Waterlow Hospice: Considering an Alternative Space for Dying

In the forest, life and death are trapped in an endless cycle – the nutrient cycle – where living matter turn to dead matter, which then re-feed the creation of the living. In the U.K, most people die in hospital – undignified closed-off sterilised containers. Thus, the project proposes hospice that uses the metaphor of the forest as a natural site for living and dying, gradually embracing the normalness of death in nature to make its acceptance easier. Patients are put to rest in a forest park, their bodies turning into trees which shade the living. Spaces gradient from inside to out, allowing patients to find their ideal comfort condition. Here, dead-matter material provide patients with comfort. Altogether, the hospice focuses on patient comfort while suggesting that dying might not be so scary.

C O N S I D E R I N G A N A L T E R N A T I V E S P A C E F O R D Y I N G

W a t e r l o w P a r k H o s p i c e:

UNCALIBRATED SPACES

FOR DYING: HOSPITALS

and our aversion to death

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Even when a love one is at the end of his/her life, we send them to hospital to try to ‘cure’ them. We so fear accepting death that most in the U.K die in hospital, a space meant to return people to health. Here, the needs of the terminally ill/dying individual (with ‘x’ time to live) are second-rate. They are put on medication or life support in spaces undignifying to their heightened emotional and spiritual needs with little respect. Dr Brian Hughes explains that the stressfulness of hospital environments can even increase the body’s sensitivity to pain (note: the dying tend to feel bodily pain toward life’s end) due to cortisol production, due to the attributes of a hospital outlined to the right:

Ken Worpole, Senior Professor at London’s The Cities Institute, has greatly expounded on how bureaucratic hospital environments are inconsiderate to the emotional and physiological needs of a dying individual who requires greater care, attention and empathy. He outlines, “hospitals are also built catastrophes, anonymous institutional complexes run by cast bureaucracies, and totally unfit for the purpose they have been designed for.” He debates on whether wards offer support or lump the sick and dying together away from healthy society.

STRESS ISOLATION

DEPERSONALISATION NOISE

IN HOSPITALS, DEATH IS CONSIDERED A FAILURE. WHERE CAN THE DYING/TERMINALLY ILL DIE IN PEACE?

50% OF ALL COMPLAINS IN THE NATIONAL HEALTH SERVICE (NHS) RELATE TO THE CARE OF A PERSON WHO IS DYING.”

“IN OUR CIVILIZATION, A DEATH OUTSIDE THE HOME CAN BE LIKENED TO A DEATH OUTSIDE SOCIETY - BECAUSE, IN A HOSPITAL ENVIRONMENT DEATH IS STILL SOMETHING OF WHICH TO BE ASHAMED.”

Ken Worpole in The Architecture of Palliative Care

HOSPITAL WARDS - IMPERSONAL AND MONOTONOUS - ARE UNDIGNIFYING AND UNSYMPATHETIC TOWARD THE HEIGHTENED NEEDS OF THE DYING

Most people in the U.K currently die in hospital - 45%

St Thomas’s Hospital, London with its impregnable jail-like appearance

Undignifying and unsympathetic monotony of hospital wards where people die

IMPROVED SPACES FOR DYING: HOSPICES and death acceptance

The hospice is the first urban typology dedicated to the dying (with people admitted usually having 12 months to live). Here, death is not negated, rather, accepted as a natural part of life as it helps people pass away with the least pain possible through palliative care (PC). PC are the medical methods used to reduce pain in the body and the mind, including medication, psychotherapy, physiotherapy, etc.

The first modern hospice, St Christopher’s Hospice in Sydenham London, was founded in 1967 by Cicely Saunders. Ms. Saunders wanted to “establish a more homely place where people could die.” The hospice was to welcome the dying to live out their final moments as full and self-aware a way as possible in a family and community focused context. Patients are even allowed to enjoy gin or cigarettes under their nurse’s supervision. Yet, this hospice still comes with its shortcomings...

CURRENT SHORTCOMINGS OF HOSPICE TYPOLOGY:

1. lingering taboo of death

Despite hospices being a place where death is accepted, death can still go undiscussed, as Tracy Jeffreys, nurse educator at the Royal Trinity Hospice explains. This makes it very difficult for the hospice to make care plans and after death arrangements. How might this be approached architecturally?

Tracy Jeffreys, nurse educator at Royal Trinity Hospice - interviewed 19/01/21

SOCIAL SUPPORT

DESTRESS EXERCISE

2. hospital-like enclosure

LEVEL OF CONTROL

Ciciley Saunders, founder of the first hospice

Worpole in The Architecture of Palliative Care

Hospice are usually designed to be a monolithic space, allowing greater control, movement throughout and sanitation, however lack hierarchy with all internal spaces clumped together inside with no connection to the outside. This results in spaces that have little or no connection to nature which is shown to reduce pain in Ulrich’s famous 1984 study.

the single ‘hard skin’ of current hospices

John of Katharine House enjoying his bedside gin

Lush greenery around Katharine House Hospice, Oxford

“SO THEY WILL NOT DIE ALONE.”

