July 20, 2008
We Can’t Prevent Death, but We Can Make It Easier
I was once shown a Victorian book called Reading Without Tears. It was designed to teach young children to read many years before Janet and John's grandparents.
One story has the line 'the doctor said she would die; and she did die'. Obviously an astute colleague.
The idea of the wicked stepmother came from the fact many women died in childbirth and so many children had a stepmother.
The average Victorian marriage lasted 16 years before one of the couple died.
But the Victorians were shocked by Gilbert and Sullivan's HMS Pinafore when the Captain swore and said 'damn-me it's too bad'.
And any mention of sex would have upset even the most liberal of Victorians.
Now death has replaced sex as the great taboo.
There may be swearing and nudity on live television, but no one has yet written a hilarious sit-com based in an undertakers.
Unlike the Victorians most people in the western world have little first hand experience of bereavement.
Most people are adult before they lose anyone close and then it is often a grandparent or even a great grandparent.
As a result we have hidden death away and not discussed it.
Doctors and hospitals aim to save lives.
When cure is not a realistic option we say 'nothing can be done'.
Are we trying to hide the 500,000 deaths a year in the UK?
This week the Government has promised to improve the care of the dying.
Maybe nothing can be done to offer a cure, but there is still plenty of care on offer.
It is a difficult question to ask; where would you like to die? But two thirds of people answer 'at home'.
And yet 58 per cent die in hospital. Can we change this?
Of course we cannot plan if someone is admitted to hospital in an emergency after a major accident or heart attack.
The staff work hard to save them and, occasionally, this is not possible. But most deaths follow a long illness such as cancer or dementia.
And many people are admitted to hospital because the family are unable to cope.
Rowcroft Hospice opened just after I became a local GP.
Fairly soon its influence was felt throughout South Devon.
Both hospital and community staff became more positive. Pain and discomfort was no longer seen as inevitable.
We began to understand the importance of emotional support for the patient and their family.
Now we work closely together. We keep palliative care registers.
GPs and their staff have regular meetings with the palliative care team, discussing all the patients on the register. How can we do better?
In the guidelines one of the important questions is 'where do you want to die?'
Many of the ideas from Government are not new.
Many palliative care teams, GPs and nurses are already providing excellent care.
In some areas the number of people able to stay at home to die has doubled. We need to bring the whole country up to the level of the best.
This requires nursing and medical support in the home. There will be rapid response teams available in a crisis.
A few years ago I faced one of my toughest teaching assignments.
There was a conference on terminal care. The organiser contacted me.
"It's all a bit heavy. Can you do a short, lively funny talk on death, dying and bereavement?"
We may find it hard to laugh, but we should be able to talk about it.
When asked where I would like to die I suggested anywhere built after 2040.
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