Rabbi Dale Schreiber likes to talk a lot about hope. It can be a somewhat elusive subject for those facing serious medical challenges or end-of-life care situations.
But as a chaplain working in the world of hospice, this Philadelphia native feels that it is important to help patients and loved ones chart what she calls “the goals of hope,” ranging from extension of life and the alleviation of discomfort to maintenance of dignity and thoughts about the family’s future.
Raised in Rochester, N.Y., Schreiber, 69, came to St. Louis in 1985. She didn’t decide to become a rabbi until she turned 50 and after spending two decades as a clinical audiologist and, later, a Jewish educator.
For more than a decade, Schreiber worked as a chaplain with Barnes-Jewish Hospital and is now with Pathways Hospice and Palliative Care.
What are the misconceptions surrounding hospice?
I think that, in general, the biggest misconception is that it is about death. One of the interesting things for me in becoming a hospice rabbi is that I’ve had patients for three consecutive years who have not died and who have consistently qualified for hospice care. It is not really just for the last few days or the last few weeks of life. It is about choosing quality of life in the final chapters of one’s existence.
What about age? Is it only for seniors?
No. I’ve had patients from 20 years of age to 104. Again, people think of it as something that you do within the last few days of dying. In Judaism, at least, that’s when we start to reduce the kind of stimulation when we recognize that people are transitioning through the dying process to death. Just when we should be attending to them, people are choosing to enter hospice where the activity level is so intense. It draws our focus away from being with the person who is dying and supporting the family who is caught up in all of the decisions that have to be made about admission into hospice. I guess my preference would be that Jewish families consider hospice earlier in the trajectory.
Is planning important? Do people sometimes wait until the last minute?
I think what happens is that Jews are covenantal people. We like to be in partnership. So when our physicians consult with families and say that there is really not much more that conventional medicine can offer and I would like you to consider hospice, some families are very resistant because it feels like they are giving up hope. Hope is a very important value in Judaism. They sometimes think that if somebody is admitted to hospice, they lose their choices when, in fact, they have lots of choices. They can choose to keep their own physician. They can choose to stay on certain medications. They can choose to live their life as fully as possible, to go out and be active in those things that give them pleasure. But when they need a significant amount of care, it is right there. You have a team, a nurse, a patient care assistant, a social worker and a chaplain who doesn’t necessarily deal with religion.
What’s the role of a chaplain?
It is not about religion per se. It is about providing support and to help people find the most meaningful ways of being in their lives until they die.
How did you become involved in hospice?
I studied for the rabbinate through the Alliance for Jewish Renewal and, during that time, I became a certified chaplain and I did Jewish care coordination and oncology care at Barnes-Jewish Hospital. I was the senior rabbi there for a decade. Then I retired. I took a year off, and I traveled and I took care of lots of family things. And then I realized I still wanted to be involved. Bikur cholim, exploring the needs of the sick has always been one of my chief mitzvot that calls to me. That and welcoming strangers. Hospice is one of those opportunities that allows me to do both.
What other considerations might be important to think about in regard to hospice?
In Judaism, we have this idea that we are not supposed to shorten life, even by a moment, but the other half of that coin is not to prolong dying. That’s a very narrow landscape so [it is good to have] some guidance when you are in that time of life because we haven’t a lot of personal experiences with people dying if you are outside the medical profession. Issues about whether or not we should push somebody to drink or whether we should insist they eat all have to do with what is happening in the immediate process and being able to give families landmarks so they can make the best decisions for the right reasons.