Understanding death and dying
This blog post is something I have been writing and wanting to publish for a long time, but not quite had the courage to do so. I have written this as a friend and family member as well as a doctor and it is not a piece all about doom and gloom. I hope that everyone finds it an interesting read and can relate to some part of it.
What death and dying means to me
My family have always commented on my literal approach to death. Whether it is because of my medical training and the exposure I have had or if that’s maybe one of the reasons I have coped working in a trauma centre. I feel comfortable talking about death and dying without feeling huge emotion and so this is why I thought I could write this and hopefully help people to understand their own feelings, or have the confidence to be a little more open about it.
Due to my job I have already witnessed too much death. I believe a doctor will always remember their first patient that died and for me it was a lovely old lady who had no family or next of kin, so my senior colleague and I made sure that we spent as much time with her as possible. We were with her in her last moments so that she was not alone, and she was then taken away to the mortuary and that was that - so brief and sudden. Some could be upset by this situation but I will never forget her or who she was and feel grateful to have met her and been there at the end.
Since working in A&E there have been all different scenarios that have led to some comfortable and peaceful deaths, traumatic ones with a lot of drama, and many sad times. Only recently across the world have doctors started talking about how these situations can make them feel and in my department we try to debrief and talk about this, not only with regards to what we could have done differently as clinicians but also about how we feel, within a safe forum.
What I find most challenging about death at work - mostly from cardiac arrests or traumatic events - are the relatives’ reactions. Nothing will ever prepare you for how a family member may react. I have witnessed every emotion you can imagine: relief, silence, screaming, gratitude, aggression and threats, wailing and despair. Part of my job is to be there to help these people almost as much as my patient, to help them understand what has happened and what will happen next, whilst trying to comprehend what they are experiencing in that moment.
This brings me on to my personal life. I am so lucky that I have both my parents, my two sisters and one grandparent. If you are reading this and are not so fortunate, you may feel I’m not qualified to write this. If this is the case, please read on and I hope that by the end I can change your mind.
In October 2014 my fit and healthy mum went in to hospital for a routine operation under general anaesthetic. I was there waiting for her when she came out of the operation and after waiting longer than expected she returned looking unwell. I had just finished a set of night shifts, hadn’t slept and was feeling on edge after travelling straight from work in London up to Yorkshire, but something didn’t feel right. Sparing the details there was a huge problem and she ended up back in emergency theatre then intensive care. I was alone, sleep deprived, had to tell my dad and sisters down the phone what was going on whilst genuinely thinking I would never see my mum again. My husband was at the other end of the country and I just did not know what to do. From that moment, whilst sitting alone in the hospital canteen I thought about everything my mum did for me, how my dad cannot function without her and what would happen to us all because she was going to die. I don’t think I’ve felt fear like it before.
This fear combined with fatigue and the stress of trying to keep my family informed with just the right amount of information led to sheer panic and my husband was subjected to this down the phone from hundreds of miles away. Throughout this time the fear was not for my self or how my life would change, but how I would be able to manage my dad and my sisters who I don’t think share the same attitude towards this as I do. This is what made me fall apart a bit, and maybe that’s why others do too.
I was so lucky that my mum survived, is well and will probably feel a bit sad reading this, but after that time I felt different at work. I was more emotional when being involved in cardiac arrests, would get tearful when talking to relatives and generally felt my resilience was diminished. It took a long time for that to build back up.
Why I wanted to write this
I wanted to write this because there has been a lot of death in my life recently and it does bear a weight on our shoulders, no matter who we are or what that person means to us.
Last year the mother of my boyfriend from school died. I was really taken aback at how much it affected me; I found myself constantly going over everything she and I had done together when I had spent endless weekends at their house, her favourite wine, her amazing cooking. Part of me was sad that she had not continued being in my life after my relationship ended with her son, but if she was still alive I may not have given this another thought. I now think about her every day.
2018 has already been rather eventful. There is a whole list of positives but on the other hand there have been deaths that have affected me in different ways.
First was the death of my oldest and best friend’s mum, who happened to also be my mum’s best friend. She had been in my life from the very beginning, I called her my second mummy and I will always love her very much. Her children have dealt with so much and I almost felt I had no right to feel so bereft. My job here is to look out for my friend and be there for her if and whenever she needs me to be, and if I can remember her mum for all of the wonderful things she did for us in her life then I feel I am being a good friend.
A few days later my husband’s grandma died. She had been in hospital for a good few weeks but it still seemed to be a bit of a shock and I was torn between my duties as a doctor and how I like to communicate with my patient’s relatives, but also my role as a daughter-in-law and supportive wife, so this was a difficult time.
