Thinking Beyond Science

The trouble is, whereas birth, love and even bereavement are widely discussed, death itself has become increasingly taboo. Not knowing what to expect, people take their cues instead from vicarious experiences: television, films, novels, social media and the news. These sensationalized yet simultaneously trivialized versions of dying and death have replaced what was once everyone’s common experience of observing the dying of people around them, of seeing death often enough to recognize its patterns, to become familiar with life lived well within the limits of decreasing vigor, and even to develop a familiarity with the sequences of the deathbed.

Better healthcare, new treatments like antibiotics, kidney dialysis and early chemotherapy, better nutrition, immunization programmes and other developments radically changed people’s experiences of illness and offered hope of cure, or at least postponement of dying, that was previously impossible. This triggered a behavior change that saw the sickest people being rushed into hospital for treatment instead of waiting at home to die. Life expectancies increased; many lives were enhanced and lengthened.

Perhaps the most familiar these days is pregnancy and birth. We know the nine-month pattern of pregnancy: the changing symptoms as morning sickness gives way to heartburn; the early quickening and later slowing of the baby’s movements as the swollen belly constricts activity towards term; the pattern and stages of a normal birth. Watching dying is like watching birth: in both, there are recognizable stages in a progression of changes towards the anticipated outcome. Mainly, both processes can proceed safely without intervention, as any wise midwife knows. In fact, normal birth is probably more uncomfortable than normal dying, yet people have come to associate the idea of dying with pain and indignity that are rarely the case.

Sometimes, things that are right in front of our noses are not truly noticed until someone else calls them to our attention.

Sometimes, courage is about more than choosing a brave course of action. Rather than performing brave deeds, courage may involve living bravely, even as life ebbs. Or it may involve embarking on a conversation that feels very uncomfortable, and yet enables someone to feel accompanied in their darkness, like a good deed in a naughty world.

The pattern of decline towards death varies in its trajectory, yet for an individual it follows a relatively even flow, and energy declines initially only year to year, later month to month, and eventually week by week. Towards the very end of life energy levels are less day by day, and this is usually a signal that time is very short. Time to gather. Time to say any important things not yet said.

But sometimes there is an unexpected last rise before the final fall, a kind of swansong. Often this is unexplained, but occasionally there is a clear cause, and sometimes the energy rush is a mixed blessing.

Watching people approaching an anticipated death offers families and friends a comfort as they all arrange their priorities and live each day as it arrives. Sometimes, though, death arrives unannounced and unanticipated. In some circumstances this is seen by the survivors as a blessing, although adjustment to sudden death is often harder than a bereavement when there has been a chance to say goodbye.

Perhaps the cruelest circumstance, though, is when a sick person has been getting better and seems to be ‘out of danger, only to be snatched by death in a completely unforeseen manner. When this happens, a shocking adjustment has to be made by loved ones – and by professionals too.

While most dying is manageable and gentle when it approaches in an anticipated way, the truth is that sudden and unexpected deaths do happen, and not all of them are ‘tidy. Although loss of consciousness during a sudden death usually protects the dying person from full awareness of the situation, those around them retain memories that may be difficult to bear.

Bereaved people, even those who have witnessed the apparently peaceful death of a loved one, often need to tell their story repeatedly, and that is an important part of transferring the experience they endured into a memory, instead of reliving it like a parallel reality every time they think about it.

And those of us who look after very sick people sometimes need to debrief too. It keeps us well, and able to go back to the workplace to be rewounded in the line of duty.

Source : With the End in Mind: Dying, Death, and Wisdom in an Age of Denial by Kathryn Mannix

Goodreads : https://www.goodreads.com/book/show/35099051-with-the-end-in-mind

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