My first Dublin conversation was with the woman next to me on my flight. Aside from briefly offering her gum, our Atlantic crossing was silent. I devoured the in-flight entertainment, while she made the wise choice to sleep the whole way. However, as we descended, we started up the usual traveler’s introduction. I asked where she was from (Chicago) and where she was going (a friend’s wedding in England and taking the chance to travel Europe). In response, she asked me “Are you going home?”
And yet, it keeps happening. Several times I have been stopped and asked for directions, even on the first couple days when I was blindly wandering. With the red hair and the British Isles face, I suspect this is the only place on my trip where I will be easily confused for a native. At least until I open my mouth and an American accent pours out.
After my first couple days in a hostel, I moved to a private room in a large house on Royal Canal Terrace in North Dublin. It’s an old, 19th century building, built to host the workers who built the nearby Broadstone Railway Station. My hosts are an engaged couple, one a graphic designer, the other a professional footballer (his current team is here). While my room is my own, I share a kitchen, a bathroom, and a common area with the other guests, ranging from a Spanish English teacher taking supplemental English courses, a French interior design student working at an internship, an intern with the Portuguese Embassy, and a Mexican dentist working towards a European dentistry license. It feels like a dorm, with the strange interstitial spaces between private and public, the personal and the shared, the tensions exaggerated by their temporary nature. Other than our hosts, we are all just passing through, but for at least a month, this is our home.
The idea of a temporary home, central to the Watson experience, has had an interesting reflection in my project. I’ve only conducted one interview so far, with Dr. Regina McQuillan with St. Francis Hospice in Raheny. Unlike the hospice where I worked, St. Francis offers inpatient care in addition to outpatient and in-home. Inpatient care is for the most complex cases, those who require 24-hour monitoring, where patients eat, sleep, and live on-site.
On my tour, I noticed the strong smell of cigarettes wafting from some rooms, very unusual for a medical facility. Dr. McQuillan explained that while Ireland was one of the first countries to pass a smoking ban, nursing homes, inpatient hospices, and mental hospitals are exempted. On its face, this seems counterintuitive. In a place dedicated to health, why allow smoking? Dr. McQuillan pointed out an intuitive logic: “Well, it’s their home.” And that’s true. Even if those living in inpatient wards are necessarily just passing through, it remains their home.
It’s complicated though. After our conversation, I thought about working in nursing homes and the balance between making it a home and providing medical care. We called boarders residents, not patients. Families would put up pictures and decorations from residents past lives. Most of the time, residents were left to their own devices, just like the adults they were.
But in reality, in many American nursing homes the emphasis is on the first, not the last word. Residents’ morning schedules are rigidly controlled, making sure everyone is showered and wheeled down for breakfast on time. While newer facilities are changing their layout, most still have the classic long, tiled hospital-style hallways, and few have locks on their doors. It’s convenient for medical staff, and makes it easier to insure a certain type of treatment, but it’s certainly not homelike.
Perhaps it’s going too far to consider the right to smoke inside a symbolic representation of different philosophies of care, but I’m going to try. The smoking ban in Ireland is specifically designed to stop smoking in the workplace. Even if smoking is constrained to certain designated areas, elevating these medical spaces above the rules is to insist that the hospice is designed for the resident’s convenience, not the medical staff. It’s to insist those who have the most complex needs, who require the most medical effort, are more than cases to be managed, that they have had and continue to have lives beyond their illnesses, beyond the medicine-patient relationship. So what the hell, let them have a smoke.
This carries deep into the design philosophy of St. Francis Hospice’s facility. Unlike the pinwheel structure of the average American nursing home, with the nurses station in the middle, able to see the door to every room, the hallways are long and winding, with reading rooms off to the side. There is an emphasis on natural light, and a garden in the center. The respect for burial tradition is also built into the building, with an in-house mortuary. While families no longer sit with corpses until it is time for the burial, there is a tradition of visiting the remains of people where they died, so the dead’s connections may greet the primary mourners and say prayers over the body before it is removed to the church. Such a practice also emphasizes the importance of the family in the dying process, not just the patient.
Of course, Dr. McQuillan would criticize how I’ve extended these design choices to assume the absolute primacy of patient preference. I’m still processing our conversation, and I hope to observe how she performs her work, but she mentioned two critical considerations the above analysis might miss. First, in her words, “The books on palliative medicine were written by individualistic countries” but places like Ireland view the dying as a part of a larger network. Thus in care, it’s not just the patient’s desires that must be considered, but the families and the broader society.
Second, and more towards situating medical choices in their societal context, is my treatment of the facility as a home. Perhaps this shows my bias. Working in hospice, the priority was always in making sure patients could die in their homes, in line with data that indicates most people say that is what they want. But Dr. McQuillan notes that it is the healthy who say they want to die at home, not the sick. As their health deteriorates, patients become more scared. If their spouse is elderly and something goes wrong, what will happen? Those in hospitals are often in six person wards, with limited privacy. In both of these cases, around the clock monitoring and care, with a private room, starts to look more appealing. And if there were unlimited private rooms, it would be. But resources are always limited, and a patients hope for a private room can push out another person needs require near constant monitoring. Whether the option for inpatient care is available or not rests with a more distant professional, the doctor, rather than in the hands of the patient.
I have other thoughts from our interview, but I’ll leave them for when I’ve seen and talked to more people.
Here’s some of the other stuff I’ve been up to in my (copious) spare time.
Honestly, I haven’t been great at taking pictures (I’m getting better!), but I’ll include what I have so far. I’ve spent a lot of time meandering the city. Dublin tends to hide or forget to put up its street signs, and it prefers curving side-roads to a grid with large avenues, which makes it a fun place to get lost. I made it to the Guinness Storehouse, which, while a bit touristy, did explain its role as an emblem of national pride. The Guinness family has had a long history of supporting the city, as one of the first companies to accept unions, building housing for the homeless, or paying for the construction of St. Stephen’s Green. While not Catholic themselves, they fought for Catholic emancipation under British rule in an era when it was deeply unpopular.
It’s the anniversary of the 1916 Rising here, a weeklong rebellion against British rule whose failure led to the detainment of thousands of Irish nationalists and the execution of many figures, resulting in the sort of martyrdom that laid the groundwork for the 1918 War of Irish Independence. I got a brief tour of the exhibit at the National Museum and I hope to dig into more details of the history. I’ve also spent some time in the National Gallery, though it’s currently undergoing serious renovation.
Finally, on Friday, the French houseguest and I went to a performance of traditional Irish music in a nearby pub. Well, performance is probably the wrong word. All of the musicians were just sitting on bar benches in a separate room, swapping reels and singing sad songs. They seemed like old friends playing for each other, while the few of us crammed into the space looked on and the sounds of a Friday night echoed from the bar. It was a warm summer’s night, but I felt like there must have been a crackling fire. I didn’t take photos. It seemed like too private a place, another kind of a home in the backroom of a pub.