Following all this was the death of my very special friend’s father. My friend and I met two years ago and due to my working pattern and her being on maternity leave, we see each other almost every day and have become really close. In late September her dad was diagnosed with a recurrence of cancer, which had previously been in remission and he became very ill, very quickly. Within four months he had died and my friend and her family have had to deal with all of this sadness. I have witnessed the ups and downs, the tears and the laughter and I tried my best to listen, counsel and support in every way that I can as well as help her out with her eight month old daughter.
Being a friend to someone who is grieving or dealing with someone close to them that is dying can be very tricky, but what I feel the most important thing to do is to be there and listen. Our thoughts and beliefs of death and dying are very different and so we cannot judge others reactions. We cannot preach our own opinion and certainly cannot expect people to feel the same way as we do.
Grieving and Bereavement
There is a lot of evidence based on studies from all over the world over many decades about the effects of grief and bereavement in both adults and children. We can be affected psychologically, emotionally and physically.
Similar to other stressful and depressive situations the death of someone we love can impair our immune response, change our endocrine function and increase the release of other hormones in our body. This further proves that our mind is so acutely connected to the rest of our body that we cannot always expect to continue functioning normally when going through such life events.
Elisabeth Kübler-Ross was the first to publish her ‘stages’ of grief : denial, anger, bargaining, depression, and then acceptance<1>. Although this was in relation to how we feel about our own death, this theory has been rolled out throughout the years and many have gone on to modify it further. One study describes four phases, with the middle two - intense pining and anxiety, and disorganisation and despair - as interchangeable with potential for recurrence of both, over and over. Another study has shown that two thirds of us are actually resilient after a death and experience no depression or disability from the experience.
Talking about it
Thankfully over the past few years more is being done to promote awareness of mental health and the benefits of talking. Some people are unable to say the ‘D’ word and prefer to refer to it as ‘passing away’, ‘losing’ someone or other phrases that may make them feel less uncomfortable, or easier to then discuss what has happened.
What I want to try and do from this blog post is get more people talking about their feelings towards death or dying; whether is it fear and thoughts of your own or someone else's, and for a few more people to be ok about saying they feel sad, or even that they don’t.
There is absolutely nothing wrong with being fine about someone close to you dying. It does not mean you don’t care and it certainly doesn’t mean you have no feelings, but that you are processing things differently. Death is our life’s only inevitability and yet the thing we can fear the most.
What can we do to help others
We all need to make sure that if we know someone who is going through anything that relates to what I have written, we offer to talk to them and lend them our ear. People don’t often ask to talk about how they feel so it takes a good friend to read between the lines.
You may not know what to say, but that’s ok because a lot of the time it is just about listening. Listen to why they are upset or angry and if they ask you a question that you can’t answer, that is ok.
As well as encouraging each other to talk, we should be mindful of other adults and children around us that may be going through difficult times at the moment. There are some really good resources that I think everyone should read or listen to, regardless of what you are experiencing.
Firstly, ‘Being Mortal’ by Atul Gawande is one of the best books I have ever read. The author is an American surgeon who has revolutionised several areas of modern day medicine and I think he is wonderful. His book discusses end of life care for people of all ages in all parts of the world, why it seems to be a bit of a taboo and why we often do not do the right thing. Non-medical friends and family that have read this have loved it and learnt from it too. Click here to take a look.
Fearne Cotton has recently started a fantastic podcast series called ‘Happy Place’ and her 4th episode was made with a personal friend, Zephyr Wildeman and talked about the death of her husband as a young mum in a foreign country and how she has managed to come through it all. It’s a really brilliant listen - click here for that.
If you have a child or a younger relative who is in a situation where they need to understand what death means there are a lot of charities and resources available to help them.
Research has shown that using Disney films (like The Lion King) can help to start the conversation, which I think is a fantastic starter. It is not fair to shy away from talking to children about death<2>.
My mum is a librarian at a secondary school and recommended the following books for children:
"Michael Rosen’s Sad Book is beautifully written and illustrated. Suitable for reading to young children, as well as for adults, it explains loss and grief in a way which makes the reader aware that it is OK and normal to be sad when someone close to you dies.
A Monster Calls by Patrick Ness is also about a boy coming to terms with understanding the impending loss of his mother. This book won the Carnegie Prize for children’s literature.
For young adults, John Green’s book The Fault In Our Stars is a beautifully explored love story between teenage cancer patients. Sounds a bit twee, but it is certainly not. It is down to earth and not at all maudlin, although pupils at the school where I work tell me that when they went to see the film (also recommended) they started crying at the opening credits. But they had already read the book."
The internet has a whole range of websites and advice available and here are some for children and young adults that I found very informative:
For adults, the UK cancer charities have good support networks and systems in place for grieving families, and below are also some very helpful websites that can help us too:
If you have had any experience with what I have discussed I would love to hear from you in the comments below or by email. By talking we can help each other with anything that we are going through.