Living alone may be difficult, but what about dying alone? Physicians and nurses are the new priests accompanying people as they face death. But the experience of nursing homes, assisted living, and palliative wards are often some of the loneliest spaces in human culture. “He said, ‘Someone finally saw me. I’ve been in this hospital for 20 years and I didn’t think anyone ever saw me.’” This episode is part 5 of a series, SOLO, which explores the theological, moral, and psychological dimensions of loneliness, solitude, and being alone. In this episode, Columbia physician and medical ethicist Lydia Dugdale joins Macie Bridge to reflect on loneliness, solitude, and what it means to die—and live—well. Drawing from her clinical work in New York City and the years of research and experience that went into her book The Lost Art of Dying, Dugdale exposes a crisis of unrepresented patients dying alone, the loss of communal care, and medicine’s discomfort with mortality. She recalls the medieval Ars Moriendi tradition, where dying was intentionally communal, and explores how virtue and community sustain a good death. Together they discuss solitude as restorative rather than fearful, loneliness as a modern epidemic, and the sacred responsibility of seeing one another deeply. With stories from her patients and her own reflections on family, COVID isolation, and faith, Dugdale illuminates how medicine, mortality, and moral imagination converge on one truth: to die well, we must learn to live well … together. Helpful Links and Resources - The Lost Art of Dying: Reviving Forgotten Wisdom by Lydia S. Dugdale https://www.harpercollins.com/products/the-lost-art-of-dying-ls-dugdale?variant=40081791942690 - Pew Research Center Study on Loneliness (2025) https://www.pewresearch.org/2025/01/16/emotional-well-being/ - Harvard Study of Adult Development on Loneliness https://www.adultdevelopmentstudy.org/ Episode Highlights 1. “If you want to die well, you have to live well.” 2. “Community doesn’t appear out of nowhere at the bedside.” 3. “He said, ‘Someone finally saw me. I’ve been in this hospital for 20 years and I didn’t think anyone ever saw me.’” 4. “We are social creatures. Human beings are meant to be in relationship.” 5. “Solitude, just like rest or Sabbath, is something all of us need.” About Lydia Dugdale Lydia S. Dugdale, MD, MAR is a physician and medical ethicist at Columbia University, where she serves as Professor of Medicine and Director of the Center for Clinical Medical Ethics. She is the author of The Lost Art of Dying: Reviving Forgotten Wisdom and a leading voice on virtue ethics, mortality, and human flourishing in medicine. Show Notes Loneliness, Solitude, and the City - New York’s “unrepresented” patients—those who have no one to make decisions for them. - The phenomenon of people “surrounded but unseen” in urban life. - “I have a loving family … but I never see them.” Medicine and the Pandemic - Loneliness intensified during COVID-19: patients dying alone under strict hospital restrictions. - Dugdale’s reflections on balancing social responsibility with human connection. - “We are social creatures. Human beings are meant to be in relationship.” Technology, Fear, and the Online Shadow Community - Post-pandemic isolation worsened by online echo chambers. - One in five adults reports loneliness—back to pre-pandemic levels. The Lost Art of Dying - Medieval Ars Moriendi: learning to die well by living well. - Virtue and community as the foundation for a good death. - “If you don’t want to die an impatient, bitter, despairing old fool, then you need to practice hope and patience and joy.” Modern Medicine’s Fear of Death - Physicians unpracticed—and afraid—to talk about mortality. - “Doctors themselves are afraid to talk about death.” - How palliative care both helps and distances doctors from mortality. Community and Mortality - The man who reconnected with his estranged children after reading The Lost Art of Dying. - “He said, ‘I want my kids there when I die.’” - Living well so that dying isn’t lonely. Programs of Connection and the Body of Christ - Volunteer models, day programs, and mutual care as small restorations of community. - “The more we commit to others, the more others commit back to us.” Solitude and the Human Spirit - Distinguishing solitude, loneliness, and social isolation. - Solitude as restorative and necessary: “All of us need solitude. It’s a kind of rest.” - The contemplative life as vital for engagement with the world. Death, Autonomy, and Community - The limits of “my death, my choice.” - The communal role in death: “We should have folks at our deathbeds.” - Medieval parish customs of accompanying the dying. Seeing and Being Seen - A patient long thought impossible to care for says, “Someone finally saw me.” - Seeing others deeply as moral and spiritual work. - “How can we see each other and connect in a meaningful way?” Production Notes - This podcast featured Lydia Dugdale - Interview by Macie Bridge - Edited and Produced by Evan Rosa - Hosted by Evan Rosa - Production Assistance by Alexa Rollow, Emily Brookfield, and Hope Chun - A Production of the Yale Center for Faith & Culture at Yale Divinity School https://faith.yale.edu/about - Support For the Life of the World podcast by giving to the Yale Center for Faith & Culture: https://faith.yale.edu/give
Living alone may be difficult, but what about dying alone? Physicians and nurses are the new priests accompanying people as they face death. But the experience of nursing homes, assisted living, and palliative wards are often some of the loneliest spaces in human culture.
