December 11, 2012
“Dying is something you have to do all by yourself. There are no cohorts, no accomplices, no compadres … it’s a solo act.”
William O’Shaughnessy:
For the next 50 minutes while we’re in your keeping … a very tricky subject. I’m not sure it’s the cheeriest, happy-go-lucky topic to be talking about in the countdown to Christmas, but it’s to be dealt with – sooner or later for all of us, I expect. Our special guest is the medical director of Calvary Hospital in the Bronx. His name … listen to this … is Dr. Christopher Comfort. You’re aptly named, sir.
Dr. Christopher Comfort:
Mr. O’Shaughnessy, thanks for having us. I guess it’s unusual, the work I do, working at a place that takes care of loved ones who are dying and they do come to us, I guess, for comfort.
WO:
Doctor Comfort, we’ve heard about Calvary over the years … a palliative care place. And what does the word palliative mean?
CC:
Calvary is fairly unusual. It is the only place quite like it in the country. It’s a hospital … a place where people come very, very ill … usually at the end of life requiring very sophisticated kind of care, not with the intent of cure, but with the intent of keeping them comfortable until their very last days. And I think in some ways that defines what palliative is all about. It’s a new term in medicine – palliative comes from a strange derivation of Latin … meaning to cover or shadow. The thinking is that no longer is there the possibility of a cure of illness or disease, but what we do is cover up those symptoms that are distressing to individuals. We deal with the suffering individuals go through, either during the last stages of their illness or perhaps even before that. It’s a new discipline because it also says in addition to symptom control or taking care of difficult, egregious symptoms, we also include loved ones in the care.
WO:
Doctor … you’ve been at this for 17 years. Do you ever go home drained? You’re a Westchester guy. You were in the Bronx as a regular general practitioner. How did you get over to Calvary full time? You’re now the medical director …
CC:
I was involved with Calvary while in practice. I used the facility for the excellent care of some of my patients and slowly made the migration to work at the institution including directing the medical program. I had the honor of working with some wonderful people … Frank Calamari who is the president of the hospital … Dr. Michael Brescia, who began this work some 50 years ago, a real pioneer in the concept and implementation of palliative care. So for me it was a transition that really was an honor not only for the patients I’ve been able to work with, but the professionals I’ve been able to associate with.
WO:
You mention Calamari … we hear him everywhere on the airwaves. Is there really a Frank Calamari, or is that an actor?
CC:
There really is … and he sounds exactly like that in person.
WO:
And what about Dr. Brescia … he’s a legendary guy … been there for a hundred years.
CC:
He’s an amazing individual. In fact, the history is almost a Bronx/Westchester story in terms of Dr. Brescia. His beginnings were actually in the Bronx VA program. And, in fact, his real claim to fame is not starting a world-famous program in terms of palliation. He and Jack Cimino, who was a compatriot of his, actually developed and implemented the arteriovenous shunt which is the access device used by every individual on dialysis. 50 years ago he and Jack developed the technology. It revolutionized dialysis for literally the whole world. This is Dr. Brescia who then, after developing that, said he needed to move on to something I guess he thought had even more meaning. And so he came and worked in the South Bronx with a group of nuns and established the medical program at Calvary that has grown into what it is today.
WO:
Dr. Comfort … you told us Calvary was the only one of its kind in the country. Why doesn’t Chicago have a Calvary? Or Houston?
CC:
Our country and my profession has been very slow to develop in terms of recognizing the benefits of palliation and palliative care. This is a field that has developed over the last 15 years and only in the last five years has become popular. New York has had the honor and luxury of having this kind of program for about 110 years.
WO:
Is it a Catholic thing?
CC:
It may be rooted in faith because the mission of the institution to take care of individuals in their last days is really a compassionate mission. And it is a mission began 110 years ago actually out of the work of widows of the New York City Fire Department who began a program in Manhattan which in the 1930’s and1940’s moved up to the Bronx. The Archdiocese of New York has been involved in this work for years. And through both the Sisters of Faith and Archdiocesan individuals the mission has grown through its infancy to a true medical program as it exists today.
WO:
Cardinal O’Connor used to say he does bedpans. Did O’Connor come to your joint?
CC:
We have had all the cardinals over the last 50 – 60 years come and actively participate. Some have come to witness what goes on. Some have come to actually participate. Some had loved ones who have come and died with us.
