Death doesn’t have to be scary…

I was sitting in the doctor’s office today, filling in blood request forms, with one of the nurses, when she looked up, and across at a very old man with dementia and multiple comorbidities, who is unable to eat, drink, move, or communicate in any way.

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‘I think he might have died,’ she said.

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We both looked over. He was lying with his jaw slack, white as a sheet. We waited for his chest to move. He closed his mouth.

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‘Nope,’ she said.

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We both got back to our paperwork.

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It’s these patients that make my heart sink. I haven’t been in their situation, so I can’t really say with any degree of certainty, but I think, if I was them, I’d just like to be left to toddle off to the great offshore swell in the sky (or whatever it is you believe happens when the lights go out).

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There’s always surveys in the Daily hateMail saying how more and more people are dying in hospital, and how awful this is, because people would rather die at home, and I (for once) agree. But we’ve medicalised death to such an extent that we’re totally afraid of it. A hundred years ago we faced death in our homes all the time. Children died young of infections, mothers died in childbirth, people died of tb and pneumonia and all sorts of things. We were used to people dying at home. But now we’re not – and due to antibiotics and vaccination programmes, and safer childbirth practices, people generally die when they’re old, of an illness they’ve had for a while.

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And we as doctors fight death with every sword and rapier at our disposal. We seem to see it as some sort of failure. But it’s not. It’s the inevitable end to this rather wild ride, and if you’ve ever seen a vampire movie, it seems like a good thing. The undead always seem to be trying to end their endless existence. If there was no death, life wouldn’t be such an excellent and exciting thing.

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But if your granny, or mum is old and teetering on the brink, the natural reaction is to try and do whatever you can to save her. Which means phoning the doctor, or taking her to hospital. And then, having had our services requested, we go into overdrive, sticking them with needles, putting them through x-rays, filling them with fluids, catheterizing them. But a part of me is always saying inside, ‘We’ve all got to go sometime – and we have to die of something. Maybe now is just their time?’

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There are two things we can do about this. Firstly, before we become old and decrepit and senile, we can all fill in an Advance Directive. This is a legal document, that says exactly what we would want to happen in certain medical situations, should they arise. It needs to be specific, and it has to be signed and witnessed, so people usually need the help of their GP and sometimes a solicitor. But that means that we are in control of our own destiny. So if I become so demented that I can’t eat, talk, poo, wee, drink, smile or communicate at all, then I think I’d be quite happy to not have any antibiotics for a urinary infection, and just be made comfortable at home, and allowed to shuffle off this mortal coil.

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The other thing we can do, as doctors, is manage people’s expectations, and relatives’ expectations – to maybe gently suggest that if their mum is that far gone, that we let them go, and stop trying to drag them back so desperately. And that maybe next time they get sick, we just allow them to die at home in their own bed, with the people they love around them, instead of racing off to hospital.

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I don’t really know how we’re going to change this. But for the sake of the man opposite me, and hundreds of thousands like him, I think we all need to work together, and make death a little less frightening.

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