“He said, ‘Someone finally saw me. I’ve been in this hospital for 20 years and I didn’t think anyone ever saw me.’”
This episode is part 5 of a series, SOLO, which explores the theological, moral, and psychological dimensions of loneliness, solitude, and being alone.
In this episode, Columbia physician and medical ethicist Lydia Dugdale joins Macie Bridge to reflect on loneliness, solitude, and what it means to die—and live—well. Drawing from her clinical work in New York City and the years of research and experience that went into her book The Lost Art of Dying, Dugdale exposes a crisis of unrepresented patients dying alone, the loss of communal care, and medicine’s discomfort with mortality.
She recalls the medieval Ars Moriendi tradition, where dying was intentionally communal, and explores how virtue and community sustain a good death. Together they discuss solitude as restorative rather than fearful, loneliness as a modern epidemic, and the sacred responsibility of seeing one another deeply. With stories from her patients and her own reflections on family, COVID isolation, and faith, Dugdale illuminates how medicine, mortality, and moral imagination converge on one truth: to die well, we must learn to live well … together.
Lydia S. Dugdale, MD, MAR is a physician and medical ethicist at Columbia University, where she serves as Professor of Medicine and Director of the Center for Clinical Medical Ethics. She is the author of The Lost Art of Dying: Reviving Forgotten Wisdom and a leading voice on virtue ethics, mortality, and human flourishing in medicine.
Loneliness, Solitude, and the City
Medicine and the Pandemic
Technology, Fear, and the Online Shadow Community
The Lost Art of Dying
Modern Medicine’s Fear of Death
Community and Mortality
Programs of Connection and the Body of Christ
Solitude and the Human Spirit
Death, Autonomy, and Community
Seeing and Being Seen
Production Notes
This transcript was generated automatically and may contain errors.
Evan Rosa: From the Yale Center For Faith and Culture, this is for the life of the world. A podcast about seeking and living a life worthy of our humanity.
Lydia Dugdale: We might be surrounded by people and yet who is really digging into our lives in a way that's transformative, that's generative that. Nurturing. I think that's the kind of depth that we lack, that so many people lack, and I think kind of modern life has, has fed that phenomenon. So I think socially we're worse off than ever.
Arguably, the contemplative life is the most critical for being able to engage outward. That is. Regardless of whether we're extroverted or introverted, all people need a certain amount of solitude. I would think, if anything, to reset. People who have a natural orientation toward the divine might say that's necessary for communion with God.
People who reject. That sort of framing or metaphysics. I, I still think even if you reject God, you need a certain amount of solitude to just reset as a human creature. You know, I'm sure there's a spectrum where some people want a lot and some people want very little, but I think just like rest or Sabbath, all of us needs.
Solitude. It's a kind of rest. That's the message on loneliness, which is that we are in a world where sometimes it's we ourselves. Sometimes it's the neighbor next door. Sometimes it's a colleague at work or the checkout person at the grocery store. How can we. See each other and connect in a meaningful way where people feel seen and not a superficial sort of seeing, but seeing in a way that that touches hearts and transforms lives.
And so I think that's the challenge. I, again, none of us does it perfectly, but I think that we. Fire to do it better. And the more we practice, the better we get. And the more we practice, the more other people will engage in that sort of outreach, if you will. And I think it will help to mend some wounds in this very broken world.
Macie Bridge: I am Macie Bridge with the Yale Center For Faith and Culture, and this is Solo, a series on solitude, loneliness, and being alone.
In the western world, death is not handled as it once was. Mostly it's left to the professionals. Our elderly populations spend their final years in assisted living settings apart from the rest of us. Those who are terminally ill are cared for in medical settings. If a person is lucky enough to pass at home surrounded by loved ones, we still leave the final care for a body most often to others.
The ways we've in. Institutionalized medical and death care have made fertile ground for lonely ends.
Now, I know talking about death is uncomfortable because it's a part of the human experience we've siloed out of our regular lives, and yet thinking about our own deaths, the fact that our lives will eventually end, and our hopes for who we might want to care for us in that time. Is actually a powerful exercise to help us think in new ways about how we want to live.
Now speaking to the problem of loneliness, witnessed in medical settings and end of life care, I'm joined today by Dr. Lydia Dugdale. Lydia is a practicing internist and a hospital ethicist, and is a Yale Center For Faith and Culture partner, scholar. She currently serves as. Of medicine at the Columbia University Medical Center and as the director of the Center for Clinical Medical Ethics and is also author of the popular book, the Lost Art of Dying.
Lydia brings to us her own experiences as a practicing physician in New York City and considers the place of community in hospitals and in death through her recovered approach to the ndi, the Art of Dying. As we near the end of my solo conversations, I hope you find this conversation just as powerful to your thinking about the world's loneliness epidemic as I did.
