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January 5 - February 17, 2021
The death rate remains 100 per cent, and the pattern of the final days, and the way we actually die, are unchanged. What is different is that we have lost the familiarity we once had with that process, and we have lost the vocabulary and etiquette that served us so well in past times, when death was acknowledged to be inevitable. Instead of dying in a dear and familiar room with people we love around us, we now die in ambulances and emergency rooms and intensive care units, our loved ones separated from us by the machinery of life preservation.
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we can all live better, as well as die better, by keeping the end in mind.
There are only two days with fewer than twenty-four hours in each lifetime, sitting like bookends astride our lives: one is celebrated every year, yet it is the other that makes us see living as precious.
The nurse was wise; she knew that reassurance would not help Sabine, and that listening, encouraging, allowing the full depth of her despair and fear to be expressed, was a vital gift at that moment.
whether bravery is about being fearless or about tolerating fear.
The news of the cancer had an interesting effect on Nana: almost as though she had been waiting to know what would bring about her eventual death, she seemed so relaxed that several family members wondered whether she had really understood the news.
This last vigil is a place of accountability, a dawning realisation of the true value of the life that is about to end; a place of watching and listening; a time to contemplate what connects us, and how the approaching separation will change our own lives forever. How intently we serve, who only sit and wait.
the core principle is that we are made unhappy by the way we interpret events. Distressing emotions are triggered by disturbing underlying thoughts, and helping a patient to notice these thoughts and to consider whether or not they are accurate and helpful is key to enabling them to change.
When does a treatment that was begun to save a life become an interference that is simply prolonging death? Can a life-sustaining treatment, begun in hope, turn into a trap that binds a failing body to existence? And if so, what are the ‘rules’ about stopping treatment that no longer helps the person to live well?
one of the toughest parts of our job: making friends with patients who are making friends with death.
Ujjal ran away from that certain, controlled dying to live with the hope of uncertainty.
Anticipating death can enable a dying person to consider their options, and to make clear plans for what care they would like as death approaches. For some people this might mean ‘Try as hard as possible to keep me alive,’ but for most (and especially for any who have seen a peaceful death) it will mean ‘Focus on my peace and comfort, not the length of survival.’
What a privilege, to be able to observe families as they are forged in a furnace of love and belonging, so often with its fiercest heat at the ebbing of a life.
The timing of each death is a mystery. Although we can anticipate when time is getting short, and indeed it becomes easier to estimate life expectancy as the end of life approaches, on occasion the moment of death seems to be related to something more than just the underlying illness.
she has a blood transfusion every week, and she needs transfusions of platelets on alternate days. Her survival is dependent on the kindness of strangers.
My small contribution is regular telephone conversations, using my CBT knowledge to help Lil separate out her realistic, sad thoughts about the future from catastrophic imaginings that turn every day into a minefield.
Unhappiness grows like a weed that takes root in imperceptible cracks in our psyche. Lil and I examine her experiences, identify the weeds, and she vigilantly uproots them as she feels her mood slipping.
they bowed with grace and tender dignity to the inevitable, ensuring that Helena’s death was as enhanced by love as the whole of the rest of her life.
By modelling a way of dealing with a truth that society tries to hide, you can begin a legacy that calls death by name, accepts that it is a part of life, and encourages others to do likewise.
Most people adopt some kind of framework that allows them to recognise and respond to the values that give them a sense of purpose. For some their framework is religion, or politics; for others it is the cycles of nature, or the vast unfolding of the universe. For some it is a more immediate system of interpersonal relationships, or thoughtful appreciation of music, art or poetry. Whatever the framework, this search for ‘meaning beyond and yet including myself’ is a metaphysical construct that is the spiritual dimension of being human.
at the end of life, many people make a ‘spiritual reckoning’ of their worth and the meaning of the life that is ebbing; they seek to transcend the difficulties that beset them, and to consider a bigger picture. This impulse allows extraordinary acts of courage and devotion, of humility and compassion, supported and validated by their personal spiritual constructs. It is perhaps that spiritual dimension of humanness that reveals us at our very best, even (or perhaps especially) here at the edge of life.
It’s a truth rarely acknowledged that as we live longer thanks to modern medicine, it is our years of old age that are extended, not our years of youth and vigour.
The quality of an individual’s life can really only be measured by that person.
They adjust their hope from avoiding death to embracing each day as death approaches. They can let go of the tyranny of planning and worrying about the future, and simply bask in the present.
over the first part of a human lifetime, each of us identifies who we believe ourselves to be.
This transformation of world view is a spiritual transformation, whether theistic or not. It enables the person to review their life and to recognise and regret any hurt they may have caused other people, and often to desire to make amends. It is this recognition that underlies the first of the recurring last messages of dying people: ‘I am sorry. Please forgive me.’ It also supports their desire to avoid causing any further hurt, and this translates into a deeper patience with others’ shortcomings.
they are examples of what we can all become: beacons of compassion, living in the moment, looking backwards with gratitude and forgiveness, and focused on the simple things that really matter.
What are the values that guide your decisions in life? How well have you met your own expectations? Do you judge yourself with as much kindness as you judge other people? Is there any change you would like to make so that your way of life fits better with your values and beliefs? What first step could you take?
