weeks with Jewish holidays during this course).

There will be an orientation session on how to use the online platform and access the materials on Monday, September 4th, 2017, at 5 pm PDST/8 pm EDST online.

Information on attending the online orientation and course will be sent to those registered. Register or contact us for more information.

REGISTRATION

You can register for any Gamliel Institute course online at jewish-funerals.org/gamreg. A full description of all of the courses is found there.

For more information, visit the Gamliel Institute website, or at the Kavod v’Nichum website. Please contact us for information or assistance by email info@jewish-funerals.org, or phone at 410-733-3700.

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Gamliel Café

Gamliel Students are invited to an informal online monthly session on the 3rd Wednedsays of most months. Each month, a different person will offer a short teaching or share some thoughts on a topic of interest to them, and those who are online will have a chance to respond, share their own stories and information, and build our Gamliel Institute community connections. This initiative is being headed up by Rena Boroditsky and Rick Light. You should receive email reminders monthly. The next scheduled session of the Gamliel Café is October 18th.

If you are interested in teaching for a session, you can contact us at j.blair@jewish-funerals.org, or info@jewish-funerals.org.

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Gamliel Graduate Courses

Graduates of the Gamliel Institute, and Gamliel students who have completed three or more Gamliel Institute courses should be on the lookout for information on a series of “Gamliel Graduate’ Courses, advanced sessions focusing in on different topics. These will be in groups of three sessions each quarter (three consecutive weeks), with different topics addressed in each series.  The goal is to look at these topics in more depth than possible during the core courses. We plan to begin this Fall, in October and November. The first series will be on Psalms. Registration will be required, and there will be a tuition charge of $72 for the three sessions. Heading this intiative is the dynamic duo of Rena Boroditsky and Rick Light. Contact us –  register at www.jewish-funerals.org/gamreg/, or email info@jewish-funerals.org.

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DONATIONS

Donations are always needed and most welcome to support the work of Kavod v’Nichum and the Gamliel Institute, helping us to bring you the conference, offer community trainings, provide scholarships to students, refurbish and update course materials, expand our teaching, support programs such as Taste of Gamliel, the Gamliel Café, and the Gamliel Gracuates courses, provide and add to online resources, encourage and support communities in establishing, training, and improving their Chevrah Kadisha, and assist with many other programs and activities.

You can donate online at http://jewish-funerals.org/gamliel-institute-financial-support or by snail mail to: either Kavod v’Nichum, or to The Gamliel Institute, both c/o David Zinner, Executive Director, Kavod v’Nichum, 8112 Sea Water Path, Columbia, MD  21045. Kavod v’Nichum [and the Gamliel Institute] is a recognized and registered 501(c)(3) organization, and donations may be tax-deductible to the full extent provided by law. Call 410-733-3700 if you have any questions or want to know more about supporting Kavod v’Nichum or the Gamliel Institute.

You can also become a member (Individual or Group) of Kavod v’Nichum to help support our work. Click here (http://www.jewish-funerals.org/money/).

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MORE INFORMATION

If you would like to receive the periodic Kavod v’Nichum Newsletter by email, or be added to the Kavod v’Nichum Chevrah Kadisha & Jewish Cemetery email discussion list, please be in touch and let us know at info@jewish-funerals.org.

You can also be sent a regular email link to the Expired And Inspired blog by sending a message requesting to be added to the distribution list to j.blair@jewish-funerals.org.

Be sure to check out the Kavod V’Nichum website at www.jewish-funerals.org, and for information on the Gamliel Institute, courses planned, and student work in this field also visit the Gamliel.Institute website.

RECEIVE NOTICES WHEN THIS BLOG IS UPDATED!

Sign up on our Facebook Group page: just search for and LIKE Chevra Kadisha sponsored by Kavod vNichum, or follow our Twitter feed @chevra_kadisha.

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SUBMISSIONS ALWAYS WELCOME

If you have an idea for an entry you would like to submit to this blog, please be in touch. Email J.blair@jewish-funerals.org. We are always interested in original unpublished materials that would be of interest to our readers, relating to the broad topics surrounding the continuum of Jewish preparation, planning, rituals, rites, customs, practices, activities, and celebrations approaching the end of life, at the time of death, during the funeral, in the grief and mourning process, and in comforting those dying and those mourning, as well as the actions and work of those who address those needs, including those serving in Bikkur Cholim, Caring Committees, the Chevrah Kadisha, as Shomrim, funeral providers, in funeral homes and mortuaries, and operators and maintainers of cemeteries.