Thanks for listening today.
Lydia, thank you so much for joining me on the podcast today.
Lydia Dugdale: Pleasure to be here.
Macie Bridge: I'm hoping that as we. Launch into this conversation. You might first introduce our audience to, um, yourself and your work a little bit. You are a practicing internist and a professor of medicine at Columbia. You've practiced at Yale, and you also direct the Center for Medical Ethics at Columbia.
I would love to hear a little bit more about how medicine and ethics have intertwined into your life. How did those streams of thinking and practice come to you?
Lydia Dugdale: Sure. Well, I never wanted to be a physician. When I kind of had this inescapable call to medicine that was sustained over many years and ultimately relented and went to medical school, I found that I was in a discipline that.
Was very foreign to my sensibilities. So I come from very much of a humanities family and having to memorize thousands of facts about the human body and regurgitate them on exams was not. What really excited me, it didn't really animate me at all. I was happy to know how the human body worked and, um, was grateful that I could do the science, but felt a little bit out of place.
And so when I found ethics, which I was at the University of Chicago for medical school and medical ethics is a big part of the. Environment there. There's a very big ethics center, but also a big part of the first year medical students introduction to the profession. And so out of the gate I was able to contend with these thorny questions that really got at the intersection of life and death.
Uh, I had been a debater in high school and college, and so to be able to debate questions that actually. Had high stakes. They weren't just theoretical. This just wasn't a policy debate on a college campus. But really, people's lives hung in the balance. That seems like the kind of activity that would give me a home in medicine, a place to belong.
I also loved the interdisciplinarity of it, so to be sitting around the table with philosophers and theologians and chaplains and uh, legal scholars. Physicians, social workers, nurses, all together deliberating about these complex cases felt like the right place for me. And so I kind of grew up in ethics at the University of Chicago, and then was able to develop that more during my time at Yale and of course at Yale Divinity School where I was able to obtain my master's in ethics, very gratefully.
Yeah.
Macie Bridge: Wonderful. I'm grateful for that intersection and what you can bring to our conversation on solitude and loneliness. I've been doing a lot of thinking on this subject from a variety of angles with a variety of different practitioners, and I'm really curious, how do you see loneliness and also solitude coming up in.
Your practice today and in your work? We're living in a post pandemic world, and I'm curious where that's showing up in the medical field.
Lydia Dugdale: Yeah, sure. So now I live and practice in New York City, and what's interesting about New York is that I think it is, I think large cities in general, but New York in particular tend to attract people who have.
Burnt bridges for one reason or another with their families and communities. So how this manifests in my current clinical life is that I have large numbers of patients that we refer to as unrepresented. The old language for this was un befriended, but I think people felt like that sounded a little bit harsh or judgmental.
And so we now say unrepresented. And what that refers to is people who are sick and unable to make decisions for themselves. May be physically sick or mentally ill, unable to make decisions for themselves. And yet there are medical decisions to be made. And these unrepresented patients have no one. They have no family member, no adult children, no neighbor, no one in their lives who can help guide their medical decision making and the.
Number of patients I've cared for here in New York, for whom that is true, is an extraordinary number. I I, it's far more than when I was in Connecticut or when I was in Chicago. And I think that's the big city phenomenon. And, and you know, many of these patients may have family, they're just estranged from their family.
They're cut off whatever the trauma was. There's no more relationship. Sometimes we get family members on the phone and they say, oh no, I haven't spoken to 'em in 20 years. I'm not about to. And so you have that. Kind of problem of sick people in the hospital for whom decisions have to be made. There's no one.
But then I also see patients in a primary care clinic, so I'm the kind of gp, I have adults come in with their various chronic illnesses or acute illnesses, and it's not uncommon, especially among my older patients, for them to say things like, I have a loving family. They're so great, but I never see them.
They work all the time. They're too busy or they live too far away. Or the grandkids don't have any time for me anymore. It was fine when they were young, but now they don't have time for me. And this I think, is a refrain that is, is is sort of emblematic of modern life that we might be surrounded by people and yet who is really digging into our lives in a way that's transformative, that's generative, that's nurturing.
I think that's the kind of depth. That we lack, that so many people lack, and I think kind of modern life has, has fed that phenomenon.
Macie Bridge: Mm-hmm. Do you think that these experiences of loneliness or like if, if a person is in this social situation that you're describing of maybe estranged from their family or not having the community that would be ideal around them, those feelings of loneliness, do you see them as.
Becoming more acute when they're brought into medical settings?
Lydia Dugdale: Yeah, I mean, yes and no. So I think when a person is physically ill. And has a lot of fear. It's nice to have someone on whom they can depend, who will be a comfort, a support. And so in those circumstances, when the person is conscious and doesn't have a community close by the acuity, the intensity of the loneliness is heightened.
