Dancing with Dr Death

‘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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15 Comments on Dancing with Dr Death

  1. I wish to state that I unreservedly retract the allegations in my previous posting against Whipps Cross and Trelisk hospitals concerning the causes for the deaths of my mother and father and that they were false and untrue and that I accept in full the cause of their deaths were those described on their death certificates.

    • Don’t worry about it Derek. Everyone understands you have had a double blow that no one could take with equanimity, and we all look for reasons for what hits us as a gratuitously painful happening. My family are still not reconciled to the death of my younger brother in what was expected to be a routine operation. Time heals all wounds, or so we tell ourselves.

  2. Dear Mr. Guthrie and Mr. Wilson.

    I feel pressed into revealing that which I’m both angry and ashamed for.

    Both my parents were killed-off in hospital. The first was my father who, habitually playing up his ‘chest
    complaint’, was taken into Whipps Cross hospital – that notorious hospital was 5* treatment! – and given palliative care after ‘a turn’ at home. I was in France but was informed by my brother and I came to England to be with my father each day whilst in hospital. He was sitting up in bed fully conversant and in full control of his faculties in a four-bed ward. Two days later on visiting him, he had been moved to a private side ward and we were told that his health had seriously deteriorated. On entering the room he was conducting an imaginary orchestra with a bemused look on his face and totally incoherent: he died that same night. Being naive and trusting, I accepted the improbable but later realised that he was pumped full of morphine which stopped his heart.

    Two years later my mother, a robust and healthy 84 year-old, fell and broke her hip and was admitted to Trelisk hospital in Cornwall where she was lodged with my brother. Two weeks later, my brother phoned me in France to say that my mother was close to death! The next day I drove the 1,000 mile journey to Cornwall to be at her bedside. She was in a semi-coma and unable to communicate and died that night. Again, I accepted the situation but later realised that she had been starved and deprived of water which ended her life.

    The ‘Liverpool care pathway’ for non interventionist care was totally discredited 10 years later and the scandal of the Mid-Staffs hospital where patients were desperately drinking water from flower vases and numerous ‘early deaths’ caused no one in authority to be held to account – just a couple of ‘fall-guy’ nurses. Please! Do not lecture me on the infallibility of medical care or motives.

  3. I suspect Dr. Langdon was highlighting the need to talk about death more openly. In palliative care we regularly see families try to have these discussions with relatives before its too late, or try to guess what their relative would have wanted if they can’t.

    It is uncomfortable talking about one’s own-or loved one’s- death, but is often left until too late.

    I’m also astounded how quickly people become hostile and jump on their soap boxes here.

  4. Most people I suspect are not scared of death. It’s the pain and indignities that precede it. Access to effective painkillers for the dying is the civilized answer. A doctor’s prime duty is to do no harm. That doesn’t mean prolonging life at all cost, which can result in a lot of harm without any benefit.

  5. Dear Mr. Guthrie. I appreciate that demands for apologies for expressing an opinion has recently become fashionable but it won’t come from me nor will I respond to such demands. I did not say that Dr. Langdon was proposing euthanasia but that she was ‘treading very close’. As with abortion in Britain and the U.S. once the door is cracked open, more extreme measures are likely to follow.

    The policy of euthanasia and sterilisation by the Nazi Party was endorsed by those today we call ‘progressives’ who have been in the forefront to make the killing of the unborn a ‘human right’ and would also welcome assisted suicide. The horrific wholesale murder of ‘undesirables’ by the Nazis did not start until the early 1940s and prior to 1939, aspects of the legitimate government in Germany from 1933 was admired by many eminent people in Britain and the U.S. as was the Soviet Union of Joseph Stalin.

    Be vigilant and be cautious of those who propose novel ideas for society.

    • Ahh. I wondered what you and the others were on about.
      Britain and America are not extreme on abortion or euthanasia surely?
      The most extreme nation on abortion is El Salvador where the bestial catholic priest-ridden government jails innocent girls for life for miscarriages.