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Briefs: L.A. Koreans and Jews protest anti-Semitic cartoons published in South Korea;


L.A. Koreans and Jews protest anti-Semitic cartoons published in South Korea

Leaders of the Korean and Jewish communities in Los Angeles have joined forces to vigorously protest anti-Semitic cartoons in a book published in South Korea and translated into English.

A typical cartoon depicts a newspaper, magazine, radio and TV set with the caption: “In a word, American public debate belongs to the Jews, and it is no exaggeration to say that [U.S. media] are the voice of the Jews.”

The publication in question, which is in comic book format, is one in a series titled, “Distant Countries and Neighboring Countries,” and is designed to teach young Korean students about other nations.

It was written by Lee Won-bok, a popular South Korean university professor and author, and the book’s English translation has reportedly sold more than 10 million copies.

“I don’t have words to describe the outrage I feel,” Yohngsohk Choe, co-chairman of the Korean Patriotic Action Movement in the U.S.A., told the Los Angeles Times.

Choe was among leaders of the large local Korean American community who met last Friday with Rabbi Abraham Cooper, associate dean of the Simon Wiesenthal Center.

Choe added, “The depictions are explosive. They have the potential to harm good relationships with our Jewish American neighbors in Los Angeles.”

Cooper said he had written the publisher of the book, asking her “to carefully review the slanders in this book that historically have led to anti-Semitic violence and genocide,” and “consider providing facts about the Jewish people, our religion and values to young South Koreans.”

The publisher, Eun-Ju Park, answered by e-mail that she would check into the matter “more closely and correct what needs to be corrected,” a response Cooper considered unsatisfactory.

— Tom Tugend, Contributing Editor

Jewish liaisons for Bush and Clinton outline work in ‘the real West Wing’

Noam Neusner, who served as Jewish liaison and special assistant to President George W. Bush, said last Thursday that while the president welcomes comments from major Jewish organizations on matters of national policy, “it was kind of crazy” for the Union of Reform Judaism to pass a resolution condemning the Iraq War.

Neusner and Jay K. Footlik, who was President Bill Clinton’s Jewish liaison, spoke at Sinai Temple at the 2007 Rabbi Samuel N. Sherman Memorial Lecture. Titled, “The Real West Wing,” the event was co-sponsored by StandWithUs and moderated by Rabbi David Wolpe.

It is the job of the Jewish liaison to advise the president on a wide range of issues, including such things as lives of Jews in the military, allegations of proselytizing or arranging the annual White House Chanukah party. Footlik said some people believe that the Jewish liaison works for Jewish community, rather than for the president. He pointed out that American Jews are “not shy” about telling the White House their feelings.

In response to a question about anti-Semitism in America, both men said that in spite of the impact of President Jimmy Carter’s recent book, support for Israel remains solid, but they stressed “you can’t take it for granted.”

Each cited examples of their administration’s commitment to Israel and the Jewish people and expressed confidence that regardless who wins the 2008 elections, American support for Israel will remain strong.

— Peter L. Rothholz, Contributing Writer

Milken schools chief announces retirement

Stephen S. Wise Schools went into high gear to find a successor for Dr. Rennie Wrubel, who last week announced her intention to retire from the position of head of school of Milken Community High School and Stephen S. Wise Middle School on June 30, 2008.

Wrubel, 62, has headed the schools for 10 years, during which time she has increased enrollment, made both the academics and Judaic studies more rigorous and built up the Jewish culture of the school, according to Metuka Benjamin, director of education for Stephen S. Wise Schools.

“She has been a great asset to Milken and really helped develop and build Milken,” Benjamin said. “She brought it to the next level.”

On Feb. 22, Wrubel sent a letter to Benjamin, explaining that she and her husband, who is 10 years her senior, longed to spend more time with each other and with family. Her daughter and son-in-law live in Israel with three children — a 4-year-old and twin 10-month-olds.

“Leading Milken for these past 10 years has been the highlight of my 41 years in education. It has been far more than a job to me; it has been an act of love,” Wrubel wrote, saying the decision to retire was one filled with emotion.