Yeah, I think that's absolutely true. But the flip side is that when people are very sick and hospitalized, oftentimes family will rally. Suddenly all of these people come out of the woodwork and the person shows up to the hospital thinking that no one has time for them anymore. But then families are applying for FMLA, which is a family medical leave act, uh, so that they can take time off from work and care for this aging or sick loved one.
So. You see both scenarios. Now, of course, the whole phenomenon of loneliness was really blown out of control during COVI, not just because of the social isolation that was imposed by, well by the government really, but also because of the visitor restrictions we had in the hospital during that time. So it was, that whole phenomenon was much, much worse during the pandemic.
Macie Bridge: I have two pandemic related questions for you, maybe. I'll go into more specifically. First, I've heard in the realm of theological thinkers the idea that during the pandemic, those that would have prioritized social connection over the medical recommendations of isolation were. In some ways, putting the, the benefits of human social connection over life itself and sort of weighing the cost of literally life itself over living well, what many people would characterize needing this human connection as an aspect of living well.
What is your perspective on that and how did that come into your work during the pandemic?
Lydia Dugdale: Yeah, I mean, we are social creatures. Human beings are meant. To be in relationship. So we prioritized being with people in a socially responsible way during COVID. So what did that mean? For one, we would certainly take our kids out a couple of times a day and.
Just walk them. I had little, my kids were little during COVID. You know, we lived in a tiny New York City apartment and kids need to be outside. They need to get fresh air. They need to see other people. Once we were past that first kind of couple of months of COVID. Badness summer of 2020, that's when we started doing a lot of picnics and the recommendation was, put your picnic blanket down six feet apart from your friend's picnic blanket and don't share food, whatever.
We did that a lot just to get the kids out, seeing other kids. We let them run around. We did all of that kind of thing. I'll say my, I have family members, let me just put it this way, who were much less concerned about COVID.
Macie Bridge: Mm-hmm.
Lydia Dugdale: And absolutely prioritized people over policy and I can't fault them for that, especially if you were young and healthy.
And we know that the people at high risk of being very sick from COVID and dying from COVID were older, right? We, we had all that data. If you're not immunocompromised and you're young and healthy, the odds of you having much more than cold symptoms with pretty profound fatigue for seven to 10 days. Was pretty light now.
I was working in the COVID Epicenter here in New York City, so it wouldn't have been responsible for me with my exposure every day in the hospital to then risk sharing any of that with people. So I tended to follow the guidelines. Of course, now, you know, they say the six feet rule was totally made up and.
But generally if somebody is coughing in your face, you're much more likely to get sick than if they're coughing a ways away from you. So yeah, six feet may have been made up, but there's some kind of practical wisdom behind it, and I can't really fault the government for trying to come up with a number that people could understand.
So I'm a rule follower, but I was also in the, in the heart of it.
Macie Bridge: But I think those rules woke. Us up to thinking more intentionally about our social interactions, maybe in a way that had started to slip from intentional, conscious thought in our society. I'm curious, do you see differences in the way that we're thinking about isolation post COVID now that we're five years out as it comes into medical ethics?
Lydia Dugdale: So I think socially we're worse off than ever. Statistically we are where we were pre pandemic in terms of what the medical community's doing. What happens in medicine is there's something we often refer to as the tyranny of the urgent. You're. Constantly faced with various crises, right? So most recently in New York, it was a legionella outbreak, a kind of pneumonia that often harbors in water systems, in apartment buildings or hotels causing a pneumonia that can be lethal to older people.
Or it's the mosquito-borne illnesses, which seem to be getting worse. And more serious. And so now we're spraying for mosquitoes in Staten Island and you know, so there's always something in medicine. And to step back and say, oh wait, what about the one in five adults who feels very lonely? Those are not people that are showing up acutely ill.
They come to the public attention when, I mean, really when there's tragedy, whether it's suicide or killing. If they're existing along coexisting with their loneliness, they're not coming to public attention, which is why for me, one of the biggest sadnesses of COVID was the lockdowns on nursing homes and long-term care facilities.
Macie Bridge: Hmm.
Lydia Dugdale: Most people do not realize that folks living in nursing homes and long-term care facilities had very extended visitor restrictions. That went on for well, more than a year. And when you're already living in an institution with little social connection, besides the staff that work there. Often low paid, not necessarily highly regarded staff.
And I'm not saying that's correct. I'm just saying that's the reality. To put such, uh, draconian lockdowns on older folks. Yes, we were trying to arguably protect them from the virus, but I mean, many died or had severe worsening of health during the time that they were forbidden from seeing loved ones. I remember reading an account even of one woman.
Who didn't see her own husband, who lived in the same facility, I think for more than six months. I mean, it was months and months and months that they could not see one another because of the COVID restrictions. And that just seems inhumane. Right? That's, that is a good motivation. To save lives from virus.