‘MOST PEOPLE ARE NOW CONVINCED THAT HOSPICES CAN DEAL WITH THE PAIN OF DYING, WHICH IS WHY THE MOVEMENT HAS BECOME ONE OF BRITAIN’S GREAT SUCCESS STORIES.”

Ken

RECALIBRATING THE HOSPICE: FOREST metaphor

shortcoming 1: lingering taboo of death design approach: normalizing death through nature

The forest metaphor is introduced as a broad design approach to the shortcomings of the hospice typology.

The reluctance to discuss death in hospice makes it hard for the hospice to make after death plans. In England, millions leave after-death issues (wills, end of life care, funerals etc) unresolved when they die due to the taboo, distressing for the family. Avoiding death limits creativity in designing their spaces.

The forest metaphor encourages use to see that death is abundant and common. Dead matter such as dead leaves and coffee grounds would be turned into building material through mycelium fungi to provide comfort to patients. On-site burials can take place, seeing death as something common in this forest. (The capsula mundi is an urn that turns bodies into trees).

nutrient

returned

‘death’ as building material - mycelium choices of on-site burials

Mycelium turns dead-matter such as dead leaves and animals into usable building material. In this way, death is able to provide comfort to patients. This is used as a trojan horse to discuss death in the hospice.

U.K mycelium coffins

British headlines of the taboo of death

capsula mundi urn

mycelium as material comfort

mycelium dead forest matter natural burials,

THE FOREST METAPHOR ENCOURAGES US TO SEE THAT DEATH IS NORMAL & POIGNANT LIKE IN NATURE.

RECALIBRATING THE HOSPICE: FOREST metaphor

design approach: normalizing death through nature - capsula mundi

capsula mundi urn

The capsula mundi is an urn that uses the body to grow a tree - designed by Anna Citelli and Raoul Bretzel. It is an alternative method of burying a body after dead and enscapsulates the nutrient cycle, where the nutrients of the body are returned. In this forest, as more pass away, somehow, more life flourished, with more trees are grown - a paradox where death leads to more life.

nutrient returned

oxygen + food

RECALIBRATING THE HOSPICE: FOREST metaphor

shortcoming 2: hospital-like enclosure design approach: inside-outside gradient - enabling choice

The hard enclosure of the hospice might be reconsidered. The new hospice might allow for a gradient from closed, manmade, private spaces to open, natural public space - and the spaces in between. This allows a dying person to find a place most comfortable to them, but also might start to engage with the notion of death which is found outside in the forest.

RECALIBRATING THE HOSPICE: FOREST metaphor

design approach:

inside-outside gradient - history of architecture as therapy

The forest metaphor approach allows for the re-integration of architecture’s role as part of the therapy.

Historically, architecture stopped being part of therapy in the mid-20th century as hopitals focused on the newly developed machines and medicines and not on the spaces itself. Gone were the days of dignifying health-architecture like Brunelleschi’s hospital or Aalto’s sanatorium which used space to introduce space and light to treat patients. This hospital architecture - sterile and undignifying - became the standard for other healthcare architectures even hospices. How might the forest re-introduce architecture as therapy?

ARCHITECTURE STOPPED BEING PART OF THE THERAPEUTIC PROCESS IN THE MID 20TH-CENTURY WITH THE RISE OF MEDICATION AND MACHINERY.

1419 - Brunelleschi’s Ospedale degli Innocenti - Couryards for air and light

1929 - Aalto’s Paimo Sanatorium - Balconies for fresh air

1950 - Bartholomew Hospital in London - Undignifying wards

2016 - Foster’s Maggie Centre - Re-introducing architecture as therapy

Medication and machinery became the focus of hospitals/healthcare

How can we re-integrate architecture into the therapeutic process through nature?

the transitional forest inside - outside / life - death

Architecture as a gradient to nature and death.

GRADIENT HOSPICE:

Providing choice + addressing death

The first gradient iteration goes from closed inside spaces to open nature to ease patients into death in the form of a cemetery park, with trees that give back to the users of the hospice (oxygen and shade). The dead could be placed in Capsula Mundis, their nutrients used to grow trees, and making death almost visible. This iteration was too bold, however it formed a starting point.