      How do you decide between the human right of a 12 year old raped by her father and the right that you claim for a foetus that is not yet a conscious person? Traditional Catholic teaching followed Aristotle that there was no soul or humanity till quickening and even Islam did much the same allowing a longer 120 days before abortion was unacceptable. The ensoulment on conception opinion is historically recent.

      It is not compassionate – and not moral because it removes uncertainty and choice -to have a rigid rule. It’s just as reprehensible as to say that one must never tell a lie and never kill.

      I really cannot understand your thinking here.

      • Hard cases make for bad laws. There are occasions when abortion is justified such as when the would-be mother’s life is at risk and rape for which to terminate a pregnancy can be performed very early and would be justified. I have little interest in excesses in foreign countries as they should deal with their own demons. I care primarily for the country of my birth and its transformation from a largely civilised and sane society to one that attempts to defy reality and practises double-think.

        • Certainly agree we live in an insane asylum – another sensible person, a doctor, loses his job because of these fascistic trans laws this week.

          Maybe all this physical exercise and self-entitlement has destroyed our minds.

    • Dear Derek

      With your words “You… appear to endorse that which… a certain political party in Germany proposed” you absolutely *did* say that she was proposing a policy of compulsory euthanasia – at least in your somewhat bizarre understanding of what she wrote. Also “…you have little fear of such a policy” – quite unequivocal, you seem to know what she thinks too.

      I’ve read the article again, and can see no evidence of anything other than that inappropriate resuscitation of elderly patients who already had a formal diagnosis of dementia, and were near the end of their lives, and suffering from other debilitating conditions causing extended suffering, is not in their best interests. I have absolutely no idea where abortion comes into this at all either.

      It is clear that you have what I believe is termed an ‘agenda’, and find any excuse whatever to twist somebody’s words to fit, however obtusely.

      To explicitly assert that a doctor, who proposes potentially reducing suffering at the end of life by discussing openly what has hitherto been a taboo subject, is a Nazi sympathizer, is ludicrously obscene and borderline libellous.

      She won’t get an apology from you, but it’s sad that she has to ensure this kind of irrational sniping from somebody who can only interpret her words through highly restrictive tunnel vision.

  6. And if you’re going to vaguely hint at sympathies the Nazi party, at least have the honesty to say so instead of using weasel words.

  7. I’m surprised by this doctor’s uneasiness with death. I would have hazarded that frequency and familiarity would disable the ordinary human emotional response in a professional context. Provocative of thought.

    Our understanding of death is certainly learned and not inborn. Soldiers in conflict zones sometimes find young children clinging to a dead parent begging for food, unaware of the change that is permanent. (Some higher mammals have been seen acting similarly, a behaviour that has been misinterpreted as mourning.)

    You can see why many people seek and have always sought consolation in religion’s promise of another life, or a continuing life. But in a sense we do not disappear when we die since nothing can destroyed, or created come to that: what we observe is change, as has been understood since ancient times. (Everyone’s heard of Heraclitus and his river.)

    Arthur Schopenhauer seems to me to have the most plausible metaphysics: all existence is a blind force or energy that he confusingly called the Will. We are one of numberless temporary assemblages of appearances that survive for a time (80 years on average in the UK, 65 in Russia) and then return to the tumultuous world of Will that has been within us, restrained, all along. A man can do what he wills, he said, but he cannot will what he wills. Think about it.

  8. You’re treading very close to eugenics Dr. Langdon and appear to endorse that which the Fabianists of the 1930s along with a certain political party in Germany proposed. It seems odd to me that you have little fear of such a policy but, in a previous article, you wish to deprive perfectly healthy people from having the means to preserve their life from would-be murderers.

    • I cannot imagine how you have drawn this conclusion after reading the article. There is not a single word which endorses euthenising the disabled or people with treatable psychiatric disorders, compulsory or otherwise.

      If you can’t be more specific, or link to the other article you refer to, I think you need to apologise.

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