Part 1—The End-of-Life Conveyor Belt

What do people want as they near the end of their lives? Surveys consistently show that the vast majority don’t want to spend their final days in a noisy, sterile-looking hospital room, hooked up to ventilators, tethered to IVs and feeding tubes. They’d rather die at home, surrounded by family and friends. They want to live out their final days in comfort, free of pain. But most people at the end of life will not experience a gentle landing. Only 20 percent die at home. The rest end up in hospitals, nursing homes, and other institutions. More people than ever before spend their final hours often incoherent, kept alive by machines and medical interventions—many experiencing unwanted pain and suffering. Increasing numbers of people are dying in pain—61 percent in 2010, a 12 percent increase from 1998.

There is a way to address pain and suffering—it’s called palliative care—healing and comfort care for people who are nearing death or facing a serious, life-threatening illness. But despite all the advances we’ve made in modern medicine, palliative care is not universally available for everyone nearing the end of life.

Zen Hospice and the Benefits of Palliative Care

The hospice movement was the first to provide palliative services for the terminally ill on a widespread basis. It was started by Cicely Saunders in England in the late 1960s. Saunders established St. Christopher’s Hospice, the first hospice to use pain and symptom control, compassionate care, and palliative care for patients near death. In the early 1980s, the hospice movement spread to the United
Luca Singer, Zen Hospice Project resident
States. The Zen Hospice Project in San Francisco was one of the city’s first residential hospices that started during the AIDS crisis. Zen Hospice is housed in an old Victorian and space is limited—it can only accommodate six residents at any one time. Luca Singer was one of the lucky people who spent his final days at the hospice. It took several months for Luca to be admitted. By then, Luca was in excruciating pain. “My brain is constantly swelling,” said Luca, “I have a tumor behind my right eye—five brain surgeries, terminal brain cancer. Sometimes, it’s so painful, I puke.” In addition to the brain cancer, Luca got hit by a car and broke both his legs, his hip, arm, and shoulder.

When I met Luca in the spring of 2016, he was resting comfortably in a bright, sun-filled room that overlooked a quiet tree-lined street. Luca called this place “a healing sanctuary.” His pain was mostly under control and his depression is not as acute, thanks to the palliative care team at Zen Hospice. The medical staff treated his physical pain with medication and hospice volunteers, spiritual counselors, and social workers helped lift his spirits.

George Keller, Executive Director,
Zen Hospice Project

George Keller, executive director of Zen Hospice, says the goal is to address the needs of the whole person, with the aim of maximizing his comfort. “We’re trying to make it possible for people to live more fully until they die,” said Keller, “What we do is make an attempt to be present with the person. ‘May I touch you? Would you like me to hold your hand? Are your feet warm?’ Or just be quiet that unfolds into a communication.”

Good food is an important source of comfort for many people. The kitchen is at the heart of Zen Hospice—warm, freshly baked cookies and pastries for staff and volunteers and home-cooked meals specially prepared for each resident. It’s definitely not the bland food many of us
Priscilla Callos, Zen Hospice Project Chef
associate with hospitals. Before his illness, Luca worked as a chef and he gave Zen Hospice his highest rating—“gourmet” was the way he described his meals. “I feel like royalty and I feel spoiled the moment I wake to the moment I go to sleep,” said Luca, “I couldn’t be in a better place. It’s a dream come true. Everything I wanted, needed, and desired is being met.”

A few months after we spoke, Luca passed away peacefully in his sleep.

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