Death is ubiquitous in the media this week. What with Saturday’s bombings in Istanbul, and the Brussels bombings on Wednesday, the papers are full of it.
The deaths of these people in Turkey and Belgium have sent shockwaves through the West and beyond. I had a heated discussion over email with a friend, debating whether or not the ‘overly-liberal’ concept of freedom of expression is in some way responsible for what happened. That allowing people the freedom to hold extreme views is equal to endorsing such beliefs. Is Western liberalism responsible for what happened? Is the only way to deal with terrorism to silence more people, to imprison more people? I don’t know.
The first time I saw a body was after I had been working on the unit for several months. A patient had died and his daughter had come in to see him and say goodbye. She had mobility problems so I said I would go into the room with her, fetch her a chair and so on. As we approached the room she stopped me and said, “I’ve never seen a dead person before. What will he look like?” I said, “I don’t know, I’ve never seen one either, but we’ll go in and find out together.” So we did. It was all very calm and quiet. It felt remarkably normal. We sat for a few minutes by the bed until the nurse came in and I went back to my desk.
It made me think about how absent death is from most of our lives, most of the time. We don’t talk about it much. When it is portrayed or discussed in films, books, magazines, it often wears a gloss of tragic romanticism. I don’t think it’s really like that. It’s sort of flat, and quiet, and by its very nature totally devoid of drama.
The way in which we care for dying people in hospitals at the moment is not perfect. Assumptions are made about patient quality of life; certain choices are denied; sometimes families are not as involved as they should be. Sometimes there isn’t time or funding for someone to just sit with a patient and be with them until the end. But in my experience the vast majority of the time, staff will treat the dying and their relatives with respect and kindness. I wonder if this will change as the NHS becomes more privatised? If time is money, are the dying costing cash while giving no return? I have great reservations about a health service motivated by financial gain, and I fear that the terminally ill, who are among the most vulnerable patients, would be some of the people who’d suffer the most in such a system.
Talking about death is on the rise in Britain, though. In recent years death doulas have started holding ‘death cafés’, where you can have a cuppa and a good old chinwag about the grand finale. Whether you think it’s a morbid or a healthy approach, it’s surely good to talk about it rather than pretend it isn’t going to happen.
I am proud to work in an NHS that still has the time, compassion and ability to be with patients when they die so that they don’t have to face it alone. But as resources are stripped back, services are cut and staff work longer and longer hours for less and less pay, I can see that this may not always be possible. That saddens me because I know that for most healthcare workers it is something they see as an integral part of their profession. I know consultants who will always take time out of their hectic days to sit with a patient and comfort them when delivering the worst news anyone expects to hear. I know nurses and HCAs who will stay an extra hour to be with a frightened patient or their grieving friends and family. I know volunteers who will give up their own free time just to come and be with someone so that they aren’t alone in their final hours. Will this culture of care be able to survive in an NHS that is always pushed for time, money, energy and morale?
Here’s a statement from a friend of mine about to graduate in medicine and become a junior doctor.
When I was 17 I applied to medical school to become a doctor; now I’m turning 23 and will soon be joining the NHS. In my final year of training dozens of current junior doctors have warned me against joining the profession and I’m beginning to worry. Under the current contract I’ve seen doctors having to cover the jobs of three people, newly qualified doctors making decisions without the senior support they need, and how doctors’ mental health suffers. Not a single doctor I’ve met is in any doubt that the new contract is going to make things ten times worse: as doctors flee abroad or to other professions those who remain will be stretched thinner than ever and the system will break down. I want to work as a doctor in a system that is safe and I don’t want my career to destroy my life.
I don’t believe that the NHS is a sinking ship, but I can’t help but feel things are heading that way, fast. If access to decent healthcare is a human right, we must take care to defend our healthcare system and ensure that the changes that lie ahead do not take the responsibility of caring out of the hands of professionals and place it into the hands of financiers.
Death at Sea
It’s done without fuss.
Hands are folded, eyes closed
Someone seals up the bag, last stitch through the nose
Heaves the weight over
To the hungry crash
So far below that we forget before the splash
The cold quiet cracks open in the deep
As the sad sack slips slowly down to sleep.
Up on deck, the captain, new hat and shoes
Beckons with a smile full of clues
Says Come with me, I’ll show you how things look
On the other side of now.