2020 - Blog

 

Now is the time to talk about death
 

Dr John Dean, consultant cardiologist at the Royal Devon & Exeter Hospital. The views expressed are his own

"Every day for the last few weeks the news headlines have been dominated by the number of those who have died due to the current corona- virus (Covid-19) pandemic.

Death may seem an unwelcome guest, but if you fail to prepare yourself for her visit, you may end up being treated in a wholly inappropriate way as you approach the end of your life. It might not feel like it, but now is the time to talk about death, the one certainty in our lives.

Only a tiny proportion of the patients I see who are admitted to hospital with a potentially life threatening illness have ever had any meaningful discussion with their family about how they would wish to be treated at the end of their life. Doctors are obliged to talk to patients, who they feel are close to death, about whether they would wish to be revived if disaster strikes and their heart stops beating.

Many are surprised that we even ask the question, expecting that we will automatically do everything we can to keep them alive. Perhaps not appreciating how brutal and invasive attempts at resuscitation can be, that the prospects of a successful outcome are very low, and how, undignified it can be to end your life on an intensive care unit. Even survival may result in a prolonged spell of debilitation, sometimes with no prospect of a full recovery.

If you have never given these matters any thought, having this discussion for the first time when you are lying gravely ill in a hospital bed is hardly ideal. Covid 19 has already brought many thousands to a premature death and many more will surely follow in the months ahead.

In the South West, we have so far been spared the huge number of fatalities in places such as London and our local hospitals seem well set to deal with the expected surge in cases. Although the virus harvests most of its victims from the elderly and those who already have significant medical problems, it can also cut short the lives of young people in their prime. To compound the misery, most hospitals have forbidden visitors apart from one individual at the bedside at the very end of life. Even so, many die alone and some may even be buried in isolation.

So why not take this opportunity to discuss death and the process of dying with your family?

It will probably feel very awkward, it is a topic that we seldom discuss and many would regard it as taboo.

But isn’t it strange that we are so reticent to talk about the only life event that is a certainty for all of us?

You might ask them where they would prefer to die, in hospital or at home? You could explore what treatment they would wish to receive for a life threatening illness and what they would find unacceptable?

What level of suffering of disability would they be prepared to tolerate?

If you were paralysed, needed a machine to help you  breath, required a tube in your stomach to feed you and were only able to communicate by twitching a cheek muscle, would you want to carry on living? I would not, but Professor Stephen Hawking, who died last year, tolerated this state of affairs for decades. Everyone is different.

And finally, if you haven’t said I love you to those you value most in this world, do it now'. Don’t save it to your last breath - there may be no one to say it to".

 

© Plymouth Herald - Thought of the day - 17th April 2020

 

 

 

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