Death is part of life in hospital. Indeed, half of all deaths in England occur in these hives of activity, where we help many to evade the end for a little longer . Death is such a frequent part of our work in fact, that it can become routine. Last week a man died before we got to see him on our morning ward round. He died some time between having his breakfast and the 9am observations round. He was old, had been unwell for a long time, and his death was expected, although no-one predicted it would be that morning. It caused hardly a ripple. Nurses, doctors and physiotherapists exchanged surprised glances, then shrugged and immediately focused their attention on their next tasks. His death became an admin task, as the junior doctors planned when they would find the time to complete his death certificate, discharge summary, and paperwork for our departmental morbidity and mortality meeting.
The Huffington Post have published an article I wrote on art and death. The edited version can be seen here. The original blog follows.
Last night I watched Time to Live from BBC2’s Life Stories series. Twelve people who have a terminal diagnosis share what they have learned about themselves and about life, knowing that it is short. They are people of all ages who have managed to find positives in their terminal prognosis and are making the most of the time they have left.
It is a fascinating, beautiful and uplifting, but also heartbreaking film. We can all learn something from these twelve people who live life with an intensity few of us experience, and who appreciate and celebrate the life they have.
I got to know Joseph * over a number of months. He was first admitted to hospital in April, when his bed overlooked the garden with trees in bud. As Spring turned to Summer he was readmitted, and when Autumn came he watched the leaves change colour and fall. Each time he was admitted he spent more time in hospital and less time at home, and we worried more about whether this admission might be his last.
Posted in Death
Tagged care, chronic disease, chronic sorrow, compassion, death, fear, grief, hope, identity, illness, living bereavement, living loss, NHS, patient
I was one of the lucky ones this year and was not working on Christmas Day. After my shift on Christmas Eve I fed the cat, packed up the car with presents and headed to my brother’s house. Waiting for me was a glass of mulled wine, and a hug. Christmas Day was lovely and it was with a heavy heart that I left my family and battled the driving rain in order to get back to London for my night shift on Boxing Day. My feelings of dread were not misplaced: the shift was tough. But most of my shifts have been tough of late. I am in the midst of a six month rotation on ICU (the intensive care unit), having left the familiarity of the acute medical ward and the outpatient clinic, replacing them with a world of ventilators, alarms and intense emotions. I am used to hard work, but I find intensive care physically and emotionally exhausting. It has taken me by surprise just how difficult it is to get through the weeks and I have begun to realise that this is primarily due to a concern that not everything I am going is ‘the right thing’.
A large proportion of my life is spent within the walls of the hospitals of North East London. But when I’m not at work, I can often be found in one of London’s fantastic art galleries. Art is essential for my personal wellbeing, and a great way to dissociate myself from the trials and tribulations of being a doctor.
But every so often these two worlds collide.
Those who go
A few years ago I went to an exhibition at the Tate Modern on Futurism. It was a fantastic exhibition, highlighting a brief but incredibly influential period of modern art. I was profoundly struck by a specific piece: a tryptych by Umberto Boccioni entitled “Farewells; Those who go; Those who stay,” now on view at the Museum of Modern Art in New York. Not only is it beautiful, but the artist effectively captures the emotions inherent in farewells. It has stayed with me ever since. I was reminded of this piece recently after a particularly emotional on call shift.
Posted in Death
Tagged art, Cardiac arrest, compassion, CPR, death, Futurism, grief, holistic care, Hospital, Museum of Modern Art, patient, Tate Modern, wellbeing, witness
Last weekend I was on call in hospital and cared for George,* a patient who was entering the last stages of life. George was no longer conscious so the Consultant and I spoke to his family, discussing which interventions to continue and which we felt were no longer benefiting him. Later in the day I reviewed George and found that he had developed respiratory secretions and was in some distress. I stopped his intravenous fluids, prescribed medications to treat his symptoms and reached for the Liverpool Care Pathway. And then I stopped. In the context of the recent press coverage and the LCP review what should I do?
Image from The Guardian
Where do you want to die? How do you want to be remembered? What is it like to be present when someone dies?
Death is a subject that it is often difficult to talk about, but is something we all have in common. On this blog I have shared some of my thoughts and experiences as a healthcare professional, having seen death, dying and grief more than most people I know. I have advocated for more open discussions about the fragility of the human body, the limits of medical interventions, and the freedom to live life to the full that might be gained from embracing it’s finite nature.
As a teacher I believe I have a responsibility to prepare medical students to deal with death and grief, and wonder whether we need new ways to do this effectively. Can sharing our experiences with the public be a learning experience for all? Can the arts and humanities help us to cross the ‘us and them’ doctor-public divide?