Why We Should All Talk About Dying
3rd May 2018
Dr. Katherine Mannix
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IMHO dying is not as bad as you think. This powerful piece from Doctor Kathryn Mannix (palliative care consultant and author of 'With The End in Mind') explains why we need to talk about death.
In my humble opinion dying's probably not as bad as you're expecting. We've stopped talking about dying. We've
stopped mentioning the D words. Instead of saying ‘dead’ we say ‘passed’ or ‘passed away’. Instead of saying ‘dying’ we might say ‘seriously ill’. The families don't understand that death is approaching when those words are used. And that is in fact a bit of a problem for us.
And so now a family will sit around the bed of somebody so sick that they will be dying and not know what to say. Not know what to say to each other. Not know what to say to the dying person. And the dying person doesn't know what to say either, and doesn't know what to expect. Wondering whether each breath might be their last breath. A scene of sadness and anxiety and despair. And in my humble opinion it doesn't need to be like that at all.
We've lost the rich wisdom of normal human dying, and it's time for us to talk about dying and reclaim the wisdom.
What does normal dying look like? Well dying like giving birth really is just a process. Gradually people become more tired, more weary. As time goes by people sleep more and they're awake less.
Families can learn when to give medicines, and when to introduce visitors. Sometimes a visitor might happen or a medicine might be due during that sleep. And that's when we can discover that a change has taken place. It's tiny but it's really significant. And it's that instead of just being asleep this person has temporarily become unconscious. We can't wake them up. We can't give them that medicine. We can't tell them that that visitor is here. And yet when they waken later on they tell us they've had a good sleep. So we know that this coma doesn't feel frightening. That lapsing into unconsciousness just isn't noticed by us when it happens.
So as time goes by people are awake less and asleep more until eventually they're just unconscious all the time. We would be so relaxed that we won't bother to clear our throats, so maybe we'll be breathing in and out through little bits of mucus or saliva at the back of our throat. It can make a rattling funny noise. People talk about the death rattle as though it's something terrible, but actually it tells me that my patient is so deeply relaxed. So deeply unconscious that they're not even feeling that tickle of saliva as their air bubbles in and out through it from their lungs. So at the very end of somebody's life there will be a period of shallow breathing, and then one out-breath that just isn't followed by another in-breath. Sometimes it's so gentle that families don't even notice that it's happened.
So normal human dying is just a really gentle process. Something we can recognize, something we can prepare for, something we can manage. And this should be something we can celebrate. This is something we should be able to console each other with. But because it's become impolite to talk about dying, it's the really best kept secret in medicine. So in my humble opinion dying is something we should be reclaiming, we should be talking about, we should be consoling each other about. Please pass that on.
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