WO:
Doctor, Calvary is right over the line. We’re in New Rochelle, but our ravings are also going worldwide at the moment. I was down at Calvary the other day, a friend of ours – a very famous and beloved one: Judge Andy O’Rourke, the former Westchester county executive – is in your care and keeping. And it’s in kind of a drodsome section of the Bronx. Almost a factory section. I’ve got to tell you, your building on the outside is not the greatest architecture I’ve ever seen. But inside … it’s a magical place. It’s wonderful …
CC:
We’re in the East Bronx literally across the street from the Weiler Division of Einstein near Jacobi Hospital. Those of us in the medical field, look at it as “hospital row” in the Bronx.
WO:
But there sits Calvary … sort of apart. The other ones seem like big medical centers. Calvary is sort of … I’ve never seen a building like that.
CC:
And I think it is symbolic of what it represents. It represents a place that is different. It is unique. It has a very special and very identifiable place in the medical community.
WO:
Thank God the sun is struggling to come out … we’ve had some pretty awful, rainy, nasty days around here and our guest today is Dr. Christopher Comfort. He’s medical director of Calvary Hospital .. a great resource for Westchester and the New York area. Doctor … do you ever see miracles. Did you ever attend a miracle or witness one?
CC:
There’s no question. Miracles come in a variety of different forms. Miracles arrive with individuals who come extremely ill and actually get well and go home. For weeks … and maybe for months.
WO:
You’ve seen it?
CC:
Absolutely. Miracles happen with families that have been fractured or estranged for years and at a tragic time in the life of the family they come together to witness a very difficult event. And the healing that occurs for families is nothing short of a miracle.
WO:
But when they come together like that … is it for real? Do you believe it?
CC:
My view on it is that it is the last chance we have … the last chance for a family to come together with a loved one. It really is a sacred time for them.
WO:
Do people in your care and keeping, when they hear they’ve got to go to Calvary … is that like a death sentence?
CC:
The difficulty with the name Calvary is … yes … it is associated with the idea of dying patients.
WO
You’re a Roman, right?
CC:
Yes.
WO
So … Calvary … what was that all about?
CC:
The story of Calvary is the name of the hill where Jesus was crucified. It is a place of salvation. I think we’ve changed the concept of it being a place of death to where it is a place where someone comes that is a stepping stone to what comes next. I know Dr. Brescia likes to talk about it as entry into a special vestibule. In fact it is the waiting room … or vestibule of Heaven. And I think for many of our patients who have my belief … or may not have my belief … it is truly a place where they await a better life, a better time for themselves.
WO:
You’re the physician, you take care of them and make them comfortable. Do they tell you their mistakes, their sins, their errors, their transgressions? Do they try and make a priest out of you?
CC:
Most people actually have a wonderful gift they give me. They give me their story. Some of that has to do with mistakes. Some of it has to do with transitions … and some has to do with great joy that has occurred throughout their life.
WO:
So you’ve heard these stories, Dr. Comfort, for 17 years. Why don’t you write a book about it.
CC:
Well, Dr. Brescia is. So I don’t want to usurp his fire regarding the wonderful experiences we all have had at Calvary over the past many years.
WO:
There’s a calmness about you. Do you ever get crazy and excited and speeded up? You have a peaceful face, a nice countenance. It feels good being around you.
CC:
Well … I think that’s the way it should be.
WO:
Do you ever get speeded up?
CC:
Every once in a while.
WO:
How do you calm down?
CC:
I actually go upstairs to the patient floor, sit down, have a discussion, observe a family and realize the great blessings I have … not only to have the things – health, intellect – I have, but to realize what I’m able to give.
WO:
Does it make you feel better to see someone worse off than you are?
CC:
I’m not sure it’s exactly that, Bill. I think more it is the honor of being able to make a difference at such a difficult time with people.
WO:
Do you get the family involved with the care of your patients?