Milken is planning an international search for the position in the 16 months before Wrubel retires. With its $30 million campus, challenging academics and robust programming, the school aims to compete with L.A.’s best prep schools.

A search committee is already in formation, and administrators have hired Littleford & Associates, a consulting and executive search firm that has worked with the synagogue and its schools in the past and understands the culture and needs of the school, Benjamin told parents in a letter. John C. Littleford has already visited the school to conduct focus groups to develop a leadership profile for the position.

Once candidates have been identified and narrowed down, small groups of parents, teachers, alumni, students and administrators will have a chance to interview semifinalists and give input to the search committee. The committee aims to make a final recommendation by February 2008.

— Julie Gruenbaum Fax, Education Editor

Police Chief Bratton warns terrorism will be threat for the rest of our lives

“Terrorism, like crime, is going to be with us the rest of our lives” LAPD Chief William Bratton told Rabbi David Woznica at an open forum at Stephen S. Wise Temple Monday night.

“Since we are a likely target, we share intelligence with the FBI and the governments of Canada, Australia, the United Kingdom and Israel. We know we must trust one another and learn from each other.”He went on to reassure his audience, however, stating that “we are highly regarded for our capability and creativity, and there’s no place as well prepared as this place.”

The Strongest Link


No matter how well things go in chemotherapy, the truth is, cancer always makes new demands on you. You can’t afford to be a k’nocker, pretending you know what you’re doing or what you’re ready for. It’s not as if you are in charge.

On the morning of my final course of treatment, I was ready for the long, seven-hour routine now so familiar to me. I was bringing irises for my room, pretzels filled with peanut butter for the nurses and anticipated visits from dear friends throughout the day.

It occurred to me that now, on my sixth round, maybe I was overdoing the need for support. The nurses have become like friends, and I knew I could count on them for diversion and hope, conversation about their art projects, pets and outside interests. Why ask others to interrupt their lives when by rights I could (should?) handle this last treatment alone?

My portacath was easily accessed. The intravenous drip of steroids and kidney stabilizers was set in motion. Emily, Joyce and I were discussing the career prospects of our adult children. At 2 p.m. the doorway filled; my oncologist and the staff brought a chocolate cake and sang "Happy Last Chemo to You!"

Yes, my last chemo day proceeded naturally, dull with the drip of healing.

At 6 p.m., we caught the mistake. The IV pump had a glitch, and I had not yet begun Taxol, the first and longest part of chemo treatment. For two and one half hours, while Susan, Cynthia and Rona had been discussing art museums and second careers, I’d been getting nothing from a blocked port.

And so I was back at the beginning. Not just the beginning of the day, but, my thoughts sent spiraling, the beginning of my life. Fear took over, my blood pressure rising into the stratosphere. And I knew, with a certainty only six months of lung cancer could produce, that this was bad news. My grandmother, who died before I was born, had had high blood pressure, followed by a stroke. She’d gone blind. All my life seemed pointed at this moment, this awful dark joke. Maybe cancer wouldn’t kill me, but blood pressure might.

"Can you meditate?" nurse Stephanie asked as she turned down the light.

Yes, of course. I had practiced 20 years of meditation, plus visualization. Plus prayer. Not to mention yoga.

"Om," I began. And "Shalom."

I started the slow counting of the breath, in and out. I saw myself on a sandy beach of a tropical island at sunset. I breathed God in, and tried to breathe fear out.

Nothing worked. The slower I breathed, the worse my fear became. I was the proverbial speck, a victim of a senseless universe, with the terror of my grandmother’s legacy whispering in the wind.

And my blood press stayed high.

Then I heard the rustle of leaves. I wasn’t alone, of course. Cynthia and Rona were bringing back soup and sandwiches. But Susan was there, flipping through the newspaper nearby.

"Hold my hand?" I asked her. Within minutes, I was breathing normally. My blood pressure stabilized.

So on the very last day of chemotherapy, one valve of an IV tube was constricted, but another valve, that of the heart, opened up.

I know nothing about bravery. I know only about need. Reb Nachman of Bratslov calls prayer the cry of the brokenhearted to a father who is far away. Maybe so. But prayer can also be reaching out, to friends who are close at hand.

Alone, I am the weakest link. Together, there are soup and sandwiches for all.

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