Galway

So I am in Galway for the weekend - I got Good Friday off, so I rode the bus here this morning. It seems like a nice little city, and tomorrow I will take a bus tour of the nearby Burren and cliffs of Mohr.

Last night, Dr. McQuillan, the head doctor at the hospice and my supervisor for this rotation took me to dinner and a play in downtown Dublin. The play was "Dublin Carol" and was written by a well known young Irish writer Colin McPhereson. It was about a middle aged Irish undertaker who is forced to look back on his (less than satisfactory) life when his estranged daughter tells him his wife (whom he also hasn't seen in years) is in the hospital dying. It was very well done and touched on themes such as family relationships, death, family reunions due to terminal illness, etc, that are quite relevant to my current rotation. (Dr. McQuillan swears she didn't know the play was so relevant, she just liked the author and lead actor.) My favorite line was "A woman's love can be terribly constant. A woman can love you for 3 or 4 years without stopping." So that was a lovely evening, and I'm very lucky to have such nice hosts.

My first week at the hospice went well. I spent time in the hospice inpatient unit, rounded with the palliative care team at nearby Beaumont Hospital, and spent time in the hospice day care unit. I am learning a lot about the Irish family structure and legal system - which is quite different from the US. There are no advanced directives in the Irish legal / health care system, and giving someone power of attorney is uncommon. Divorce was only legalized 10 or 20 years ago, and many couples are separated for years but never get legally divorced, so if they become ill, their husband or wife is still the surrogate decision maker regarding their care, and will inherit all of their property unless there is a will specifying otherwise. This, along with the generally larger family sizes in Ireland seems to lead to some complications that may be less common when caring for terminally ill patients in the US. I think most of the time things get figured out fairly easily, but it is an interesting difference between the two places.

The hospice itself is a lovely facility, which was purpose-built a few years ago. They are working on plans for another hospice on the north side of Dublin to be ready around 2010. It is amazing how much community awareness and support there is of the hospice. In general, the neighborhood around the hospice seems to be more of a real community than American neighborhoods. This may be in large part due to the shared religion - Catholicism - but my impression is that it is also due to a complicated mix of larger, closer families, a smaller country, and more of a sense of place of origin. (Like the guys in the bar Sunday night who take taxis to their old neighborhood bar rather than finding a new one in their new neighborhood.) Anyway, people know who their neighbors are more, and they all know about and respect the hospice a great deal. Every time I tell someone I'm studying there, they say "Oh, the hospice is a wonderful place!" or something similar. Not only that, but many of them seem to volunteer at the hospice in one capacity or another - most commonly as a driver or a visitor for the hospice day care, but also for things like the bereavement support groups, which require a year of training, and are chaired by volunteers. I think it's nice that the hospice seems to be such a fixture in the community, and it's certainly nice that it's so admired.

Well, I have to eat dinner and then I'm off to see "Jesus: The Guantanamo Years" at the Galway Comedy festival which is on this weekend. Hopefully it won't make me feel too bad about being an American. Tomorrow night I hope to see some live music, but the bars are all closed tonight because it's Good Friday and no one is allowed to serve alcohol.