‘Its in ‘ere doc’. The thickset man, dressed incongruously in a dress suit, opens a door to a windowless room. Only synthetic light to make the examination.
I hesitate in the doorway. The sheet is folded back neatly and shows the patient in repose, lying on her back. Her face is so serene and her colour so warm that she looks as if she might be breathing.
I don’t want to be left in this room, on my own with a dead body. ‘Would you mind holding my hand?’
‘Holding your ‘and?’ the undertaker’s assistant sounds a bit surprised. ‘I mean keeping me company,’ I explain. We leave the door open.
Hesitantly I approach the body. Not knowing any other way to treat her, I treat her as a patient. I start at the wrist so as not to startle her, and feel the cold texture of her skin and no pulse. I check her pupils with my torch and her heart and breathing with my stethoscope, as if there is any doubt that she is dead. I carefully replace her flowery pyjamas, covering over her chest and tummy to preserve her dignity -as I would for a home visit.
‘Alright doc? Ready to sign?’ I nod and put the sheets back. I take off my gloves, switch off the light and shut the door, leaving the cadaver inside, in the dark.
If even doctors are so uneasy in the presence of death, can we be surprised that the rest of us can’t face up to it?
We are all bombarded ceaselessly with adverts; 1 in 8 will be diagnosed with prostate cancer, 1 in 4 will die of heart disease, they seem to be telling us that this is an outrage, that we must give money to stop this unacceptable situation TODAY.
But we all have to die of something. It is normal to die. I wish there was an advert that said
It’s normal to die of something.
We are drawn into detailed discussions of assisted death for conditions such as motor neuron disease (MND), which end in tragic alertness but an inability to move but these account for a small minority of deaths in the UK.
What we should really be discussing is what the great majority of us will end up suffering from; the exact opposite – dementia. An inability to make decisions combined with a mobile but frail, elderly and failing body.
Doctors, nurses, patients and relatives, we are all stuck in a culture where we preserve life at any cost, to the bitter end – and beyond. Eventually even antibiotics or chemo or iv fluids won’t work and the patient is finally allowed to die.
There are around 2000 patients with dementia in my local borough. It’s a number we can get a handle on, care for, look after. But to do this we all need to chip in and face death.
I have done it – to an extent. I know that one day I will take my last trip to the shops but still be able to get into the garden. That presently I won’t be able to make it downstairs but still be able to get to the toilet, and then finally I will be unable to get from the bed to the chair. I know this will happen; it happens to everyone. Sometimes I wonder what the diagnosis will be.
It’s hard to have a discussion about the nitty gritty of what we will or won’t want, or even to discuss what someone else wants when they die. For example, have you been asked to be someone’s lasting attorney for health?
But we must have that chat, in good time and make those choices.
Particularly important is to choose not to have cardio pulmonary resuscitation (CPR). Designed specifically for cardiac patients, it was never intended to reverse death for patients in general. It only works with cardiac disorders. For people with sepsis, renal failure, palliative care patients or people with dementia (to name only a few) it is not appropriate because it doesn’t help. It is sad that doctors have to discuss and offer it to all palliative patients now even though it is not an appropriate treatment, but I suppose it does encourage us to have that conversation about dying.
Having decided about CPR, anything goes. Place of death, antibiotics, who should be there…
I think we should concentrate on those of us who are mentally competent near death and start focussing on the great majority of us who will not be mentally competent and who will have a formal diagnosis of dementia. Near death we will be confused and baffled by questions from doctors badgering us. We won’t be able to decide what to do or what is right.
We all need to face our uneasiness with death – uneasiness that has been bred into us by our modern culture and high-level health care, such that even doctors can’t face death with composure. We must remember that death is normal and face-up to questions about what we will want when we get to that stage. Then when we are elderly, confused and near death we will not be kept alive against our wishes, forgetful, disorientated, through urine infection after urine infection, and miserable.
Berenice Langdon is a GP
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