CC:
That’s an excellent question. The family is important to us. The question is how does that really happen? It really happens in two ways. One is that we strive to actually involve the family in much of the actual hands on things in terms of care more than just educating families about what is going on … more than just explaining the time course that may go on. But we actively involve the family and invite them to involvement in what’s going on … for choices of medications … and inviting families for activities. We actually have very extensive recreation therapy programs where patients who may be quite ill involve themselves in activities such as arts and crafts, Bingo, where families get to participate and realize it might be the last time a family sits down with a loved one in a usual and normal social situation. More importantly, we really do feel that the experience is not limited to the patient themselves. A patient may die. I have not seen resurrection yet. I may be wrong, but I know that families, as they watch them go through what they go through, die as well. The difference is that the family does resurrect. And so we feel it is important for us to be involved in that process of resurrection that goes on with the family as they live through the reality of losing a loved one.
WO:
Do you find families, Dr. Comfort, who just can’t handle the whole thing?
CC:
I think it is an immense burden to put on any family to have to watch the death of a loved one. I don’t think it is different watching a child die or a parent … whether that parent is 30 years old or 90 years old. It’s a difficult event in a family’s life and it is certainly important to make sure it is as bearable an experience as possible.
WO:
Dr. Comfort, what is a perfect death? You just slip away? Mario Cuomo said to me once … you just swoon. What’s a perfect death?
CC:
I’m not sure I can define it for you … I’m not sure I’ve experienced or watched a perfect death. I know I have watched a lot of different ways for death to occur. I think the most important part and one of the things we strive for is to recognize if they’re suffering and to relieve that suffering because that is the mission we have. We’re not going to change the time course. But we can make a significant difference in making sure the suffering is treated.
WO:
How many people are suffering down in Calvary as we speak?
CC:
We have 225 patients we’re taking care of right now.
WO:
How many are in there because of cancer?
CC:
About 80% of the patients we’re taking care of have a primary diagnosis of cancer.
WO:
Do you take AIDS patients?
CC:
We take other diagnoses so we take patients who have diagnoses such as AIDS, also end-stage cardiac disease or end-stage lung disease. The care of those patients is very similar to the kinds of care necessary for the treatment of cancer patients.
WO:
Doctor, you said you will counsel with the family about the kind of medication. What is someone says … look, I know the hand I’ve been dealt, I’m here. But I would like to stay lucid. I’d like to think and be as productive as I can be laying here in this bed. I don’t want you to zonk me out. You don’t, in that case, just keep pumping them with feel good stuff, do you?
CC:
You know, it’s interesting to look at that question because it’s excellent. The purpose of the treatment we give is to maintain the integrity and dignity of the individual as long as it can be maintained. And that includes maintaining the awareness and thinking and the communicating capacity of that loved one. That time, as you know, is a special time for both patient and family. So it is extremely important to respect not just the wishes of the patient who might not want to have a grogginess or sedation related to medication, but realizing we strive for every patient to have good, meaningful time with loved ones.
WO:
You make it very easy to get in and out of the place. You don’t have to show your passport or sell your soul to get in the place. And you have visiting hours 24 hours a day?
CC:
We’re, as I’ve said, a little “unusual.: We have visiting 24 hours a day. There is no age restriction on visitation. You may come and visit and lo and behold you see children running around, coming to visit a loved one. You may come downstairs and see pets of patients that have been brought in to say final goodbyes. You may actually see occasions and events come to us such as weddings because loved ones are sick and can’t get there so they bring the celebration to us.
WO:
Do you ever see anybody come in there with a hip flask? Can you have a little cocktail?
CC:
We actually have a “Friday Night Cocktail” and we have volunteers who go around on Friday night to the patient rooms …
WO:
You can have an Absolut?
CC:
Those who have the doctor’s permission to have a stiff one on Friday are offered that.
WO:
Who started this? Frank Calamari, the boss man? Does he know you do this?
CC:
It happened long before him, I’m sure.
WO:
Doctor Christopher Comfort is his name. Let’s go to the phones again …
Caller:
Doctor, my Uncle Jimmy was a World War II veteran. He died young at Calvary back in the mid 60’s. And he got wonderful care, I still remember. I want to also thank you, your staff and the Catholic women who make bandages that you use there. It’s just a wonderful institution …
CC:
We have a lot of volunteers. In fact, we have an event coming up on Wednesday we call “Cafe Noel,” an entirely volunteer event. We bring Christmas to 225 loved ones, including their families. We take downstairs and turn it into a performance area. We bring in volunteers who serve food and merriment and as many patients who are able can come down to a nightclub setting to spend time with their loved ones for the performances. We repeat that in Brooklyn. We have 25 beds in Lutheran Hospital. That’s an off-shoot of Calvary and having driven out to Brooklyn weekly for the last ten years, I can tell you that sometimes the trip from Brooklyn to the Bronx or the Bronx to Brooklyn is like going to a different state. And so we realize that to provide Calvary services only in the Bronx limited the access to what we thought was wonderful care for other parts of New York City so we began a program at Lutheran Hospital with 25 beds where we have a Calvary within Lutheran and that has served the Brooklyn community for the past ten years.
