Humans have been reflecting upon their mortality for millennia, however in recent times this has resulted in a loss of vital knowledge surrounding the end of life. Despite having the unique ability to contemplate death, humans' practical wisdom pertaining to approaching it has been lost. It is indeed a problem, and if this feeling is mutual, we should figure out what our course of action should be. Women, like my grandmother back in her mid-twenties from the 1920s, were accustomed to the process of death; this aspect having been a centuries' long tradition for those of her gender. And home hospice care was their specialty in the absence of hospital assistance for one who was so gravely ill that passing away seemed imminent. At Medical School, I had only just finished my five years of education in my mid-twenties during the 1980s. However, without wisdom, without understanding and without knowledge of the implications that actually come with dying, I was lost. Unlike my grandmother who had all of those philosophies firsthand when she was in her twenties. Five long, hard years of being a doctor had taught me that the desired outcome was to do all we could to prevent death. Death's occurrence was looked upon as a medical failure and something of which we did not wish to attract attention. Shame surrounded the situation and thus it was met with silence.
Over the 20th century, we've witnessed tremendous advances in medicine; these changes have been seen within just a couple of generations. So why the difference? It's due to medical advancements that allow doctors and researchers to improve patient care, diagnosis accuracy and efficiencies with treatments. In the 1920s, when in critical condition, visiting a hospital was unlikely to be of much help. However, with time the progress made by medical professionals during the 1960s, 70s and 80s have been nothing short of fantastic; cases so severe that death seemed imminent can now be treated much better than before. The hospital provided new, innovative treatments such as antibiotics, anesthetics and cancer therapies. They also included extremely advanced surgeries, heart failure treatments and kidney failing therapies, in addition to their Intensive Care Units offering organ transplantation; some of which were pioneered right here. Taking people to hospital that were previously pronounced as very ill or dying often times resulted in astonishing medical progress, saving a tremendous amount of lives. This is something that cannot be overlooked and should be celebrated as an outstanding achievement. However, we forgot what dying looked like when we shifted our understanding of dying by taking those close to death out of the home and leaving it to the care of Health Professionals. As this transition occurred, our ownership and control over how the process unfolded disappeared.
For the past four years, having been qualified for my original career choice of Cancer medicine, I have opted to train in locations where the demand for medical attention and resources is higher. As a result, I am now in a new job. In my work, the detective journey of symptom management combined with emotionally advocating for feeling well-enough to live had led me to switch from a staple large teaching Hospital to a hospice. Having seen and learned a lot about medicine and the dying process therein, pursuing this emotional aspect of mortality was particularly worth the research trip for me. One woman, who had been a part of the French Resistance in the Second World War, was a particularly unforgettable patient for many; having had recently spent time in our hospice. Along with a halo of glorious white hair, she had piercing brown eyes - the kind of gaze that made you feel as if they could see your very soul. With her French accent never lost, this woman with an interesting story had met an English Airman and now lived in England. An air of guarded detachment characterized her, making her seem a bit mysterious and consequently, quite intimidating. Frightened of a painful death, the patient confided in her nurse that as a French Roman Catholic, if she were to lose faith in God which would result due to her agony, it would constitute a mortal sin and thus end any hope of reaching Heaven - where in faith she knew her husband was waiting. At 26 years old, I remember that feeling of knowing everything. My boss suggested we go and talk to one person who was in for a profound existential distress; they thought it would be interesting and told me to come along.
I thought I was skilled in pain control, so I started my journey hoping to obtain even more knowledge and insight. That particular conversation completely shifted the direction of my life; not only affecting the way I see things but also transforming the career I chose. Now, here I am because of that chat! The nurse and I sat nearby, while he addressed the concerns expressed by our friend about the dying process. With care and solicitude in his voice, he said "I'm sorry to hear that you're worried. Can I just tell you what usually happens as a person is passing away?" He knew there was no one-size-fits-all answer when she asked how dying happened, so he offered to share what they usually tend to see in hopes that it would help. She said yes, and he promised her that if it got too much, she had full license to tell him to stop. The interesting thing is that, no matter the cause of death, the pattern of events during someone's passing is the same. It doesn't seem to change with various illnesses. As they grow increasingly exhausted, people are finding it ever harder to find the motivation to keep going. In fact, the best way for them to regain their vigor is not with food and drink, but by simply taking some time to get a good night’s rest. People are waking up to the fact that sleep is becoming increasingly important; if they have something of importance to do, snoozing beforehand is a must. As time progresses, it's evident that sleeping is taking up more of our daily routines and leaving less time for us to be awake. As time goes by, we see that people are sleeping longer and staying awake shorter. Something interesting that we have noticed is that they don't often respond when it's medication time or when there is a visitor, so we need to awaken them. Holding her hand, he said this to her and she nodded in agreement. We can't awaken someone for a certain period of time if they have become unconscious – far more than "sleeping" deeply. When they eventually wake up, they will not necessarily realize that they have been unconscious; humans are simply unaware when state changes like this take place. At the very end of someone's life, when their brain is unconscious and the only part still functioning is their breathing, they are not simply asleep; they are also deeply unconscious in the process.