That is taken to just ridiculous extremes. And so I think that's what happens in medicine is that we are focused on whatever is in front of us at the moment, and we're not thinking about these bigger social problems that are sort of quiet and mm-hmm. And kind of just pervasive, but not getting attention.
Macie Bridge: I am coming to this interview, having done a few others on this. Topic of solitude, and one of those being with a medieval list outta the University of London, head of house, who had me thinking with her about the anchor rights and medieval Christianity and the history of vocational solitude there. And one of the things that that interview brought up for me was death and the ways that in that.
Era of our history. Um, death was much more present in our daily lives or in people's daily lives. It was present, it was in front of you, and it was a responsibility in that was expected of families to be with and to care for those who were dying. And so one of the reasons I was excited to speak with you is because you have done a lot of thinking around the art of dying and the way that death presents itself in our.
Contemporary society. I would love to hear a little bit about how you found your way into that. I'm thinking of this as we transition from the topic of these aging communities and sort of what that did for so many isolated deaths during the pandemic. How, how are you thinking about death and dying these days?
Lydia Dugdale: Ha. I guess the same way I've been thinking about him for the last 15 years. I started thinking a lot about death because. As a trainee, I was blown away by the incredible technology of the hospital and our ability to keep essentially dying. People hooked up to machines in a kind of lingering state between life and death.
So they're technically alive, but they are so profoundly impaired. No one. Believes that they will ever leave the intensive care unit alive, much less, leave the hospital, much less return to any semblance of a normal life. Mm-hmm. And for me, this felt a little bit cruel. It felt very inhumane. And yet the dominant ethos in medicine right now is patient autonomy.
So if the patient's or the patient's decision maker wants this. They understand that this is life support that is delaying death, and this is what they're insisting on. At least in New York State where I currently practice, it is illegal for us to remove life support if the, any life sustaining treatment, if the family or the patient want it.
Even if they're literally decomposing from the inside. So this was a question that I, I started noticing as a medical student, I'm thinking, who is actually having frank conversations with these people about what's going on? Why are doctors not talking about death? I started. Reading about this, and then I, there's the kind of emergence of palliative care as a discipline in medicine.
And what that did on the one hand is it gave us great resources for helping to attend to the symptoms, the uncomfortable symptoms of being sick and even dying. The problem was, is that a lot of physicians started outsourcing their comfort in talking about death to the specialists. Hmm. So I would say that most medical professionals today are very unpracticed at talking to patients about their mortality.
Macie Bridge: Ah.
Lydia Dugdale: Even though we are really the intermediaries between life and death, I'm not saying we're priests, but that used to be the role of the priest and so right. It is now the role of the physician. Arguably the nurse who is the one who's actually at the bedside much more than the doctor, but the doctor's, the one calling, the shots on treatments, sustaining the machines, et cetera.
I was very perplexed about why doctors don't talk about death. And then I started realizing, oh, doctors themselves are afraid to talk about death. Not only are they not practiced, they themselves have not. Thought through their existential questions, they have their own death anxiety. I had one colleague say to me, I don't know why you're interested in death.
She said, I myself am so afraid to die. I would never tell a patient that patient's dying. I just don't wanna talk about it.
Macie Bridge: Wow.
Lydia Dugdale: So, right. Which seems like an abdication of responsibility, but there you have it. And so yeah. So I started digging into how in other times and places people have. Addressed the questions of mortality.
And in my digging, I came across the ARS Morandi, which is this Medieval grew out of the late Middle Ages genre of literature on the preparation for death. And I started wondering whether we could revive some version of the ARS Morandi and you know, the Rs more Andy, this art of Dying, it ended up being wildly popular in the West for more than 500 years.
Lots of different religious and non-religious traditions adopted it, adapted it, wrote their own versions of it. Uh, there were illustrated versions for the illiterate, and I thought, well, look, you know, if it can be adapted by all these different religious and non-religious groups, why couldn't it work today?
And so that. Some of my work, I guess over the last 15 years in a couple different books to try to think about reimagining the Ars Morei today. But of course, central to this genre of literature over the whole 500 years is that if you want to die, you have to live well. Part of living well meant cultivating virtue, right?
So if, if you don't want to. Die an impatient, bitter, despairing, old fool. Then you need to practice hope and patience and joy, right? You need to cultivate the opposite of that. But the other part besides becoming a character of virtue or cultivating a life of virtue to live well, to die well, is that we live best in community.
And that gets back to our topic at hand. Yeah. That we, if living well is very much tied to dying, then if we want to die, we also have to. Be cultivating that community while we can, and this is something I've seen in the hospital, right? So the unrepresented patients, they ultimately are dying alone. Now they're dying with medical professionals in the vicinity.
Sure. But there's no one who is. Doing more than professional care often as they breathe their last.