Bedroom Dayroom Cemetery Park

closed open

SITE IN WATERLOW PARK BY HIGHGATE CEMETERY: Urban comfort around death

The project is situated in Waterlow Park that is part of the green area of Highgate Cemetery. There are 170,000 people burried in Highgate Cemetery, which is one of the Magnificent Seven cemeteries that was established in the 1800s. When Highgate Cemetery was opened, it was used as a social space for the locals with people visiting in their best dresses. Today, the Highgate Cemetery is mainly visited by tourists.

site + history site + hospice support

The community around Highgate cemetery is more used to death, fronting the cemetery everyday, such as the Highgate Library or Brooksfield School. Many services and organisations related to health and dying are closeby which supports the hospice on site. The site of the hospice is Waterlow Park adjacent to Highgate Cemetery where the Waterlow Tennis Courts currently stand. The site has a view to the city of London in the South and is close to the Lauderdale House which was historically used as a type of medical rest house for sick patients.

Magnificent Seven Cemeteries

1800s Highgate Cemetery

Helping Hands St John’s Ambulance First Aid Training

Middlesex Uni. Medical Campus

FIRST-HAND RESEARCH: Interviews - hospice nurse + architect of North London Hospice

KAIZER: Firstly, what are the hospice patients attitude toward death? Do they benefit more toward taking notice of it or put ting it at the back of their minds?

TRACY: So we have a variety of people and they cope with the fact that they have got a life limiting illness in a variety of ways. So some people are very open and upfront about it right from the word go. We see patients sometimes quite ear ly, so when they are referred to us they dont imminently die, some of them. Some of them have very late referrals and we see them for very short amount of time before they do die. But any one referred to us has to have a life limit illness and be expected to die within the year - that is our criteria. It just varies, so usually if we feel that person is going to be dying within the next few days to short weeks, and we havent had those discussions, we will try to introduce those discussions with them because it is really important that we find out what they have at the end of life, where they want to be. But it is usually, we build a relationship with them, the community teams go out and see them at home. Because we have 800 patients and we have 19 beds for one floor here. So most of our work done is in the community, in patients homes. And some people come in at the end and some people come in for symptom control. To an swer your question, it is very variable. think it makes it easier for us if people can talk about it, because we can put things in place, but we have supported people who never have talked about it much, it is harder sometimes, so it is very very mixed. Generally if people are more accepting of where they are going, it makes it easier.

it is there. We try and support them, we have reflection ses sions. Before covid we used to have things called short rounds which again were quite good debriefing sessions. We do try, various hospices try different things, the hospice that used to work in had wellbeing week, which were really good. I think we tried to bring something like that in here. We do try to support the staff, they have access to 6 weeks of counselling if they want it.

KAIZER: The next question would be, what would help the pa tients most with pain besides medication?

TRACY: Positioning, making sure that they have got the right equipment to ensure they are able to minimize things that cause them pain. What they are sleeping in, what they are sit ting in, anything like that. Finding out what makes the pain and try to talk that through. Physical pain is usually controlled with a mix of those things and medication. Spiritual or emotional pain is harder to control because people sometimes need to talk about what is hurting them inside. Some people are not ready for that and they might never be ready for that, so we do have counselling team here. We have to support them holistically - we have doctors, nurses, occupational therapists, physiother apists, counsellors, we dont have social workers but we can refer them to that, and even things like dieticians.

KAIZER: How often would family members visit patients?

interviewed 19/01/21 interviewed 23/04/21

KAIZER: The next question, so this is more related to you as staff, what spaces or rooms would the carestaff wish for, per haps to improve their ability to do and enjoy their jobs more?

TRACY: guess it is really for staff to have somewhere, a safe space somewhere they can go and let off steam, and be away from patients and patients families. think it is quite nice for them to have somewhere to go and eat, a little bit away. And I quite like if they have a space where they can study. Those three things: a space where they can let of steam or just go and think I guess. Space to eat, maybe a canteen, and a space to study.

KAIZER: I am guessing these are spaces you already have at your hospice?

TRACY: So we dont really have a safe secure place for staff to let off steam. mean we have spaces but they arent nec essarily for staff. They could find somewhere but there is no “designated space”, so think that would be nice. They do have what they call an education room but libraries now in hospices that they used to have are sort of gone, but do think that that is a shame. think somewhere where people can go and look up stuff up, even if it was a computer online, a place for them to have access to get stuff that would be nice. We do have a small canteen here. I have worked in places where they have much more of a restaurant almost, and think that was nicer than what we got here.

KAIZER: So the next one would be, to what extent would the care staff form emotional attachments to the patients, and how might the spaces of the hospice affect this? More of the emo tional part of it.

TRACY: We generally get to know our patients really well, the community team sometimes look after patients for months, if not years, so we have them and we get to know the whole family, it is not just the patients. And on the ward, we have time to give the patients and so we do get to know them really quite well. But think nurses do learn, I’m going to call it “detach ment”. Although you get to know people, you generally cope ok because it is part of what you are used to dealing with as a nurse, or a healthcare assistant. So there are some things that get underneath that, and that is often younger people, or people similar ages to you or somebody in your family, if you had to have recent bereavement, then obviously it is not a great place to work sometimes if you are already grieving. But generally we cope quite well, we are quite resilient. think safe spaces where you can either go and cry or go an let of steam in whatever way, that is completely away from patients and families.

