At a recent conference, the palliative care physician and author, Dr. Kathryn Mannix, spoke about death and the process of dying. She asked for those of us having witnessed death to raise our hands. In a typical lecture hall, she might see 10% of hands raised. But, in a room of physicians, 90% of our hands went into the air. She said to keep your hands up if you’ve been present for more than 10 deaths, 100, 1000, 10,000. Only her hand remained at the end. Her talk and her book, With the End in Mind: Dying, Death, and Wisdom in an Age of Denial, focus on the importance of narrating death. And her point was that it is our job and our duty as physicians to become narrators. Because, most of the time, we know the details of this final chapter.
A typical death related to illness or aging is not exciting. “It”, in Dr. Mannix’s words, “is much like watching paint dry.” She strongly feels that society’s idea of what death looks like comes from the media, where over dramatization is the norm. Instead, an illness related death, without heroic measures, is often a simple progression from sleeping more, to semi consciousness, to unconsciousness, to our last breath. Most Hospice nurses can signal family for the final minutes due to changes in circulation and breathing patterns. Death is calm and predictable. She suggests that by explaining changes and pointing out the relative comfort of the patient, sounds such as the “death rattle”, which stems from someone being unconscious and unable to clear their secretions, becomes far less frightening.
I have had 100s of discussions with patients about death. Most are relieved and very willing to go down this conversational path. Helping a patient establish an end of life plan is most always met with gratitude. In writing this, I remember the hands I’ve held and the look of relief in the eyes of my patients during these conversations. Although, I did have one pancreatic cancer patient adamant that he would not discuss death at any point. So, we did not discuss it. His wife and I had several side conversations and his goal was to be present for the birth the first grandchild. She showed me the picture of him holding this baby when I went to the funeral. He did it his way. I also recall pronouncing my first expected death in the hospital late one night as an intern. That is mostly a story for a different post, but while sitting with her daughter and dreamily listening to stories about her mom’s life I became aware of a rather unexpected emotion of poignant happiness.
But, while I’ve discussed end of life plans on a number of occasions, I have not been as detail driven as Dr. Mannix suggests. So, let the narration begin…..
“How people die lives on in the memory of those who live on.” – Dame, Cicely Saunders, founder of the modern hospice movement
4 thoughts on “Narrating Death”
Well said, Laura! Having these conversations these days is even harder, given the lack of TIME we all have to sit and have REAL conversations with patients. it is SO easy to procrastinate, and keep putting off these conversations (and the patients don’t mind delaying them either). This is part of our job.
Thank you. She was a powerful speaker and the topic is oh so relevant.
Your respect for those who wanted to talk and those who didn’t want to do so is both very important and consistent with your respectful treatment of others. Less than one week before he died, my husband declared that he wasn’t ready for Hospice and we respected his choice. Not initiated but we did have every detail prepared for in-home Hospice care so three days later, when he was ready, we were ready to begin with Weinstein Hospice as needed.
I have had the privilege of attending to five people in addition to my husband at their end of days but was not in the room with anyone when they actually died. I learned the most with my husband at whose side I remained for the entire final two days of his life – less the three hours before his death. Because of Hospice nursing support, I learned that there was a commonality with the gestures and comments he made in those last 51 hours of his life and those made by others as they approached their transition from living to living in the memory of others. All the best – Lynn
as they approached their transition from living to living in the memory of others.
Ahhh, I love that line! Thank you