Macie Bridge: I was reading your book at the last start of dying. One of the quotes that was sobering to read was you just put so succinctly that. Community doesn't appear out of nowhere at the bedside. And I was so enjoying getting into these ideas of death and dying in light of this theme of loneliness because I think maybe a part of the conversation that's been, um, lingering for me as I've been having these other conversations is that I think an acknowledgement of our mortality and the reality of death needs to inform.
The way that we live. And that's where, um, our faith has to come into the conversation as well. I think it begins raising those existential questions as you're saying that some of your colleagues maybe were struggling with looking at. It's sobering. They're hard questions to sit with. How do I cultivate community?
Not for just the sake of having folks there at my passing one day, but also so that I can share the life that I'm living up until then. Those are hard ideas to sit with and, and I think really. Important.
Lydia Dugdale: Yeah. Just to illustrate this. Mm-hmm. You know, you write a book and you never really know what it'll do, and I thought writing the law start of dying.
If it benefits one person, then I've written the book for that person. And I remember being contacted by a guy and, and I think it's benefited more than one person, but I do remember being contacted by a guy who read it. He was in good health, but older and had been estranged from his adult children for years.
And he said, I read your book and I want my kids there. When I die. I don't know when I'm gonna die, but I've committed. To investing in relationships with my adult children in ways that I haven't for decades. And he now gets together with them multiple times a year. They have dedicated family time, and for him, it's been so life giving, but it was this nudge of thinking about loneliness in the context of mortality.
And that's one of the things that I love that maybe I regret the title, the Law, art of Dying, because. The idea of a book on dying is off-putting to many people, but the premise is that it's about living well. It's about living well so that you don't die with regret. Now, regret's a complicated word. We'll all have a little bit, but if you want to die, well, you have to live well.
Mm-hmm. And that requires. Deep investment in community and relationship and relationship does not just happen. It's a work in progress and it has its ups and downs and we just keep working at it and we mess up and ask for forgiveness and people will hurt us and we forgive them. And this is the. Sort of iron sharpening iron of life and community, but we have to be all in, or we end up like all of these patients here in New York City who have no one, uh, that I can reach out to as they're dying.
Macie Bridge: I'm wondering your perspective also on there are a number of corrective it feels like. Initiatives I've read, and I think your book referenced also, especially it seems like there are some in Japan of I've been reading about some AI initiatives, but also through volunteers getting strangers essentially to build relationships in these settings of nursing homes or care facilities where relationship is essentially facilitated if relationship with family or community otherwise cultivated isn't.
A possibility. Do you think that those correctives are, or maybe I shouldn't be calling them correctives. I'm interested in your perspective on them. Do you think that those are things that are worthwhile? Are they lacking because they don't have that genetic or shared history? I'm also curious, I'm thinking mostly hearing about them in Asian countries, so I'm curious if you have perspective on those in the US as well.
Lydia Dugdale: There are all sorts of programs like that. Mm-hmm. There are day programs for older people that you could argue that the church played that sort of role. Right. The over 60 fives Bible study or community group and the, there are a lot of day programs that my patients go to and what do they do there? Meet with other people.
They share food, they'll do crafts, they might play bingo. It's giving them community when they don't have it themselves. Mm-hmm. And. Look, on some level, you could argue that even families aren't as authentic as they could be.
Evan Rosa: Hmm,
Lydia Dugdale: right? How many of us show up to, say Thanksgiving dinner knowing that there's going to be that relative or those relatives that you have to grin and bear, right?
There's that kind of phenomenon even when you're in families that are supposedly are somewhat intact, right? We all have. Dysfunction and function in, in our lives, in our, even in our own families. And so to say that somehow a social program or a minister of loneliness is insufficient it, it's kind of all insufficient.
That's why we keep working at it, and that's why we ourselves need to also be contributing, I think of. An uncle of mine who after he retired, first of all, my aunt made him do something with himself after he retired. But one of the things he elected to do was to help drive. Elderly people from his church to their various appointments, it saved money for them.
Mm-hmm. And it also gave both my uncle who is retired and keep to himself sort of guy, and these even older people from his church. It gave them both community. There was a mutual community there. And then for some patients who had to go say to dialysis three times a week or to a doctor's appointment every week.
My uncle would really get to know them. So it was a way that he could serve and also build community. And they would have community. Is that just a fix? I think there's something very real about that kind of commitment to others, and as it happens, as my uncle got on in age and himself needed help and my aunt wasn't able to help him.
People from the same program who were younger than he was, stepped in to help. And so, you know, the more, the more we commit to others, I think the more others commit back to us. And there's a little bit of paying it forward. It's the generation behind us that will help. But all that is to say that I think.
We need more of this, not less. It's gonna take many different forms. Maybe blood relatives may not be, it's not going to be perfect. It will never be perfect. But we need all of the efforts we can summon rather than be too particular about what manifestation they should take.
Macie Bridge: It almost sounds like you're describing the body of Christ.