I worked in one hospice where it was very difficult for the staff to get away from the families. Really difficult because it was all very communal spaces there and I think that was detrimen tal to their well being. (pockets of communal and personal spaces). 8:22

KAIZER: Are there any psychological services that the staff get?

TRACY: There is a helpline that you can call, something through work that you can do that with. But dont know anybody that has taken it up, maybe they just havent told me personally, but

TRACY: Before covid, it was open access and people would be in out most of the time. Not everyone would stay overnight but we have facilities, every hospice has facilities to allow people to stay overnight with the patient. Now it is really re stricted because of covid. We would allow 2 named people to come and visit, but it had to be the same two, and when that person is dying, we would allow 3 people. It is restricted now because of covid, that is not what we want. Pets would come in. Every hospice I’ve worked in is always like that.

KAIZER: Would the patients family be able to stay with them or would they move rooms?

TRACY: Here it is the same room because they have got really big single rooms here. And it was the same in the same rooms, but another hospice had bays, making it a bit different, they had a relative’s room. But if the room allowed, people would stay with the patient.

KAIZER: This is the last question, in general what suggestions would you have for architects designing a hospice in gen eral? What would you say architects could do better when designing hospices.

TRACY: Some of the patients need to be visually seen easier, so basically the hospice I used to work in, they were designing a new hospice, so you need to really look at how you need to designing things for dementia patients with things like colors. think that is really important, dont make everything beige or they cant distinguish things. (suggesting me to look at more). A proportion of patients would have dementia as dementia is increasing. But that is a whole different thing. *The other thing that liked about the design we were going for was that you could open all rooms were individual, you could actually, some of the walls would move, so overnight so if you have less staff, staff would be positioned and they could see like 5 beds at a time. That would minimize falls. That would be really good. Being able to be creative with the use of the space and making sure rooms were individual but also open at night. The nurse who would be at station would be able to see everything. Those rooms were quite nice and have partitions but some rooms would have a living area for the, like mini bed sits. Those with larger families, would be like being in your home a little bit more. think the other thing would be keen on is to have education spaces, because am an educationalist, we do external education. would like all that to be separate from people. You would have the external people coming in, but they would not go into patient facing areas. think all of those spaces, so that staff could go somewhere and get away from patients and their relatives when they need that space themselves, to eat, for their breaks and things like that, which we have here, sort of, but they didnt have in my last hospice and think that was very detrimental to their wellbeing. think that was most important. And actually for the patients and the visitors, if they have, they too could have small spaces around a courtyard or might be around some water or around a tree so they again had safe spaces to go to to just sit and think. Spiritual spaces without being denominational. We have a spiritual room which does cater to all the major religions. Anyone could go there. So think they are nice to have for patients and families but I think there needs to be something separate for staff.

KAIZER: What specific approaches to designing a hospice have you guys done with the North London hospice?

SUSIE: Our building was not that so it was literally a daycare center, which provided a number of things: it provided some respite for carers. It also provided sort of spaces for people who are in palliative care to come and meet up and have lunch. It also had a little hairdresser in it, a room where somebody would come to do hair dressing, nails, that kind of thing. There was also a room, which was like a little art studio, so there’s sort of arts and crafts kind of things became part of activities to support the human spirit, and bring people together obviously, at very difficult times, but sort of make it human, guess. And I think part of our brief from the hospice was also very much about making it domestic. So it did feel like a house. So that and, and very much not institutional. So it was like like the Maggie center approach. And also, the relationship of internal space to external space. So you’ll see in the plan, if you look at it, so you come into the front reception, and then it’s effectively a kind of like an L shape around a kind of courtyard garden, back garden opens directly onto the kind of like dining kitchen cafe type area, as well as the lounge area and the art room. And that sort of indoor-outdoor relationship was important. And then also, we’ve worked with BBUK, in terms of who were the landscape architects, so it has a mixture of water in there and flowers that smell like lavender. So basically, you’ve got things for the senses, which are very common sort of, you know, fragrances, the sound of water, the sound of wind coming from moving through foliage, and grasses, and then having sort of places where people could either go, you know, individually, or all as small groups to just either enjoy or reflect. So, suppose it’s very much as say, quite simply based around the domestic and also a link to nature, garden, changing seasons. And, we spent a lot of time with that domestic field, trying to pick furniture, which made it feel homely, albeit tying that in with concerns and their health and hygiene criteria, you know, with certain fabrics that you need to comply with, in terms of some of the seats and things like that. We were actually trying to find designers who would, you know, be able to interpret those, those sort of technical specifications, but make them again, not institutional as the approach to the ground floor. Then on the first floor, we have a couple of treatment rooms. So those were one where patients coming in could have one to ones with either doctors and nursing staff. And again, with those rooms, so they’re simple rooms, but it was very much, making sure that they had, you know, really generous, large windows that looked on to, I mean, we were lucky in this case, because on the north side, that sort of Main Street side, it looks off to the kind of green, it’s kind of like a games court, sort of Park. Nice breeze. And so actually, having picture windows to play that, again, is just a nice sense of linking with green link with the outdoor link, the seasonal change. And then on the top floor of the building was kind of like the staff area. So, it has the admin kind of office, which sits in the bigger pitched roof space. And then there is a kind of like a staff room, which actually looks onto the green space, but it also has its own balcony. And again, from our original briefing, it was really important that we think about the staff there because they are providing. So there’s a mixture of volunteers and clinical staff coming in from different areas. But obviously, when they deal with patients, it also takes emotional tolls on them. So therefore, we’re actually having a place where you can just go, relax and wind down was really important. So again, in those other spaces, really thinking as architects about the volume about the natural daylight, the quality of that and the sort of visual link to the surroundings that we had was really important.

