Death; Good death

Last things

11 July 2012
Charles
6 Comments
Categories: Attitudes to death, Death; Good death

Posted by Vale

When I was at school there was a short lived craze for making yourself faint. If I recall, you hyperventilated and then got a friend to squeeze you round the chest, at which point you passed out.

It’s now claimed that this is equivalent to a near death experience. There’s a discussion here, with descriptions of how to to do it (along with a firm warning about not trying them yourself).

Here at the GFG we don’t think it’s a very good idea either. It may be unsafe of course but we also disapprove because, while we believe strongly that people should prepare for death, self inducing a near death experience is, we feel, one of the less constructive approaches.

Religions have suggested alternatives. Hinduism promotes the idea that life has stages and that after the Celibate Student and Family Man the good Hindu will become a Hermit in Retreat and, finally, a Wandering Recluse. Not surprisingly it notes here that practice of the last two stages has become almost obsolete now.

The Christian tradition of meditating on the ‘Four Last Things’ (Death, Judgement, Hell and Heaven) may have more going for it.

Facing up to death, living with the knowledge of its inevitability, trying to prepare yourself all seem to me to be essential elements both of living and dying well. Meditating on Last Things would surely help prepare the mind.

But what Last Things might you meditate on? Death Judgement, Hell and Heaven don’t do it for me at all.

As an alternative I have started work on a personal list. It’s provisional at the moment but might include: meditation on ancestors and all that has made me the person I am; on the things that, from this vantage point, have turned out to matter; on the things that I have made or started; above all on everything that I have learned to love.

This feels like work in progress though. What would be amongst your Last Things?

People are still dying of old age. What are the damn medics doing about it?

7 March 2012
Charles
1 Comment
Categories: Attitudes to death, Death; Good death, What do we die of and when?
 

Extracts from an excellent article in the Washington Post: 

I know where this phone call is going. I’m on the hospital wards, and a physician in the emergency room downstairs is talking to me about an elderly patient who needs to be admitted to the hospital. The patient is new to me, but the story is familiar: He has several chronic conditions — heart failure, weak kidneys, anemia, Parkinson’s and mild dementia — all tentatively held in check by a fistful of medications. He has been falling more frequently, and his appetite has fallen off, too. Now a stroke threatens to topple this house of cards.The ER physician and I talk briefly about what can be done. The stroke has driven the patient’s blood pressure through the roof, aggravating his heart failure, which in turn is threatening his fragile kidneys. The stroke is bad enough that, given his disabilities related to his Parkinson’s, he will probably never walk again. In elderly patients with a web of medical conditions, the potential complications of any therapy are often large and the benefits small. It’s a medical checkmate; all moves end in abdication.

I head to the ER. If I’m lucky, the family will accept the news that, in a time when we can separate conjoined twins and reattach severed limbs, people still wear out and die of old age. If I’m lucky, the family will recognize that their loved one’s life is nearing its end.

We want our loved ones to live as long as possible, but our culture has come to view death as a medical failure rather than life’s natural conclusion.

Suffering is like a fire: Those who sit closest feel the most heat; a picture of a fire gives off no warmth. That’s why it’s typically the son or daughter who has been physically closest to an elderly parent’s pain who is the most willing to let go.

At a certain stage of life, aggressive medical treatment can become sanctioned torture. When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. We’ve committed ourselves to relieving suffering, not causing it. A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.”

Read the whole article here.

Death of a race car

6 March 2012
Charles
2 Comments
Categories: Death; Good death, dying

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.

Ash Wednesday – buy now!

22 February 2012
Charles
3 Comments
Categories: Death; Good death

Posted by Vale

Every age has a genius, a spirit, a particular character. The Victorians, for example, excelled at sentimentality and three volume novels, while, in ancient Greece, philosophers lounged on street corners making public nuisances of themselves.

But what of our own age? What do we do that defines us? There are lots of candidates of course, but one of them, surely, is our gift for making money out of our great days of ritual and celebration. Christmas of course; All Hallows, or Halloween, as it has become; but, to my mind, our greatest achievement is Easter. Who would have thought, even a few years ago, that you could start selling easter eggs not just before Lent, but before Christmas as well! No one could deny there is a sort of genius at work there.

You’d think that, by now, we’d have covered all the bases, but I think there are still some untapped opportunities. Take Ash Wednesday for example: it’s a quiet time of year (if you overlook the pre-Lenten easter eggs); it’s ancient, long pre-dating Christianity’s colonisation, and the fact that it involves death hasn’t hindered Halloween at all.

