Today I finished a book that made me want to pump the air with passion, and equally sob at the beauty, compassion and love that was written on its very pages. With The End in Mind by Kathryn Mannix features all of the things that need to be spoken about more comfortably in everyday life; the process of facing the end of either your own life, or that of a loved one.
We will all die at some point, this fact is indisputable, but as the years have gone by our tolerance to talk about this topic has risen to the degree that we don’t often hear of people broaching such a subject in everyday conversation. Even when circumstances mean that this discussion should take place to provide clarity and peace of mind, there is little courage put forward to avoid the distressed from feeling isolated and alone.
However, there is still a feeling that we drastically fall short when this conversation actually matters the most. The guidelines tell us that a patient should be offered a whole range of support when given only a short period of time to live – spiritual, emotional, physical and psychological with an emphasis put upon the latter two areas. But are we offering this to all who are living with a progressive and terminal illness?
Our passion to survive against the odds mean that many people are being needlessly admitted to hospital for interventional procedures that may be doomed from the start, instead of being provided the peace and support to die in a surrounding they are comfortable with, and surrounded by those who love them. And all because even the clinicians taking care of us are afraid to face the D word. Death. It is observed as failure, yet when the time has come, there is no other choice.
So, what are we afraid of? While those who are older are indeed generally more accepting of death, there are still barriers than actually prevent us from living out a ‘good death’ because we simply do not talk about our wishes. We do not want to face the prospect of living without our loved one, but the probability tells you that it more than likely will happen. And by being unprepared we will actually suffer more from the silence shared. Patients worry of pain, of being a burden, they get angry at the loss they will face and ultimately, they withdraw from society who no longer know how to communicate with them because there is no courage to face the facts.
Death is a not a disease, it is a fact of life, and as such it needs to be in some respects celebrated than to be feared.
The introduction and rise of hospices in our communities have put onus on this ideal of death, more often than not we endeavour that we will die without pain, maintaining some resemblance of our quality of life and dignity even in our final days as well as ensuring that the healthcare workers around us continue to assess the potential psychological support we may need. Similarly, we want to have our affairs in order, our funerals planned, our finances tied up and know that the ones we leave behind will be safe without us. However, can this be achieved if we do not talk about death until it may potentially be too late?
And shouldn’t we provide the patient the opportunity to talk out their fears than to shun them because we find the topic too hard to deal with?
The significance of cancer-related deaths affecting our population over the last decades has called for an urgent review on how we offer palliative and end of life services so that we can reduce the distress for all those involved. Though difficult to introduce, starting this conversation with patients earlier provides a greater outcome as they see out their final months, weeks and days enabling them to come to terms with their illness and essentially have more time to tie up all the loose ends that they may otherwise ignore.
Some of you may unfortunately be dealing with this topic in your life, but for those who are not, why not consider expressing your wishes to your loved one, attempt to open the door to that conversation and see how it can perhaps provide you with comfort than fear. Don’t they say we should face our fear? Stare it right in the face? Try staring death in the face, it may not escape us, but it does not mean we have to suffer in our silence.
Katie Bagshawe is currently a Student Diagnostic Radiographer at the University of Derby. She holds an MSc in Psychology from Sheffield Hallam University.
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