KAIZER: Thank you. It sounds very sensorial, good as it helps people live with mindfulness and in the now - enriching experience. It seems quite emotionally taxing.

SUSIE: We’re also doing, just out of interest. It hasn’t. It’s kind of open, but because of COVID, it’s not totally fully operational, we’re doing, I think if you go on my website, you’ll find it. It is the Alder Bereavement Center is in Liverpool. So in Liverpool, there’s a children’s hospital called the Alder Hospital and we completed last September, a small building, really small building, it’s actually even smaller than the hospice, which is a kind of daycare center for people and families who have who have lost children. So and that embodies a lot of similar things that I’ve sort of picked up in the North London hospice, as an organization, it’s run by volunteers who have all experienced, at some point, the bereavement of a child and have a real first-hand experience of the trauma of that, and the different stages you go through to try to recover from that. And so our building again, is very small, but it’s a series of sort of clustered rooms, which are focused around, again, the kind of heart space, which has got this sort of like a living area and sort of kitchen area, so that you’ve got focus, sort of social focus, and the making of food as it is a good way to sort of either bring people together or break break down barriers. And then we’ve also got there in front of the building a room, which is kind of, it’s a big enough group room. So you could do yoga in there, you could have sort of different, you know, maybe five tables with four chairs around each so that people can sit in little groups. You can have either large group therapy sessions, or is the face of as the other type of things. And then the other side of the hearts faces a building gets a bit more private away from the front entrance, we’ve got a series of counseling rooms of slightly different sizes, and then also therapy room, which is where you have a massage. But again, all of that is sets in a walled garden. So, we use the narrative, it’s an old English book, or a sort of late Victorian book called The Secret Garden. Which was the story of that was that it was a walled garden in a manor house. And the man who owns that manner house, his wife had nurtured a walled garden and made that made it beautiful, and there was a swing in it, she fell off, broke, her neck, died. Anyway, her sister had, in India, had a child, her parents died of malaria and think that the little girl was brought back to the UK was a contained quizzical thing. And anyway, basically, she discovered this garden which had been locked up and then with the help of a local lad, that began, he began teaching her about nature and gardening. And basically, it was using the narrative of garden nurturing, and growing, to sort of break down a contained little girl, bring the uncle who was sort of in complete mourning, eventually coming to accept his wife’s death, through this garden. We use the narrative of the walled garden so the wall also gives a sense of sanctuary and sense where you can also it’s a safe space where it’s okay to cry. It’s okay to share the most painful emotions. So again we use the garden. And again, we used BBUK, the same landscape architects as we used from North London hospice with the garden, each of the therapy rooms, for example, or consulting with the counseling rooms, has got an open space where you could sit out, and then it’s like it’s been framed with a hedge, or will be when they grow properly, a sense of implied enclosure, again, for just differing levels of privacy. And then within the garden, we’ve got other areas where they will be doing vegetable patches, and so not using the garden a visual amenity, but when you could use it either for external exercises or some level of gardening. Gardening, as an activity in itself, again, has got a lot of very positive mental health benefits, you see something grow, that’s very positive, just the act of whether it’s leading or whatever it takes them off some the raw emotion and so using the kind of therapies, more holistic therapies, as or allowing the garden and the architecture to give backdrops for those kinds of activities.

KAIZER: So the final question, related to the taboo of death, is: because like a hospice is a place where people spend their final weeks, and a lot of them pass as well. So was just wondering, in practice whether this aspect of death and dying was a part of the design discussion, or was it more like taboo and avoided?

