[I want to share some stories of peaceful natural deaths.
To shake the uncomfortable silence society still maintains around death.
To contrast with TV medical dramas.
So heres ‘Edith’s’ story.
This not her real name. Ive changed multiple details to make sure ‘Edith’ isnt identifiable]
I’m out on some home visits for the Out of Hours Service. First stop is a lady in a nursing home.
When I get there, a care assistant tells me that Edith has been in bed for ten days. She has late-stage dementia, and has had multiple mini-strokes. Often, they can’t get her to swallow all of her ridiculously long list of medications. She is being visited by staff from the local hospice, who last saw her yesterday.
I knock and go into her room. There’s a haze of talc and an overpowering fragrance of lavender. Edith herself is just a wisp of white hair beneath a mound of bedding.
When I dig her out, it’s obvious that she’s always been small. Now though, she looks like a skinny kid drowning in her mum’s nightie.
She’s not talking, and I’m not sure if she can hear or understand me, but I ask her if its OK for me to listen to her chest. I can see from her skin that she’s not dehydrated. Her bottom and heels — the places bed sores start — are fine, which shows the high quality of the nursing care. Her lips and tongue are dry and I make some suggestions as to how this might be improved. As I do up the teeny buttons on her nightdress, I notice there’s not even a single photo beside Edith’s bed.
The care assistant and I go out into the corridor and I ask: “What about her family?” I’m told that Edith has never married. She’s the age, now I come to think of it, for having had a fiancée who died in the War. Apparently, her neighbour, Stanley, was in yesterday to see her. He knows that she is terminally ill and will be back again to see her tomorrow.
A female visitor strides up to me and insists on a full update about Edith.
I’ve got a list of other visits to other sick people. And the phone queues are backing up at the out-of-hours centre. But the woman seizes my arm and immediately rings to get the necessary permission from Edith’s next of kin.
Edith’s neighbour has had to take on that role too.
From what I can hear, the woman doesn’t seem to know Stanley well, if at all. I wonder how much she already knows about Edith’s current situation, and how much it’s really appropriate to tell her?
If I talk about ‘Dying’, I’m going to be asked ‘How long has she got, doc?’ When I never really know the exact answer to this question.
There’s lots of evidence that doctors are not good at judging when, or sometimes even if, someone is going to die. It’s not just me. ‘Dying’ is — technically as well as emotionally — a difficult diagnosis to make. I met Edith maybe 15 minutes ago, and she hasn’t been able to speak even a single word to me. I’m definitely not going to bring up the topic now, I decide.
I say: “Let’s go in and look at this lady together.”
And when we all troop in, I’m grateful that I always talk to family and friends in front of the patient.
Because Edith is herself very definitely bringing up the topic of dying.
She has started Cheyne-Stoking. This irregular breathing happens towards the very end of life. It’s confusing and can be distressing to watch as dying people repeatedly seem to stop breathing. Is she dead? Or isn’t she? She is … No, she isn’t ……… Yes? …………………… No! ……….. and so on and so on.
The visitor sucks in a little gasp and the care assistant starts prodding Edith’s chest to try to get her to breathe better. Cheyne-Stokes breathing is never improved by poking the patient, and I move in to stop this. Without saying anything of course, since the visitor doesn’t need to know that the care assistant doesn’t seem to understand what is going on.
I sit down on the edge of Edith’s bed. The infection control regulations say I’m not supposed to do this, but down here, I can physically block the care assistant. I look up at the visitor and ask her with my eyes if she wants to sit where I am. She shakes her head, but doesn’t move away, so I concentrate back on Edith.
Diagnosing dying is not the slightest bit difficult now. It’s still not easy to know exactly when someone will actually die, since Cheyne Stokes breathing sometimes continues for several days. But Edith is definitely going to die very soon.
Luckily, even at this late stage, it’s not at all true that ‘nothing more can be done’.
Even if it’s something distinctly low tech.
I stroke and then gently hold Edith’s hand. I smooth out her tufts of silver-white hair. I’m beside her, simply sitting with her.
Really quite quickly, Edith stops breathing.
Though, of course, I wait a little while because those Cheyne-Stokes are often deceptive.
When Edith really has taken her last breath, I stand up and ask the visitor if she is OK. I don’t even know this woman’s name, but she’s just become my sort-of-patient and I need to look after her.
“I’m alright”, she says slowly, “I’m alright”.
Carefully, I ask: “Did you know how unwell she was?”
She looks down and tells me that she hasn’t seen her friend for many years, since before the dementia and all the strokes took hold. “We used to be really close”, she tells me.
Quietly, I say: “Many people might not have managed as well as you, with what just happened”.
She looks straight back at me: “You were calm, so I was calm”.
As she says this, I know that we are sharing human kindness.
She is giving me a gift, just like she’d seen me giving her friend a gift.
This was one of those important times that come in everyone’s life.
Gifts make them easier. Easier for everyone.
“I’m going to let Stanley know she had someone with her right at the end”, she tells me.
I’m privileged and proud to have been that someone.
Doctors don’t often witness a natural death. We’re there for many more of the ugly drawn-out ones. For the futile resuscitations. But not so many of the peaceful natural deaths — partly because no-one needs a doctor for a peaceful death. It’s a time for families.
And I just got to be a part of Edith’s family.
Edith’s friend smiles at me. “Everything was done”, she says. “Everything she needed was done”.
She reaches out and hugs me. And I smile back at her.