WO:
You know, I’m sort of figuring this out that Calvary is not such a heavy, heavy what hangs over place. Life goes on it seems …
CC:
This is where life continues. In fact, I’ve often thought the difficulty is not dying. The difficulty is the fear of what will happen as you lead up to dying. So our concept is very simple. Calvary is a place where the prognosis or event may occur, but it is also a place where we allow life to continue as long as it can continue and the meaningful things that can be done during that time are maintained.
WO:
You know … you are more articulate than a lot of priests I know. Do you have guys with Roman collars walking along your halls?
CC:
We actually have about 25 full time pastoral care staff who take care of patients. Not only Roman collars, but we have a significant number of all religious persuasions.
WO:
Do you have a rabbi on your staff?
CC:
We have two. We began a program over the last couple of weeks with Yeshiva University, through our friends at Einstein, where we are doing work for the Orthodox Jewish community. We receive referrals from Brooklyn and Rockland County for the care of dying patients of the Orthodox Jewish religion addressing the very particular needs belief systems of that group in an effort to have that life continue as long as it can.
WO:
How about Muslims? Do you have any Muslim patients?
CC:
In fact, we do. It’s amazing to look at different ethnic groups and realize each of us as communities deal with life and with death differently. The practices of a Hindu … a Muslim … a Jewish individual … or a Catholic … there are some similarities. But there are some nuances, some differences in terms of both beliefs and the way individuals go through the experience of illness.
WO:
What is the best thing a friend can do if somebody is at the end of his or her life? Do you say … you’re going to be alright. You’re going to be out of here soon … ?
CC:
We’ve learned … and it’s been painful. But we’ve learned you don’t make promises you can’t keep. At a time when people are quite ill … and patients suffer, that is not the time for a promise to be made and those of us in the medical profession often do that. Let me give you an example: If you had the misfortune of having to accompany a loved one to a doctor’s office for a visit and bad news is given … the doctor leans over and says I’m sorry, sir … but I have to tell you you’ve got lung cancer and you who are merely accompanying them are sad and begin to cry. It’s not uncommon for the doctor to lean in and say, it will be alright. The problem is for you at that point and time and the meaning of that experience, to know and accept that it’s not going to be alright. In fact, your life and the life of the loved one is changed forever. So, my advice for family and friends is that the most important thing you can do is to simply witness. To witness … that is to be there. Be a physical presence. Be an emotional presence. And a spiritual presence, not to have any expectation that magically you can make anything better. But that it is enough to actually witness the event.
WO:
It would appear, I would opine, that you’re doing the Lord’s work. Are you a pretty religious guy?
CC:
Not really … I have a belief system in making sure suffering is relieved. I have a belief system in making sure attention is paid to the needs of loved ones around a dying patient. But I make no firm promises regarding what comes thereafter. That is certainly an individual perspective.
WO:
Nobody knows …?
CC:
No one knows.
WO:
Doctor Comfort … do you tell people, you’ve got three days or you’ve got a month. Or you’ve got six weeks?
CC:
Well, it’s kind of interesting to look at the accuracy of physicians in determining prognosis.
WO:
Can you tell?
CC:
I can’t. Having done this work for an extensive period of time. I can clearly identify decline in individuals so there is an expectation of dying let’s say within a 24-hour period of time. I think most physicians are pretty accurate with that. But past that, when you get to two weeks. Or you’ve got six weeks or six months … it’s very, very difficult for the physician.
WO:
But when they try and pin you down … what do you tell them. How long have I got, Doc? How many times have you been asked that?
CC:
Probably thousands.
WO:
What do you tell them?
CC:
I tell them it could be a short period of time. It could be a long period of time. But I guarantee you, I’ll be here with you through the whole process.