SUSIE: No, it’s not avoided, it’s, it’s absolutely addressed heads on because being sort of seriously ill and in palliative care means both the individual, the person, and the family around them have to have to look at this part of life. And sort of talking about that. Once one begins to articulate internal feelings, one begins to find an all in feelings, which may be are confused and scary and will begin to find words or are able to find the forum which is safe enough to try out words without feeling scared or judged, actually. You begin to find ways to articulate those feelings, which is actually very helpful to beginning to sort of embrace the issue or the sort of the situation. So, suppose that was in terms of the architecture again, it was always in both buildings, making sure that there are spaces where you can have small rooms, larger rooms, bigger groups, smaller groups, people on their own, actually another one in the Alder Center was the washroom, so the loo. Part of the brief was actually to make it a really a generous loo with a basin with not too big a mirror. And a seating area, and a little table with some flowers and a good quality of light so that actually it’s okay to go and just, you know, cry. And then try and pull yourself together. So it’s all of those things, which are manifestations of human pain and emotion, that the architecture has to allow. will also talk slightly personally. But, the experience of palliative care, quite often means the person has gone through quite a lot of pain, literally physical pain. And sometimes there is a point where the notion of death becomes a friend and not a scary thing. It is a weird thing. Some of the comments that people made to us, particularly in the North London hospice, because that is palliative, Alder Centre is slightly different because these are younger children and that sort of the wrong end of life. But a couple of years ago, literally, two years ago, went down with double lung failure, pneumonia, and was in intensive care for two weeks was completely out of it, but anyways, that’s the trajectory of two weeks of going down with pneumonia where you cannot breathe. And then I’ve heard with COVID, with these false ventilators, they are awful. And it was like can’t do not have the energy to hang on anywhere. And just thought could just float off. And actually, then the notion of death becomes a relief. And so that sort of that experience also loops back into some of the briefing conversations that we had, particularly on North London about what death means. And think ultimately, it’s sort of a realization, it is a natural part of life. So, your right, it is taboo, because it’s a difficult thing to handle for everybody. But it is part of life. And actually, another aspect that the Alder Centre had is, because with death there is a person who dies, but then there are the people they leave behind. And so it’s then how you address their need for to heal themselves and to get over loss, but actually also to celebrate a life and memories. So, in the Alder Centre this is why growing and trees and nature is very important, they have a sort of symbol of a tree. So, trees grow, they lose leaves, and then they grow them again, you know, it’s a sort of seasonal sort of sequence. And so what they do is they actually have a metal tree, probably about a metre and a half high and over the course of the year, everyone who has lost a child, you know, they come in and they write they write memories down on leaves. Shaped piece of paper, and these are put onto the tree. And then at Christmas time they have a Christmas service in the in Liverpool Cathedral. And this tree is brought in and the leaves are taken off, and they are sort of pressed as it were collected. But it’s a way of sort of collecting memories, enjoying them and also remembering good things actually, but then also as a sort of ceremony at the end of each year, taking them off. And then it sort of grows again.

KAIZER: It’s kind of like the nutrient cycling in nature. It makes it kind of death less scary to see it in nature. And yeah, this is exactly what I’m picking up on and hearing you mentioned the rituals that can go along with it. And this, celebration almost makes it almost less of a taboo. And that’s like, super powerful. So yeah, think that’s really nice. It sounds like you had a very personal experience with death and when I was doing my readings, I found that it’s always great to have first hand knowledge where you are very close to the subject. However, did you find in practice, at AHMM, while most don’t, so did you find that there was any friction of people talking about death? Because it’s a very vulnerable subjects. Were you finding what during design discussions is there almost like a type of avoidance?

SUSIE: I think at Alder Centre was the most recent one. we were doing the North London Hospice several years before that. Because it was an RIBA competition, we actually have quite emotional conversations about it, both internally and also in the interviews. Because actually, everyone has an experience of death or some sort now, whether that’s a parent, siblings. think what we found is that some people are more open, and I’m just naturally probably more open. Paul who work with is open. And we found it quite easy. And actually, he was going to his mother was quite ill at that point and actually died during the design process, you know, so it becomes all of this becomes very poignant, and more meaningful. And actually, you find quite often if you, if you begin talking about these people generally do begin to open up. Yeah, it’s normally people won’t volunteer, if they do, are in that sort of realm, where people begin to open up, people will sort of talk, and suppose our clients, or from the competition, they made it very clear that it was being run by people who are volunteers to this who all experienced the death of a child. So, they talk incredibly emotionally about the experience of it. You know, as architects, part of our role should be to listen to different briefs, you know, interpret them. So listening is a big part of it.

KAIZER: In your case it sounds really open because Niall McLaughlin, he made a mention in England death is quite taboo, whereas in Ireland, people are quite open about it. But it seems from your personal experience in the field and at AHMM, people are actually surprisingly open to talk about it.