She is sitting right up in bed, entranced by his words as he describes dying to her. Every now and then she strokes his hand, nodding along to confirm she is listening. I'm sitting on my stool, horrified that he would bring something like that up at a time like this. Once the brain has become deeply unconscious, the only (limited) functions working are those relating to breathing "Cycles". These Cycles would normally be invisible to people, and so now as he talked to her it is noticeable. Breathing automatically in a reflex fashion, Cycles start with deep breaths then gradually shallower, before switching back to deep breaths again. Faster rhythms can also be repeated; starting at a quick rate, slowing and occasionally pausing, and then returning to the fast pace again. Families might notice that the person is sighing, groaning, or appearing uncomfortable; however, they should always check if they are simply unable to feel their throat and unknowingly breathing out through their voice box, making a noise as part of the reflexive action. Likewise, saliva or a specialist mouth disinfecting fluid won't make someone cough or swallow, and will therefore not irritate their throat - they just lie still while the fluid collects at the back of it. Families can sometimes misinterpret a dying loved one's movements, believing they are choking or drowning due to the bubbles passing through the thin layer of fluid covering their lungs; however, this is not caused by air moving into and out of the patient's body. If your nieces and nephews, among other relatives, are here, one of the things we'll do is make sure we explain to them what is happening to you. Nodding in agreement as she strokes his hands, she carefully listens to everything he is saying. The last breath usually happens during a phase of slow breathing, with no special signs or sudden pain. There's no rush of fear, nor any fading away as it doesn't feel like what is portrayed in television and cinema. Instead, simply one breath exhaled without another one inhaling to follow. The family, in the room around a person who is dying, were expecting the Hollywood finale they had heard of. However, we working in palliative care would sometimes realize that the person had stopped breathing - without the family having noticed yet.
Closing her eyes and laying back on her pillows, she reveled in the moment as he willingly put his hands in hers. She squeezed them encouragingly and then brought them up to her face where she kissed them gently. I just watched, entranced by the beauty of this peaceful act. My boss asked me if I was OK, to which I nodded and then headed to the kitchen. With a tissue in hand, tears streaming down my face, all I could think about was what had just occurred - the aloof and uncompromising manner in which we were told that our services, were not required anymore. My job as the most Julia doctor was to save the life of the person dying. However, I never noticed until now the pattern that he had just explained - although I have seen this hundreds of times! This was one of two absolutely huge ideas exploding in my brain at once. I was too consumed with monitoring individual vital signs such as oxygen levels, pulse rate, and kidney function that it stopped me from seeing how they were related to a larger pattern. The process of ordinary human dying is, just like the same process of giving birth, a journey all on its own. Both are characterized by physical changes and emotional and spiritual shifts. Few people journey along exactly the same pathway while leaving this earth as they did when they first arrived to it, yet every experience is unique. We can pace ourselves, recognize the different stages and identify where we are at in our journey - this is how we can work out our progress. It was fascinating to witness Sabine's reaction as she realized that death can be addressed head-on, explained to a dying person in an ordinary manner. Along with understanding, it brings much needed light into their lives - dispelling the fear and negative imaginings that cloud their thoughts.
Thousands of times have I, in my palliative care career, gone on to have that conversation. I always offer to stop countless times. Even though I keep offering, the outcome remains the same. I can honestly claim that getting stopped by my own patients is an experience I have never got to have. But what still happens in the end is usually a moment of relaxation that can also come with compassion and empathy. One may be asking, "Can you tell my family – my wife, husband, kids and parents – even though this wasn't what we were expecting?" And the answer is yes. We can deliver this tender message. We mustn't entrust entirely to palliative care individuals or healthcare professionals the task of regaining the vital knowledge that's been lost, rather families can endeavor to bring back that Lost Wisdom. The implications of such a loss cannot be overstated; we must do everything we can to rediscover it. I invite everyone listening to take this issue of massive social public health seriously and act to resolve it. My grandmother knew about dying because she saw it while those around her were healing, who explained its process to her. Consequently, this enabled her to comprehend the event and freed her from any fear. We mortals must say "Enough!" Let us, as similar and adoring Mortals, take a stance, put our foot down and declare that it is no longer viable to stay in this stagnant pool of despair. We must act now when those around us need our love the most. Death may not be viewed as a medical event as it typically is, but it undeniably has far-reaching implications for both patients and health care providers. From changes in a family unit to routine procedures being altered, death has the potential to impact many aspects of life. A social gathering that is also a highly individualized experience, rather death goes beyond the consequences of relationships and more into the realm of emotional depth. We can relate to and unpack our sadness, searching for ways to soothe and provide support to one another in trying times. Moreover, together we are actively reclaiming the loss of life while expressing our deep gratitude for each other's griefs and consolations.
See also: https://mygodsentangels.com/