I'm also curious to ask you about solitude as sort of a different. Sting from loneliness. One of the things that I'm learning is how loneliness really is. Just the feeling that stems from, or the space between what we want and what we have as far as relationship goes. And I'm. Learning as I have these conversations that solitude is perhaps a much more positive thing for many of us.
Then it's often framed, and I think there's even a stigma of fear around solitude and maybe entering into spaces of solitude. I'm curious from your perspective, what the role of solitude might be in wellbeing and living well, and maybe how you see that intention with loneliness.
Lydia Dugdale: Yeah. I mean, there's a lot there, right?
So I think of solitude is different from loneliness, which is different from social isolation.
Macie Bridge: Mm-hmm.
Lydia Dugdale: Social isolation. It is what, what it, it suggests one is isolated from society or from a community, but. The distinction, I think your definition of loneliness is correct, but the distinction is that, for example, an older person with dementia might not have an awareness of loneliness.
Macie Bridge: Mm.
Lydia Dugdale: But the imposition of social isolation can be detrimental to his or her health. That older person with dementia doesn't have the ability to be able to name a goal for community or a relational goal and feel the deficit. So they might not be able to acknowledge loneliness, but we see the effects of social isolation, just like.
If you take, there's all the animals at the zoo kind of analogies where if the animals don't have partners and other little creatures with them at the zoo, they don't flourish. Solitude, solitude's. Interesting. Uh, there's, there's a lot to say. I think one's value of solitude might depend on whether one is an introvert or an extrovert.
So. I am an introvert who was thrust into a very extroverted profession. And let me tell you, after seeing 30 patients in a day, I just wanted to go home and hide under a pillow. You know, just stay away from everybody. But of course, as a mother and wife and kids and mouths to feed and all of that. There was never the option.
All I craved was solitude. Actually, I didn't even need to get through 30 patients. If I got through six, I was ready for solitude, but that wasn't an option. And my, the last 25 years, I'd say I've had an ongoing craving for solitude just because of the way I am wired. Whereas solitude for an extreme extrovert can feel more like a loneliness.
And yet I think of. Richard Foster's work Streams of Living Water. I think his book, he talks about the contemplative life and arguably of all of the different sort of streams of religious life. Say he talk, he has 'em all labeled, the charismatic stream, the Evangelical stream, the Holiness tradition, all these different traditions within Christendom.
Arguably, the contemplative life is the most critical. For being able to engage outward. That is, regardless of whether we're extroverted or introverted, all people need a certain amount of solitude. I would think, if anything, to reset people who have a natural orientation toward the divine might say that's necessary for communion with God.
People who reject that sort of. Framing or metaphysics. I still think even if you reject God, you need. A certain amount of solitude to just reset as a human creature. You know, I'm sure there's a spectrum where some people want a lot and some people want very little, but I think just like rest or Sabbath, all of us need solitude.
It, it's a kind of rest. Yeah.
Macie Bridge: I am curious when we are thinking about trying to cultivate community to walk with us in our daily lived lives and with. The reality of our mortality in sight as we are thinking about taking responsibility for our own death, as we look at that, something that we inevitably have to walk towards. How much do you think a community supports a person in grappling with that and coming to terms with that and in shaping their life before that, before it's ultimately your own thing to have to sit with.
Lydia Dugdale: Yeah. I think it is misguided that we have a view of death. That is as individual as it is.
Macie Bridge: Mm-hmm.
Lydia Dugdale: We heap a lot of responsibility on individual patients. Individual people to make decisions about their processes, approaching the end of life often as if it's just up to them. This particularly comes to the fore with questions of what the Canadians call made.
Or physician-assisted suicide, physician-assisted death, whatever you wanna call it, death with dignity, because in those circumstances, it is an individual's decision to hasten death, either through taking lethal drugs or through a lethal injection administered by a health professional for the purposes of ending it.
All right, Haing death now. What people often don't think about in those circumstances are, and I don't wanna say they're so self-absorbed, but often this is a reflection on one's own life and illness and decision. That enough is enough and therefore I'm going to end it, end it while I can, rather than drag this out.
Um, but I. There. There are accounts after accounts, after accounts of what happens to the community, especially when someone makes this decision without telling their loved ones. It can be devastating. It can be absolutely devastating. Now, it is true. The flip side is true that there are some people whose physical suffering is so great that death comes as a relief.
Whether that death is hastened or it's a natural death. Death can be a relief when suffering has been great. I'm not gonna pretend that's not true, but I think this idea of it's my body, my choice, it's my death, my choice is a lie because, and this gets to the aspirational aspect of it, we really. Live and should die in communities.
We should have folks at our deathbeds. We should have people keeping vigil in the late middle ages when someone was dying the entire parish. Whether you knew the person or not, it was if you found out that like Ms. Smith over on such and such a block was dying, the whole parish had to parade past her, deathbed her sick bed.