SUSIE: think when one opens a subject, and it’s obviously it’s easier to do it when you’re actually you’re doing a building which involves that as it’s core subjects. mean, again, from personal experience before we did North London Hospice and my father died 12 years ago, and he had three years and particularly the last year was very difficult and I went back home to support my mom to look after him at home through palliative care and had a lot of district nurses helping us and you see actually, you just have to address it. You have to you have to face it. You do have to face it. suppose, not that uncomfortable with it, but from life experiences think it was it was helpful to address some of the subject matter that we had to on the Alder Centre. But think what you said about what Niall McLaughlin was saying, think he’s right that in the UK, particularly our culture is it finds it really difficult. don’t know whether it’s sort of stems from, Brits are very kind of self contained, the old fashioned stiff-up kind of thing and expressing emotion is not the natural way.

1. Tracy Jeffreys, nurse educator at Royal Trinity Hospice

1. Tracy Jeffreys, hospice educator

2. Susie le Good, architect who designed hospices

2. Susie le Good, design director at AHMM Architects

DEVELOPING A FRAMEWORK:

Addressing life + death

addressing life: addressing death:

1.

2. reflection + senses 3. comfort

Firstly, a hospice is about life - making the most of one’s final moments with families and friends as full and self-aware as possible.

Consequently, the hospice will try to make death less scary and more acceptable by softening its stigma and taboo.

Least able sitting... being alone...

Able walking... talking...

“devices of time, signs of erosion and wear, natural elements like water and vegetation... offer a participation in visual, auditory and tactile stimuli, appeasing our anxieties of deterioration and demise.”

- Juhani Pallasmaa

Most able cycling... socialising...

Hospitals are stressful as they offer little choice. The dying comprise of different abilitied people and the hospice can encourage one to explore or find the space comfortable to the individual.

The senses are heightened toward the end of life. Pallasma discusses how spaces can appeal to the senses through the devices of time like trees which shadows move throughout the day and project time.

Referencing Friedenscreich Hundertwasser’s 5 skins of man, the building will play with notions of layers of comfort. People closer to death prefer more quiet and dark spaces, and the layers of the building can be pealed back, allowing one to find their ideal comfort.

personal comfort building material

Closeby Lauderdale House community centre uses:

marriage (life) funerals (death)

capsula mundi natural burials mycelium plant pots are made in the hospice arts room

Mycelium as material would be a trojan horse to addressing death. Site discards, fallen leaves and coffee grounds, would be used as material to create iteams of personalisation and comfort for the rooms.

Lauderdale House closeby is currently used for both marriages and funerals, showing how we might already be more comfortable around death than we think. The hospice spaces would host multiple interchangable programmes for parties or funerals.

In relation to the site’s context, patients can choose to be burried on site toward the forest, allowing death to become a natural and integrated part of the programme. Patients bodies turning into trees provides oxygen and shade for the living.

FIRST

ITERATION: Initial gradient-site considerations

The first iteration on site addresses the gradient that begins to address the key points made, mainly beginning to integrate and consider routes into the forest.

All spaces are accessible by wheelchair, however, paths begin to slope and shoot off, allowing patients with different abilities to explore and become curious of the forest. Handrailings from the bedrooms allow patients to walk into the forest, going as far as they are able.

Inside-inside protect patients when they are most vulnerable physically and visually, while more abled people prefer gatherings and socialising. The gradient allows the patient a choice of space and openness.

Shigeru Ban - Naked House

1. CHOICE OF OPACITY:

Curtains

People toward the end of life prefer darker, more quiet spaces, allowing bedrooms to slowly get darker. Curving walls provide visual cover while being outside - allowing a patient to enjoy being outside while not feeling so exposed in the park. The onion-like architectural layers can be peeled back to choose openness and opacity.

Hundertwasser’s 5 skins of man questions the layers of comfort a patient has and the introduction of curtains allows for its adjustment.

Petra Blaisse’s curtains integrated into OMA’s Maison a Bordeaux softens the notions of inside-outside, public-private.

Maison a Bordeaux, Petra Blaisse for OMA

Friedenscreich Hundertwasser’s 5 skins of man

Layers of curtains/visual opacity to the outside

2. REFLECTION + SENSES

Tree as device of time

Central trees temporarily decorate surfaces in leaf shadows that change throughout the day. As Pallasmaa posits, this allows patients to participate in mindfulness by observing calming and appeasing natural phenomenon and stimulithe moving shadows of a tree.

Juhani Pallasmaa’s ‘devices of time’

“devices of time, signs of erosion and wear, natural elements like water and vegetation... offer a participation in visual, auditory and tactile stimuli, appeasing our anxieties of deterioration and demise.”

Tea House, A1 Architects

Shadows of trees are projected onto a fibreglass dome, softly projecting nature into the internal space that change throughout the day.

Tree as sundial

8 am shadows of leaves on shadow catching surface 6 pm shadows of leaves on shadow catching surface

Drapped language

The language is developed to drape, like curtains across the structure of the building, that encapsulate layering, comfort, fragility and encourage shadows that patients can observe. The components of the building include the main concrete walls, mycelium inserts and concrete drapped roof.