WO:
You say you’re not religious, I don’t believe you. Not for a minute.
CC:
Well, I think I’m spiritual. And I think Calvary is spiritual. And I think this is important because the patients we take care of and those we minister to, some may be Catholic, some Christian, some Jewish, some Hindu, some Muslim, and the common experience for that is not a particular religious belief, but it is the spiritual nature of what goes on.
WO:
How do you get through to the patients the realization that they may never be leaving the hospital?
CC:
That’s a very, very good question. Let me take it from a couple of perspectives. One I don’t think people have thought about is that, sometimes the experience of advanced illness or severe illness is so difficult for the patient that it is a relief for them to know they will be taken care of and they will not suffer and the last thing on their mind is the idea of being home or being in a hospital. It is being taken care of. Secondly, and it is a sad kind of commentary on the way we take care of patients these days – and this isn’t so much a medical issue, this is a social issue. As we decline, as we get sicker, many times it becomes impossible for the care of the patient at home because the way things go here in our country, the burden of the care falls upon family. And there are many, many people who don’t have either involved families or a sophisticated enough structure where they can maintain themselves at home.
It’s an amazing thing … when you think about 100 years ago all of us would have said to that question – I’ve seen it. And I see it all the time. Because death and dying was a usual part of life. Now, it is something sequestered and something separated from our experience. I do teaching of medical students and residents and I’ll ask medical students … have you seen someone die? And they will tell me they never have.
WO:
There’s an old line … I used to attribute this to Jimmy Cannon, the great Hearst sportswriter, or the great Breslin himself. But it may have been Pete Hamill: Dying is something you have to do all by yourself. There are no cohorts, no accomplices, no compadres … it’s a solo act.
CC:
It is also a process. It is like birth, isn’t it? Out you come and you’re alone as you go through what is a difficult process. I don’t remember the process myself. But it’s clear the final goodbye … the final exit is an exit that has to be accomplished alone.
WO:
How do you and your colleagues at Calvary decide who needs to go to a nursing home? Or who needs to stay at home?
CC:
We also have a very extensive home program. It’s divided into two parts. One is a home care program that takes care of patients in the home setting. And those patients may be very ill with advanced chronic disease and may be needing those services for just a short period of time.
We then have a hospice program. Hospice is a program that takes care of patients who have advanced disease and typically are dying. And the intent is to maintain those patients at home. And so we have a full division of Calvary known as Calvary At Home which is our hospice program that takes care of thousands of patients in the New York City area. But not in a hospital setting.
WO:
Who pays for all this? Insurance? The Archdiocese? Rich benefactors?
CC:
There are a variety of ways. Some of those are by insurance.
WO:
Are the insurance companies hip to this palliative stuff you’re doing?
CC:
It’s getting better. There is more of an understanding of palliation and palliative care as an “entitled” benefit for those who have insurance. I think actually all have come along and really stepped up to the plate to make sure they are at least addressing the issue of providing that kind of care to patients. And really it’s a credit to not only the medical community, but to the community of those who are insured who have been able to advocate for themselves.
Caller:
I want to say thank you to you, your staff and to WVOX for this opportunity because I didn’t know how to reach out to Calvary beside writing a letter … but I just want to say thank you. I had my first experience going to Calvary when a good friend of the family passed away over Thanksgiving. She was there for a couple of months. I had my first experience going to Calvary. I have to tell you, I was very reluctant. You hear about people and their last days. As soon as I walked through that door – the security, the people at the desk, they made me feel comfortable. Then I went up to the floor, the nurses and staff, everyone was terrific. Then I went into the room, it made me feel better that my friend was so much at ease and the care and how clean the place is. I was very impressed and I felt very good. My friend was there for a couple of months and I really didn’t know what to expect. You think of dying … you don’t know what to say, what to feel …
CC:
One thing we’ve come to realize is we appreciate words of thanks. We send it the other way. It is always an honor to take care of someone and the thanks don’t really reside with us. The thanks resides with the confidence people put in us to be able to take care of people at such a difficult time and also take care of those around them. It’s a great honor.
