Most people I know have never watched a person die. Even those that have been to funerals and therefore have seen and been in physical proximity to a body, have rarely been present at the moment of death. The moment when in the eyes of the dying person the lights go out.
I have been there, in the moment, a number of times and remember every time with eerie clarity. Sometimes I have known the patient well; other times I have only met them in their last minutes or seconds. Sometimes it has been almost ethereally peaceful. Other times it has been frantic, chaotic or distressing despite our best efforts to treat end of life symptoms. Most often it has just happened.
Jean* had been admitted from her nursing home with end-stage dementia and multi-organ failure and was clearly in the last hours of life when she arrived in the emergency department. I admitted her in the morning and was passing through the medical assessment unit a few hours later and felt the need to pop in and make sure she was comfortable. There was a stillness in her room that felt anticipatory. I offered to stay whilst the healthcare assistant went to attend to another patient and so happened to be sat by Jean’s bed when she died. She was calm and comfortable. When the moment came it felt like the world paused for a moment and held its breath, while she held hers, then exhaled as she breathed her last breath.
And then the world continued on, with one less person in it.
Each time I have had this experience I have felt the same incredulity at the enormity of the moment. Whether I apply a philosophical or a religious framework, I struggle to grasp what happens when everything that makes up the person; their memories, actions, impact, emotions, beliefs are suddenly gone. The contrast between the significance of the event, and the undramatic way it often occurs, never fails to astound me.
When I know that one of my patients is dying I always feel an urge to check on them rather more often than is clinically necessary. Somehow I feel a responsibility to make sure they are not alone for the final moment. I know that many nurses share this feeling, but I sometimes wonder who we are really there for. Are we fulfilling an unwritten societal contract that means we must ensure no individual has to face the abyss alone; or are we, the living, reasserting our own vitality by forcing ourselves into close proximity with death? I know many nurses who, whether religious or not, still insist on opening the window after a patient has died to “let the soul out,” as part of a ritual ingrained in them during their training. Even the confirmation of death by a doctor, which mandates checking pupil reactions, palpating for the pulse, and listening for heart and breath sounds, feels part of the ritual. In a busy shift this necessary pause feels appropriate to mark the fact that the world has lost another individual. The need for ritual at the end of live is pervasive across ages and cultures, but in an era of high expectations of healthcare we seem to struggle more with the inevitable than ever before.
“For the love of God,” Damian Hirst
We need a greater acceptance of the body’s physical frailty and a more realistic view of the limits of medical intervention. We need to find a more tangible connection with all stages of the circle of life, despite our sanitised and secularised society. We need to embrace the fact that the inevitability of our own mortality sets us free to live in the moment. As Wittgenstein noted “eternal life belongs to those who live in the present.”
I intend to make every day I have left count, before the lights go out.
drlj 
I was with my mother when she died and was struck by how entirely natural it seemed. As natural as, and somehow analogous to, childbirth. It was a very profound moment. It was not about loss, but about Nature.
Thank you for sharing your experience. The emotions around death are unique to each individual and each situation, but it is a universal event, and the acceptance that it is natural is essential. At the right time, letting go and accepting that we cannot “fight” can allow a greater connection with the process for all of us.
I was with 2 of my 4 Grandparents when they died, My mother when she died and my grandparents in law when they died. Thank you so much for explaining so eloquently the process and feeling around these significant events
Thank you. I think we all have feelings about death that we find hard to articulate. We can gain a lot from each other by talking more about something we will all experience.
Having stared my own mortality in the face, life takes on a whole new meaning. I am grateful for every moment I am alive though I no longer fear death. I am almost 8 months past by “expiry” date, after living with a ticking time bomb in my head I am making the most of each ad every day.
I can’t begin to imagine the emotions you must have experienced. It is great to hear that you are making the most of each and every day. You are an inspiration.
That’s lovely to hear Julia – congrats! I am also living with ticking time bombs – in my breast, bones and around my organs.
drlj – this is a lovely post. When I first read it through I thought “I totally get that” but on second reading I’m more confused by the quote you finish on and when I tried to explain it to my husband, I couldn’t. It’s probably my mushy chemo brain but could you expand on it? Thank you!
Thank you for sharing your experience, Linsey, and I’m glad you liked the post. To be honest I’m not sure I can fully explain the quote, but it seems to encapsulate many thoughts I have about life, death and the permanence and impermanence of our existence. It is taken from Wittgenstein’s Tractatus Logico-Philosophicus. A more complete version is “Death is not an event in life: we do not live to experience death. If we take eternity to mean not infinite temporal duration but timelessness, then eternal life belongs to those who live in the present. Our life has no end in just the way in which our visual field has no limits.” Wittgenstein rejects ideas about immortality, or the soul living on, and asserts that for the individual the world ends at death. However, rather than this being something to despair of he encourages us to value death as, without it, life would not have meaning. Quality of life, rather than quantity, is what we should aspire to, and this requires us to fully experience the present. I hope this makes some sense and helps you to discuss things with your husband. Best wishes.
I wish you well on your journey Linsey. I hope that it all works out well for you. Stay strong ♥
Thanks drlj, that’s a really helpful reply. As someone who practices mindful meditation I think living in the present is really important and that’s why I wanted to understand the quote better, thank you.
Julia – and to you too. I am going with your mantra of making the most of everyday. Hope for the best, prepare for the worst means the bucket list has started!
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