Hospice living room

COMFORT

Mycelium is a fungus that can consolidate loose dead organic material (from the forest or hospice waste) into usesable material with good performance. This acts as a trojan horse into death’s discussion - in the art room, patients may make their own plant pots or curtains from mycelium to decorate their room and begin to mention how interesting it is that dead matter can be used for comfort. The walls of the day room can be rotated to allow for people to sit alone, or move walls to face larger groups.

3. COMFORT

Spaces for crying

Everyone reacts differently to a death of a love one, some cry, others don’t. Some prefer to cry alone, others with the consolation of another, some preferring to be indoors, others outdoors. Subtle moments, such a seat in the washroom, tells a family member who has lost someone that it is o.k to cry here, with the mycelium walls muffling the sound.

Space for crying with the consolation of another

Seat for crying outside

Seat for crying alone in the washroom

Massing + Program + Forest

The building has different types of bedrooms for patients of different abilities, the massing laid out with the other functions. All of which face the forest in which natural burials and capsula mundi occurs, the dead providing nutrients to the trees which in turn provide shade for the living.

Grounds for physiotherapy

Dead providing for the living

BEGINNING OF A FOREST:

Space of living + dying

The forest that the building dissolves into, becomes a grounds for movement, physiotherapy, and comfort around death. As the physiotherapy wing opens up into the forest, the forest grounds becomes a place of physiotherapy and movement. Here, patients can explore the forest on a path and at a level comfortable to them. The forest gradients from a place of life to a place of death, where patients are put to rest and grown into trees that provide shade and air for those in the forest.

Choice of path encourages moving

Physiotherapy wing .A

Activity/art room .B Bedrooms .C

Forest grounds .D

Forest physio - pain manegement .1

Seating - rest in the forest .2

Path - Leveled concrete .3

Path - Non-leveled .4

Path - Uneven dirt pathway .5

Path - Sloping hill .6

Capsula mundi - tree for shade and air .7

A FOREST GROWS:

Death turning to life

Patients can choose to be placed into capsula mundi urns that turns their bodies into trees - providing shade, air and fruits for other patients. As more people pass away, the forest grows by hanging capsula mundi on steel structures. Patients are able to sit under the capsula mundi on seats, shaded from the sun. Here, a paradox emerges where the more that people pass, the more the forest grows, more death = more life.

SITTING IN - SITTING OUT

The inside-inside spaces, that gradients to the outside outside space allows patients to sit alone, or socialise more intimately or more openly, watching joggers passby.

Public - Living room

Private - Bedrooms

Public/Private - Forest

FINAL JOURNEY tree lifecycle metaphor

1

1. reception / tree nursery

Patients are welcomed into the reception greenhouse, a tree nursery where those who pass away in the hospice are memorialised as trees that will also be used in the natural burials. New patients are examined in insideinside examination pods.

2

Entrance hallway .1

Tree nursery/greenhouse .2

New patient examination pod .3

3

2. day room / tree growth and death

As the tree grows, it becomes a sundial that projects shadows of leaves throughout the dayroom and might begin to shed leaves, beginning to deteriorate as we do. Smaller mycelium walls can rotate, allowing personal pods to adjoin with the larger social space.

2

3

1 4

Tree sundial. 1

Leaf catching gutter .2

Leaf shadow screen .3

Rotating seating pod .4

1

3. physiotherapy and art room / dead leaves processing

The physiotherapy spaces extend the outside in. Patients use the natural grounds as one of pain management as more dead matter begin to collect. The art room to the left is where patients create mycelium pots from dead leaves and may begin to talk about death in nature.

Mycelium art room. 1

Inside physiotherapy room.2

Inside-outside foldable doors .3

Outside-inside forest physiotherapy .4

4. bedroom / functional death (mycelium curtains)

In the bedroom, where one usually dies, mycelium fabric allows the room to become darker and darker toward the end of ones life. Mycelium seats and flowerpots, like the one hiding behind the curtain, allow for personalized comfort.

Mycelium fabric curtains .1

Mycelium plant pot .2

Mycelium seat .3

5. reflection hall / beautiful death (mycelium)

After one passes, families may reflect in the reflection hall, mycelium fabric of reconstituted dead matter catching and filtering light through.

Throncrown Chapel - Jay Jones

6. forest burial /tree death and life in the end...

Finally one is buried in the garden, soon to grow into the forest, breathing air from and shaded by trees that grow from our body’s nutrients. In this forest, death is abundant and beautiful, fostering life itself.

... In this hospice, where one is able to find comfortable space, to spend the final moments alone or with family and friends, laughing or crying, maybe dying might not be so scary.

THE WATERLOW HOSPICE. for living and dying.