Troubled stories from recent deathbeds remind me of a sign at my daughters’ old school: “Beware falling pods!” The sign sat at the base of an enormous native fig tree and when those pods fell, they were like malevolent missiles. Dropping from a great height helped the pods to crack open (along with trampling by school shoes) to reveal their large seeds. Maybe families are like those trees. They grow large and strong and when an elderly parent is dying it’s a very common time for conflict and tension within families to erupt – whether over management of care, how the person’s wishes should be respected or the inheritance of important items from their life, like a ring or a chair. So it’s a time we need the “Beware falling pods!” sign. The pods hurt when they hit, but their forceful drop to shatter open, although unpleasant, is part of the life story of the tree.
When I first started writing my book We’re All Going To Die there weren’t many public conversations on the subject of death, but since then it has really moved along. Sadly, however, it hasn’t moved fast enough.
I’d like to see death education brought more widely into medical schools, for it to become part of every discussion, such as ethics, and how to communicate with patients, pretty much the same way sex education opened up and was being covered when I was a medical student.
This has happened rather effectively in other countries, such as the USA, with the introduction of ‘medical humanities’ subjects to students – but unfortunately, it hasn’t really taken off in Australia.
If this discussion around death was improved, I think it would really change things. There would be a really good platform for not just doctors but all health professionals, such as nurses or physiotherapists, who day in and day out support the dying.
Currently, there’s no formal debriefing mechanism for doctors and health care specialists. Of course we talk to each other and tell black jokes in the tearoom, but it’s not the same thing. Without more formal support, health professionals carry the impact of their interactions with death in a way that inevitably leads to ‘zooming out’ and a risk of burn-out or compassion fatigue.
Just this week I had to tell a patient, a young man with two small children who was doing well in his career, that he was completely riddled with an inoperable, terminal cancer, that the next thing he should do was go home and get his affairs in order. That’s a really difficult thing to have to tell someone but there is no formal, easily accessible debriefing mechanism for the doctors who must have those sorts of conversations, within our current medical facilities.
I hope this changes in the near future, because if it does, then we in the medical profession will be stronger and better equipped to give a much better quality of support to those experiencing the realities of mortality, either as someone dying, their carers or those who are grieving.
A story about the developing work of death doulas can be found on Page 90 in the October issue of The Australian Women’s Weekly, available now.
The introduction: “There is a quiet, serene revolution going on in the way we farewell our loved ones. Caroline Baum meets the women, known as death doulas, who prepare the way for the final journey with empathy and love.”
And a quote from Victoria Spence, who is interviewed: “No matter how violent or upsetting the circumstances, my belief is always that being informed and involved is healing, whereas denial is not.”
“With impending death, the circulation slows, the heartbeat weakens, and the breathing gets slower or more irregular, but just as the heart beat and breathing case, the brain seems to have a burst of activity.” – So says Dr Michael Barbato in a recent interview.
The interview can be found at Sydney’s Daily Telegraph. It reminds us that we know so little about the process of dying. It’s also a great introduction to Dr Barbato – who has so many insights into how to be at the deathbed of those we love.
It’s Mother’s Day in Australia – a chance to reflect on all the lovely mothers who have gone before us. I’m loving seeing my friends tributes splashed across social media. I love especially the photos of women taken so recently that I could swear they are still with us.
In many ways they are, since they live on in those they leave behind. And as we mature to take the place of elders ourselves, little things they say and did come back to remind us not only of who they were – but that they are still here.
I gasped with surprise when I first saw this photo of me with my mother. It was passed on to me by my godmother, Auntie Joan, only recently, just before she died. I had never before seen a photo from my early childhood of just Mum and me. I’m from a large family, and blessed with a twin sister and another sister exactly a year older. So the mother- baby daughter pics are always a tumble of Mum and three, if not more, little people – great photos but in a very different way.
There was another surprise in this image. It captures looks and qualities not usually seen in photos of either of us. It is as though the photo shows the way Joan saw us. And that was another unexpected gift.
So when I hold the photo I see Mum, but I feel Joan. Happy Mothers Day to you both.
Patient advocate Dorothy Kamaker reports this note from the coalface in her advocacy work.
“Deirdre wanted her 93-year-old mother Helen to be allowed to die. Helen had been three weeks in hospital with a terminal illness and was being “tortured” by futile treatments with no hope of recovery. For Deirdre, the grieving had been displaced by frustration and guilt.
“She believed she was letting her mother down because she couldn’t prevent her unnecessary suffering. Together we were able to negotiate the realignment of Helen’s treatment regime from curative to palliative care and the relief for both Helen and Deirdre was incredible to see.
“Deirdre had orchestrated the best outcome: a peaceful death. She was proud even if she was sad.”
To find out more about Dorothy, patient advocacy and advance planning go to: