“People come to you and say ‘Do you mind if I ask you how old you are?’ And you say ‘no’. It’s as if they want to say ‘Will you show me your arse?’ It’s some weird idea that it’s shameful to be old, something that is sick and smells bad instead of a source of pride — that one is a receptacle of years and years of being in the world. Why should I be ashamed of it and why should you be coy about it?”
Dudley Sutton, actor
Posted by Jon Underwood, founder of the Death Café project
“In this case, ignorance is not bliss. With death, ignorance is fear.”
Caitlin Doughty – The Order of the Good Death
The UK Commission on Improving Dignity in Care chose the 29th of February to drop their bombshell in the form of a draft report on how to improve care for the elderly. Their recommendations were dry and sensible but the Commission used their moment in the spotlight to prod at a shadowy part of our national psyche. When splashed across the media nuance was lost to the big message – we’re not compassionate enough, we need to care more. Their implication was clearly that we don’t care enough.
Though it was NHS staff that were labelled as lacking compassion there were a lot of us who felt, deep down, that we might not care enough too. If we did how would we allow incidents like those that set this Commission in motion continue to occur. Some of these were documented by the Health Ombudsman in a migraine inducing report, the kind that you have to steel yourself to open.
And when you do you learn of Mr. D whose family arrived at hospital on the day he was due to be go home and found he had been waiting for several hours. He was in pain, desperately needed the loo and couldn’t ask for help because, he was so dehydrated. His daughter said that ‘his tongue was like a piece of dried leather’. The emergency button had been placed beyond his reach, his drip had been removed and the bag of fluid had fallen and had leaked all over the floor making his feet wet. When the family asked for help to put Mr D on the commode they reported that he had ‘squealed like a piglet’ with pain. Truly a horrific experience for any family. His daughter said that ‘From the moment cancer was diagnosed my dad was completely ignored. It was as if he didn’t exist – he was an old man and was dying.’
The report continues in a totally dreadful way. You read about Mrs. H who was transferred from hospital to a care home. When she arrived the Manager found she had numerous injuries, was soaked with urine and was dressed in clothing that did not belong to her and which was held up with large paper clips. Or you read about how staff at Ealing Hospital left Mr. J forgotten in a waiting room, waiting to be told he could come in now, while his wife died in the ward nearby. Or about how staff at Oxford Radcliffe Hospital turned off Mr C’s life support despite his family’s request that they wait until they got there.
Can you imagine equivalently painful situations would be allowed to occur and reoccur if they concerned children rather than older people? Its convenient to blame medical staff but there is evidence of a much more pervasive problem. According to the European Social Survey Britain has one of the worst records in Europe on age discrimination. Age UK, our loudest voice on behalf of older people, says “Undignified care of older people does not happen in a vacuum; it is rooted in the discrimination and neglect evident towards older people in British society. Age discrimination is the most common form of discrimination in the UK.”
Abuse and neglect is a crime. Horrible incidents like the ones described above are much more likely to happen to older people. These things together, I firmly believe, constitute hate crime. In the face of them it’s hard not to feel we have some questions to answer, like why these things happen and what can we do about it.
The explosive reaction following the publication of the Dignity in Care commission report was unsurprising because they almost dared to point the finger of blame at the general public. The tone of this debate is shrill and pervaded with unease. Commentators seem happy to skip the bit about what the problem actually is and focus on what should be done about it, and about this there is almost a complete lack of clarity and agreement.
Some suggest banning the use of the word ‘dear’ to describe older people. Many say that nurses pay and conditions do not allow them mental space to be compassionate and when they are improved standards will improve too. Others suggest that NHS privatisation will only make things worse (a view one suspects they had before the report was published). Esther Rantzen is proposing Silverline, a 24-hour phone service where older people or their families can blow the whistle on cruelty or neglect. Virtually no one suggests that the Commission’s own mild and unthrilling recommendations will amount to much more than a cursory step in the right direction.
The most entertaining commentary I’ve seen was a teeth-grindingly awful piece by Allison Pearson in the Telegraph called ‘Listen darling you can’t legislate for compassion.’ Pearson thinks that “Caring is a vocation, empathy a gift”, conveniently letting herself off from ever having to develop any compassion herself. She continues “Hospitals used to know as much, back when girls with big hearts and a small clutch of CSEs were recruited to do what they did instinctively: fetch a flannel and basin to give someone a nice wash, stroke a shaking, ancient hand, share a joke over a bedpan.” Ah! The harking for the mythical past! So comforting to invoke because it didn’t exist so there is no chance of us ever getting back to it.
Pearson is wrong on so many levels but the idea that things were better then is just bollocks. This is because the issue here isn’t about reintroducing matron or even about older people. It’s about death. The people profiled by the Health Omdudman were dying. 9 out of 10 of them didn’t live to see the report get published. Things can often go to shit when people are dying and this is where so many problems lie. Key fact: 54% of the complaints that the Healthcare Commission receives are ‘bereavement related’.
It makes sense because many of us don’t do dying very well. We don’t even like to talk about it. And when we see people who are dying we can freak out, a bit or a lot, and sometimes not do the best things. It doesn’t take anything else to cause incidents like Mr. D’s.
So the flipside of this, is that someone who is more OK about death (and all that is all associated with it) should be better at looking after a dying person than someone that who is scared. This makes sense and there is a surprising amount of evidence of this point. Its not just nurses that are afraid of death – count me in and probably you too – but they are the ones who’ve mainly been studied as far as I can tell. G. G. Eakes studied the relationship between death anxiety and attitudes towards the elderly amongst 159 nursing staff. The conclusion was clear: “Nursing staff with high levels of death anxiety had significantly more negative attitudes toward the elderly than nursing staff with low levels.” Vickio and Cavanaugh found that the results of their study of 133 nurses “indicate that a connection between old age and death may underlie the relationship between death anxiety and attitudes toward elderly adults.” DePaola, Neimeyer, Lupfer and Fiedler’s comparison of 145 nurses with a control group found similarly that “increasing levels of death concern were associated with greater anxiety toward ageing, especially in the nursing home sample, and nursing personnel displayed significantly fewer positive attitudes toward the elderly than did controls.”
If our problem is fear of death then what should we do about it? The good news is that in many areas we’ve never been better at it – another reason that Allison Pearson from the Telegraph is wrong to yearn for the good old days of matron. For example, the modern Hospice movement is a magnificent British gift to the world through the pioneering work of Dame Cicely Saunders. It is noteworthy that the word ‘hospice’ is completely absent from the Health Ombudman’s report. Britain is also a world leader in natural burial thanks in large part to two decades of effort by the Natural Death Centre. There is always compelling off-centre debate on this blog. The GFG has the courage to fire sharp barbs at the big funeral chains and is clever enough to lead on big tasks like redefining ritual for non-religious funerals. There are many fantastic undertakers and celebrants and lots of great stuff is happening, like my personal project Death Café and the brilliant Order of the Good Death
Saying that this is a debate about how we care for the elderly makes nurses, care homes and hospitals the things we need to change. No one would deny that changes to date haven’t been entirely successful. Saying this is a debate about how we die would bring the focus back to where it needs to be – on the dying person and their family with nurses, care homes and hospitals there to provide compassionate support.
[Death Café works with anyone who wants to talk about death. This includes those who are dying, those that support them and everyone else. Please do get in touch if you’re minded to.]
Posted by Vale
Across the evening sky, all the birds are leaving
But how can they know it’s time for them to go?
Before the winter fire, I will still be dreaming
I have no thought of time
For who knows where the time goes?
Who knows where the time goes?
Sad, deserted shore, your fickle friends are leaving
Ah, but then you know it’s time for them to go
But I will still be here, I have no thought of leaving
I do not count the time
For who knows where the time goes?
Who knows where the time goes?
And I am not alone while my love is near me
I know it will be so until it’s time to go
So come the storms of winter and then the birds in spring again
I have no fear of time
For who knows how my love grows?
And who knows where the time goes?
Posted by Vale
“You’d better get busy, though, buddy. The goddamn sands run out on you every time you turn around. I know what I’m talking about. You’re lucky if you get time to sneeze in this goddamn phenomenal world. … I used to worry about that. I don’t worry about it very much any more. At least I’m still in love with Yorick’s skull. At least I always have time enough to stay in love with Yorick’s skull. I want an honorable goddamn skull when I’m dead, buddy. I hanker after an honorable goddamn skull like Yorick’s.”
― J.D. Salinger, Franny and Zooey
Posted by Vale
I have never loved cars. I side with H.G.Wells when he said that everytime he saw an adult on a bike ‘I no longer despair for the future of the human race’. Or Orwell when he said ‘Four wheels bad, two wheels good’. Or something like that.
But I do understand that some people feel differently, lavishing all sorts of devotion on the mechanical brutes. Even so very few cars are loved enough to have their own obituary. Jimmie Johnson’s Daytona 500 race car No. 48 was one of those special cars. It’s a tragic story that starts with the patient facing its emergency team:
Ten men in matching black-and-blue jumpsuits surrounded the $250,000 car and readied for surgery. One held a motorized saw. Another yanked his gloves tight. Their job was to bring life back to a car in critical condition.
Jimmie, the driver who crashed this beauty, is clearly not the story. Doctors looked at him and, seeing he was only shaken up, focused back on the real victim of this Daytona scrimmage.
“It’s like the ER,” Malec said. “After someone gets into an accident, you clear out the wound, cut it open and find out if she’s curable.”
Mechanics cut out the firewall…Off came the hood, too, like a chest being cracked, so the parties could see the car’s guts. The engine, all 358 cubic inches and 800 horses of it, was salvageable. The rest of the car’s front not so much.
Mechanics crowd round. There is much waving of spanners and the like (forgive me, I am not technical). But in the end not enough could be done and:
They rolled the 48 onto a platform. It lifted the car above the hauler’s main cabin and into the top compartment, behind the pristine backup. In the front of the 48, an open hose still puffed steam, the last breaths of the great machine that gave its life on Lap 2, Turn 1 of the Daytona 500.
I was relieved that the poor thing was carried away on a ‘pristine’ backup. It’s what we’d all want for a loved one. Terrific stuff. You can read the full story here.
Posted by Vale
When is a state funeral not a state funeral?
Back in 2008 there was speculation in the press about plans for a state funeral honouring the life and achievements of Lady Thatcher.
The rumours were denied at the time but have never gone away or stopped being controversial. Look at the reactions to the recent film The Iron Lady. It’s clear that the memory of Lady Thatcher still has the power to stir people up. One conservative commentator has has even argued that she should forego the honour – not because she doesn’t deserve one, but because celebrating her life so publicly would divide rather than unite the nation.
Here at GFG we have no political views. We are aloof. We rise above.
We do recall though that the last PM honoured in this way was Sir Winston Churchill – a great man who was himself not universally loved. And we were intrigued by the epetition that appeared recently on the Direct Government site here. It simply states that ‘we the undersigned believe that’:
In keeping with the great lady’s legacy, Margaret Thatcher’s state funeral should be funded and managed by the private sector to offer the best value and choice for end users and other stakeholders.
The undersigned believe that the legacy of the former PM deserves nothing less and that offering this unique opportunity is an ideal way to cut government expense and further prove the merits of liberalised economics Baroness Thatcher spearheaded.
We do not comment on the merits or not of the idea. We do, though, wonder what a privatised ‘state’ funeral might look like?
State funerals are rare. They involve lying in state and a funeral procession in which the coffin is drawn on a gun carriage by sailors from the Royal Navy. Royal Ceremonial Funerals (as for State but minus gun carriage and sailors) happen more frequently. Princess Diana’s and Queen Elizabeth the Queen Mother’s funerals’ were Royal Ceremonials.
So what might a ‘private’ state funeral look like? Fewer sailors, but more cars? The cavalcade that took Diana to Althorp would be an example. What could the industry do for Lady Thatcher?
There’s one of those curiosity stories in the Daily Mail that may tickle you. Briefly, a 95 year-old Chinese woman died. She was coffined at home and spent the following days being farewelled by her neighbours.
Six days later — the day before her funeral — neighbours arrived to find the coffin empty. A search discovered the dead woman in her kitchen and, actually, not dead at all. Having not eaten for six days, she was making herself something to eat.
Read the full story here. Enjoy the photo of the sort of coffin the idiotic Mail thought she may have occupied — a British one in a ‘chapel of rest’ standing in front of a crucifix.
Posted by Rupert Callender, owner of The Green Funeral Company.
As human beings, we look for meaning everywhere, superimposing it over everything that comes into our lives. The Australian aborigines believe that the world was vocalised into existence, literally sung into creation, and that the song needs to be continued so that reality can flourish. We are no different, giving identities to our household objects, cursing our computer when it misbehaves or urging our spluttering car toward home. We see patterns where, without us, there are none. A world that responds to our awakening gaze, and freezes again as we look away.
As undertakers, we work in an area where meanings blur and identities become less certain. For us, a body is just that: a body. Something awkward and heavy to be treated practically between us, to be lifted and moved, dressed or washed. But when they are in the presence of those who loved them, they become people again, suffused with personality and history, mute vessels for love and longing, themselves but changed. It is to witness this change that we gently lead the living toward, no more certain as to what it means than they, only sure that it is as important as it is painful.
The picture above is of one of our lowering straps, part of our meagre collection of professional equipment. We have two of them, simple strips of furniture webbing to reinforce chairs that we bought thirteen years ago in a haberdashery shop in Cornwall. You can see the colouration of the soil on them, their history stained into the edge. The red thread marks the midpoint. It rests over the centre of the grave, a guide for when we stretch them over before the coffin is laid on top.
They are just material, yet for me they are one of the most powerfully resonant things I possess. They have lowered old men and children, people whose deaths were a longed for mercy and those ripped from their families. They have held mothers leaving shellshocked children, people who have had terrible things done to them, and those who have done terrible things. They have slipped through mine and Claire’s hands a thousand times, and the hand’s of grandmothers and fathers, lovers and friends. They are tinged with our blood cut by the edges of coffins, stained with soil and mud and grass and sweat, and of course, with tears. The tears of people doing the bravest, hardest, saddest thing of their lives, gently lowering their beloved down into a grave.
They fit into a spread hand, yet reach into eternity. Not just bits of woven cloth, but portals, ladders to another world, or at least to the end of this one. At times they appear like mandalas, or spiraling universes. They seem to possess a patient wisdom, to have personality. We certainly have shared history.
I wonder what part they will play in my own end, whether their frayed edges will still be strong enough by then. In my secret heart, I know they will, that they are an umbilical cord reaching out into the womb of my own death, ravelling me nearer.
Hopefully, when my time has come I will be burnt on a hill. If I am, them perhaps one should be wrapped around me, the other to journey with Claire to who knows where.
These decisions are not ours to make, and maybe they will slip through the hands of my family as they lower me down into the ground. Where ever I am going, I have confidence that the straps will see me safely to the end. They always have.
The Undertaker
This is for the Undertaker
Who’s story is sad to tell,
For what he does is never mentioned,
And often overlooked as well.
He’s not at all what you might picture,
He’s not wrinkled, old and grey,
His face is not pasty white,
Like storybooks portray.
Some people laugh and make their jokes,
And some turn up their nose,
And many think that he is strange,
For the life that he had chose.
But there are many things that they don’t see,
And even more that they don’t know.
Like all the nights he gets no rest,
But never lets it show.
I have seen him work both day and night,
With no time to eat or sleep.
To care for those in mourning,
And comfort those who weep.
The load he carries on his shoulders,
Is more than you or I could bear.
But he always seems to find the time,
To show you that he cares.
So when you see the undertaker,
Make sure you see the man,
That does the job that no one wants
And that no one understands.
Take the time to shake his hand,
And a moment to just say “hi”,
I think you’ll find the undertaker,
Is just an ordinary guy.
Your tears are much heavier these days
I’ve seen them coming in like waves
From the ocean, I’ve seen them coming
From the ocean, I’ve seen them growing
And moving with the water
The rocking is getting more severe
They’ll sail with you anywhere
We will make it
A little further
Don’t you worry
We’re almost there
You and me
Oh we’ll be
Here always here
You and me
Your tears are much heavier these days
I’ve seen them coming in like waves
From the ocean, I’ve seen them coming
From the ocean, I’ve seen them growing
And moving with the water
And moving with the water
You and me
Oh we’ll be
Here always here
You and me
Oh we’ll be
Here always here
You and me
Oh we’ll be here
Sung at the memorial for the families of the victims of the July 22nd massacre in Norway last year.
Recommended by Jehdeiah, whom we thank.