WO:
Doctor Comfort … I asked you this in one form earlier but I want to have another whack at it. You’ve been at this 17 years. You’ve got a couple of hundred patients in your care and keeping at any hour of the day or night. Have you become sort of inured to suffering, pain and death? Do you ever go home and say … this was a really tough day? Or do you ever become attached to the patient and say I lost one of my favorites?
CC:
I think we become attached to each of the patients because what happens is rather more than taking care of some 200 people or 225 people. We’re taking care of this one person at a time and then this other person … and we’re listening to that story. And we’re experiencing that experience and it becomes very personal in terms of what goes on.
WO:
John F. Kennedy, Jr. once sat at that microphone quoting Mother Theresa: “You save them one by one by one …” But do they, I wonder, all go gentle into that good night? Or are some people just raging and fighting it off?
CC:
There are some people who fight to the end. We fight with them. Because if it’s important enough for them to fight, then it’s important enough for us to stand by them in that last effort they make. Remember … it’s how life continues. Not how I define how it continues. But it’s how that life really does continue.
WO:
So … you’ve got the fighters. Do you have the accepters?
CC:
You’ve got both.
WO:
Which are you going to be?
CC:
I’m not sure … it will be interesting to see.
WO:
Doctor … it has been an absolute joy. I can’t believe I’m applying that word to this topic and this subject. But I’ve admired Calvary and the work you do from afar for many years. And we’ve had some friends of this radio station, good friends, in your care and keeping. The late Monsignor Terry Attridge was one. So it’s an honor to have you. I’ve been sitting in front of this microphone for 50 years and I usually don’t get choked up by anyone. But you’re an inspiration to me and to all of us. When is your cabaret, your cafe? Tomorrow?
CC:
We have Cafe Noel on Wednesday night.
WO:
And when is cocktail hour? Or “high tea?”
CC:
Cocktail hour starts at 3:00.
WO:
If someone wants to volunteer, how the hell do you do that?
CC:
We actually have a program of volunteers with very specific training. We have volunteers that deal with the institution itself, clerical work, secretarial work. But we also have a number of individuals who are directly involved with patients. That includes spending time with patients, feeding those patients who in fact can’t feed themselves. We also have a program of volunteers who visit those patients who are admitted to us without a family. And those volunteers become family for the patients. So if you’re admitted and you have no family or there aren’t visitors coming to see you on a regular basis, we assign a volunteer to you who then is your family and has been instructed that they spend their time being the family you don’t have coming to see you.
WO:
If you’re visiting someone … should you bring them books or newspapers? What should you bring?
CC:
Newspapers are good. Good food is always welcomed by loved ones. Feel free to bring it in. Feel free to share it. I guarantee you it will always be appreciated.
WO:
Christmas beckons … and I’m not sure we’re ready for it. I wanted to share with you something Father Kevin Mackin, a Franciscan. Franciscans will get your head crazy. You know, these are three Hail Mary’s for a homicide priests. He’s president of Mount Saint Mary College and he sent out a Christmas card:
“My hope for you during this Christmas season is what better season for wrongs to be righted, and friends to be reunited, for new dreams to start? What better season for mending, healing, for saying and feeling what’s in the heart? What better season for love to keep glowing, for hope to start growing, for troubles to cease? What better season for sharing and giving, for once again living in joy and in peace.”
I think you guys do that all the time down at Calvary. And will you give our best to the great Calamari and Doctor Brescia.
CC:
What a pleasure to be with you. We’re grateful for your support and for the support of the community at large.
WO:
Calvary Hospital in the Bronx. It’s a great resource … and it’s ours. Sooner or later.
# # #
William O’Shaughnessy, a former president of the New York State Broadcasters Association, was chairman of Public Affairs for the National Association of Broadcasters in Washington. He has been a point man and advocate for the broadcasters of America on First Amendment and Free Speech issues, and is presently chairman of the Guardian Fund of the Broadcasters Foundation of America. He operates two of the last independent stations in the New York area: WVOX and WVIP.
He is the author of “AirWAVES” (1999) … “It All Comes Back to Me Now” (2001) … “More Riffs, Rants and Raves” (2004) … “VOX POPULI: The O’Shaughnessy Files” was released in January, 2011. He is currently working on his fifth book for Fordham University Press, an anthology which will include this interview with Doctor Comfort.
Contact:
Cindy Gallagher
Whitney Media
914-235-3279 … cindy@wvox.com
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