And bid her farewell. And then when she died, the whole community would gather, the parish would gather the men outside, the women, inside wailing, the men preparing to carry the body to the mass. So this was very much the process of the community, the A morandi, this art of dying literary tradition I mentioned.
A core part of, especially the original versions of the smore Andi, was that there was a q and a sort of a catechism that the community members would ask of the dying person, what do you believe? What is your hope? What are your prayers? Repeat this after us. And so the earliest versions were very much about securing the soul.
Obviously subsequent. Versions were not at all religious, so they took different forms, but the idea was we're not letting you go out without helping to ensure that you've got your ducks in a row. And so dying then was not an isolated thing. It was, it was, the community was central to that good death, and so we've lost that where it's just become a decision.
And then, mom, do you want us to cremate you or bury you? It's that sort of a thing that it's become.
Macie Bridge: I think you're right. I think it's so lost in our society as it is today, and I think that as we sit with these ideas of loneliness and solitude, it's essential to just. Think about, one of the things I'm continually being turned back towards is how am I being attentive to other people's loneliness rather than dwelling on my own loneliness.
So that leads me to my final question for you, which is for imagining the listener who comes to this conversation today, maybe grappling with their own loneliness, what questions does your expertise, your practice prompt you to be asking of feelings of loneliness as they arise?
Lydia Dugdale: Yeah, I think that was a really good segue.
The tricky thing about loneliness is it can also cause a sort of mental health spiral. I really think the minute that we start to feel a sort of loneliness, leading to despair, we need to jump on that. And one of the things, my husband and I have done various versions of this, and not always very well, but keeping an eye out, keeping our radar up for people who don't.
They're, they're not partnered or they're not in a kind of a community, or they don't have supportive roommates or whatever the scenario is, and try to gather those people for dinner. And increasingly we're like, maybe we can just gather for a drink, right? Because if we're too busy to think about planning a whole meal and cooking and everybody, and seating arrangements.
Just keep it simple. People just want to know that they're not not seen. This is very, very quickly. I'll tell you, I, I took care of a patient for many years. He was constantly hospitalized at Yale New Haven Hospital and. He was a miserable person. He was absolutely a miserable person and everybody knew him 'cause he was always in the hospital and everyone hoped that he would not be assigned to their team to have to take care of.
Macie Bridge: Yeah.
Lydia Dugdale: And he was assigned to me. One of my last times I was working at Yale New Haven Hospital and I thought, oh, I'm gonna model for my young doctors here how to care for a very difficult patient. And he ended up so completely destroying me verbally that I had no, had no energy left to, I was beat red and so embarrassed and humiliated.
I just took my little team and we left. And then shortly thereafter, we were checking on him a day or two later and he basically said, sit down. I need to talk to you. And so my, I only had a medical student with me at the time, and we sat down and he just started telling us his story. And I was so moved by hearing this man talk about how his chronic disease took everything away from him, his church, his family, his community, his profession, everything.
He was always hospitalized. I wrote a piece about him for a medical journal, little medical humanities thing, and I knew that if I wrote about him, I had to go share it with him. But he was such a nasty man that I really didn't, I was just praying that he'd be asleep or be at a procedure or something, but I knew I had to share it with him, which is why I can talk about this publicly, because I ended up publishing this piece.
But I went and he was asleep and I was so happy. I was trying to sneak away, and then his nurse caught me. She said, did you wanna see him? And I said, I did, but it's okay. She said, no. He's in a good mood today. You should just go in and wake him up, and I'm like, oh man, go in and wake him up. He's not gonna be in a good mood.
Anyway, I went in and I read this piece to him that I wrote about him, and he started weeping and he said, someone finally saw me, someone finally saw me. I've been in this hospital for 20 years and I didn't think anyone ever saw me. And I think that's the message on loneliness, which is that we're in a world where sometimes it's we ourselves.
Sometimes it's the neighbor next door, sometimes it's a colleague at work or the checkout person at the grocery store. How can we see each other and connect in a meaningful way where people feel seen and not a superficial sort of seeing, but. Seeing in a way that that touches hearts and transforms lives.
And so I think that's the challenge. I, again, none of us does it perfectly, but I think that we can aspire to do it better and the more we practice. The better we get and the more we practice, the more other people will engage in that sort of outreach, if you will. And I think it will help to mend some wounds in this very broken world.
Macie Bridge: Wow, Lydia. Thank you so much for bringing your wisdom and your experience to the podcast and to this series. Such a gift to be with you today.
Lydia Dugdale: Such a pleasure. Thank you so much, Macie, for having me
Evan Rosa: for the life of the world is a. Production of the Yale Center For Faith and Culture at Yale Divinity School. This episode featured Lydia Dugdale, interviewed by Macie Bridge, production assistance by Alexa Rollow, Emily Brookfield, and Hope Chun. I'm Evan Rosa and I edit and produce the show.
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