In fact it’s a fascinating day: if All Hallows reminds us about the spirits around us, Ash Wednesday challenges us to think about our own mortality. In the lovely words of the King James’ Bible, we are asked to:

‘Remember that thou art dust, and to dust thou shalt return’ (Genesis 3/9)

And to reinforce the words our forehead’s are daubed with ash.

It’s a wise tradition. Stoics (those pesky Greeks again) said that thinking about our own ending made us less afraid of death. And wouldn’t we feel more keenly alive through the rest of the year if, on this one day, we stand alone on the shore of the wide world ‘and think – till love and fame to nothingness do sink’.

But, as the Hindus would say, this is Kali Yuga, the darkest of dark ages, and we have its spirit of to consider. So – wisdom aside – aren’t the commercial possibilities obvious? If we are thinking about our own death, isn’t Ash Wednesday the perfect day to think about pre-need funeral planning too?

Come on people, there’s a chance being missed here…

Atheism and the fear of death

12 January 2012
Charles
9 Comments
Categories: Atheism, Attitudes to death, Death; Good death, Good books

Posted by Vale

It’s natural to fear death and you might think that, just as naturally, religion would help you face and overcome your fears. But it ain’t necessarily so. In a recent book, Society Without God, Anne, a 43 year old Hospice nurse from Aarhus in Denmark is interviewed. The author, Robert Zuckerman records that:

She told me that in her many years of experience working with the dying, she found that it was generally the atheists who had an easier time calmly accepting their fate, while Christians had the hardest time facing death, often being racked with worry and anxiety.

The book is a fascinating read. Zuckerman spent months interviewing people in Denmark and Sweden – the least religious in the world – to find out how secularism on such a scale affects society. Throughout you hear the authentic voices of ordinary people. Leif, a 75 year old, is a Jew and a self designated atheist. Asked what he thinks happens after we die he answers:

‘Nothing.’

‘And how does that make you feel?’

‘Well, not very sorry. It is as it is. Really I don’t feel anything about it especially.’

‘You’re not worried or scared?’

‘No I’m not. I’m not very well in health anyway, but I’m not worried.’

Sometimes we hear the surprise of the author. Reflecting on the number of non-believers who show no fear of death at all, he says that, that:

when sociologist of religion William Sims Bainbridge asks ‘How can humans…deal with the crushing awareness of mortality’ I think he is committing a mistake that many scholars of religion commit: assuming that his own fears about death are universal, when clearly they aren’t.

The effect of the interviews – on every aspect of life and society – is to present a real challenge to the argument of the religious that, without belief, society descends into sin and despair. Is it a coincidence that Danes and Swedes are recorded as the most contented in the world?

Britain, you might want to note, is not far off Scandinavia in terms of our own lack of religion.

You can buy a copy here. And there’s a good review of the book in the New York Times here.

Mellified man and the wonder of Wikipedia

20 October 2011
Charles
No comments
Categories: Death; Good death, Embalming, Humour

Posted by Vale

Wikipedia – that glorious monument to collaboration and, sometimes, hearsay – has some marvellously strange pages.

One of my favourites is the Mellified man. This is claimed to be an ancient process of preserving bodies through use of honey.Li, a Chinese pharmacologist reports that,

“some elderly men in Arabia, nearing the end of their lives, would submit themselves to a process of mummification in honey to create a healing confection. This process differed from a simple body donation because of the aspect of self-sacrifice; the mellification process would ideally start before death. The donor would stop eating any food other than honey, going as far as to bathe in the substance. Shortly, his feces (and even his sweat, according to legend) would consist of honey. When this diet finally proved fatal, the donor’s body would be placed in a stone coffin filled with honey. After a century or so, the contents would have turned into a sort of confection reputedly capable of healing broken limbs and other ailments. This confection would then be carefully sold in street markets as a hard to find item with a hefty price.”

Who knows, in this age of innovation in the disposal of dead bodies, (and a cash strapped NHS) it might catch on again.

It’s clear though, from other articles, that we have become a good deal less imaginative about death and dying. There’s another page that simply lists unusual deaths.

It’s worth a look for the sheer variety of deaths listed. There’s more roasting than you might imagine including being roasted alive in brazen bulls. A disturbing image, I would have thought, for stock marketeers in these troubled times. Then there’s the politician Draco who, in 620 BC, was smothered to death by gifts of cloaks showered upon him by appreciative citizens. There’s got to be a metaphor there for the risks all politicians face if they of accept too many gifts.

My favourite though is the Stoic philosopher, Chryssipus, who died of laughter after giving his donkey wine then seeing it attempt to eat figs.

They really knew how to live – and die – in those days.

Death with dignity

19 October 2011
Charles
No comments
Categories: Death; Good death, self-deliverance

Posted by Charles

When Meg Holmes was diagnosed with brain cancer in 2009 her husband Andrew started a blog so that he could update friends about her condition.

Meg died on 1 October. The following post describes her death.

My wife Meg died on the morning of Saturday October 1st in the loving company of her brother, sister, son, daughter and husband.

Suffering from a disease that robs one of intellect and dignity, she had the option, as a Washington resident, to choose the time of her death. She used the provisions of Washington’s “Death with Dignity” Act to hasten her death, while she was still able to converse with and understand her family members. (Oregon has long had a very similar “Death with Dignity” act, Vermont and Massachusetts are considering one).

Her family gathered on Friday and spent the day with her. She was much more alert and animated than of late and visited with each of us. Despite knowing that her death was the next day, we all slept well that night (I slept much better than for many weeks), showing us that we were prepared for her passing.

Social workers (she met privately with one from hospice and one from Swedish Hospital to affirm her decision) and the volunteer from Compassion and Choices Washington all remarked on her readiness (and that she had not been ready the previous week).

The volunteer from “Compassion and Choices Washington” showed immense skill and empathy in helping Meg and in caring for us. 

Meg died peacefully and quickly, with no signs of discomfort. It was a remarkable end to a long struggle, and released Meg from what we all knew could be a long, distressing, undignified and inevitable end. Our preparations, the company of relatives, Meg’s peaceful passing and the knowledge of her command of the situation all served to make her passing much easier for us all. 

Find Andrew’s blog here.

Grateful thanks to the excellent Death With Dignity blog for alerting me to this. Find it here.

Bereavement Counselling in the NHS (Taking the sting out of death)

10 October 2011
Charles
2 Comments
Categories: Attitudes to death, bereavement, Death; Good death, End-of-life issues

Posted by Vale

Pat is a Bereavement Counsellor working in an NHS Trust hospital. Her job is to help people affected by a death in a hospital, supporting them through their grieving. Pat is the subject of a long article inSaturday’s Guardian. It can be found here.

It’s a heartening read. Death in a hospital can be a very fraught business. Treatment, perhaps in intensive care, is hard to comprehend, and the workings of the institution are often alienating and frustrating to people who want to support someone they love at the end of their lives. And death comes in so many forms that it’s sometimes difficult simply to come to terms with what has happened.
Pat’s role – carried out, it is clear, with great love and understanding –  is to help people come to terms with what has happened. Sometimes it is a matter of looking at notes, talking to doctors and taking time to explain why someone died. Sometimes it is just about making space for grief. Pat:

“has a mantra that “nothing is wrong in grief”. She almost always honours requests from bereaved relatives, however unusual. A common wish is to touch the body of a loved one: hold their hands, or kiss their foreheads or even wash their face. One woman asked Pat if she could help her retrace the journey her 15-year-old daughter’s body made from the hospital to the mortuary, after she died from a very protracted illness. She then wanted to see where she had been blessed in the mortuary. “And there’s nothing wrong with that,” she says.”

It’s good to know that hospitals are recognising that the death of a patient is both an ending and, for bereaved family and friends, the beginning of another vital process – the need to grieve, mourn and say farewell. Important too that they recognise that their role in this next stage is crucial. Reading about the work that Pat does, however, did make me want to ask more questions about the way that the NHS treats people at the point of death.

If there is recognition of these human issues after death, is there the same concern for people as they die? How well are patients supported at those last moments? How easy is it for people to sit with the person they love; hold them and comfort them; share in the business of dying?
I’ve tried to find the relevant NHS guidance, but with little success. I did, however, turn up a Scottish NHS report called Shaping Bereavement Care – a framework for action. It has 14 recommendations, some of them recognisably relating to the good work that Pat does. The recommendation relating to the process of dying though is this one. It is a commitment to:

“undertake a review of all current policies and procedures relating to care of the dying patient, and care of the deceased, to ensure that they reflect good quality care and to assess and reduce any real or potential negative impact of these processes on those who have been bereaved.”(Recommendation 3)

It suggests that there are important connections yet to be made in this area – in the Scottish NHS at least. Although, surely, it’s not hard to join the dots between the way that people feel when they are not involved in a death and the need to involve them more in the process of dying itself? It seems clear enough to me that if the humanity, care and understanding that Pat so clearly brings to her work after a death could be brought into the hospital itself and allowed to take their place at the bedside of the dying patent, then acceptance, understanding and the grieving process itself would be immeasurably improved.

But maybe the NHS in England is already there?