Thoughts From the Couch – Let’s Talk About Death

Thoughts from the Couch – Let’s Talk About Death 

As we are facing the global pandemic that is the most challenging crisis we have faced since the second world war, papers are filled with the numbers of people who have died. As I write this a total of 4,313 people have died from COVID-19 in the UK, having risen five-fold in a week. We know that these figures do not provide a precise picture of the deaths and that they will be higher. It feels as if the tsunami has entered and few of us have experience of death on this scale, so sudden, so sinister, so lonely. For many there is the anticipation of death 

Most of us are doing all we can to help the NHS by self isolating and social distancing, but in a stark new document issued by the British Medical Association, doctors set out guidelines to ration care if the NHS becomes overwhelmed with new cases as the outbreak moves towards its peak. The BMA suggested that; “ Younger, healthier people could be given priority over older people and that those with an underlying illness may not get treatment that could save them, with healthier patients given priority instead.”

There has been data from China, where COVID-19 first spread, suggesting that older people and people with chronic medical conditions may be at higher risk of severe illness from it. The potential danger, along with the fear of its spread in communities across the world, has left many older people and families nervous. 

Many of my clients are concerned about what will happen to those loved ones living with a terminal illness if they get coronavirus. Whether any services they access, like help at home or nursing care, will continue. There have been horrendous stories of people being abandoned by their carers and left to die. There are very real worries about visiting someone and the risk of infection and so the more vulnerable family members are being left to manage on their own. For those providing care for a family member or friend, there is worry about what will happen to their care should they become ill. Clients whose parents live overseas and with whom they have limited contact and those living alone becoming lonely and depressed with a rapid deterioration in their mental health.

We are hearing stories of people dying one by one, their families kept at bay and being with strangers with whom they share their last breath. As challenging as it is something that we need to consider at this time is, should a member of our family become ill and ill enough to need to be taken to hospital, do we know what their wishes would be. 

Death is a hard conversation to have at the best of times and for many deeply uncomfortable, it is easier not to talk about it. To metaphorically cover our eyes and ears and not look at the possibility that this virus might end in death. Dr Kathryn Mannix, author of With The End In Mind and who was a palliative care nurse for thirty years, talks about the importance of understanding what is potentially going to happen if taken to hospital with Coronavirus on BBC Sounds; The Coronavirus Newscast. She explains the difference between the need to be given oxygen versus the next step, which is to be put on a ventilator. Demystifying the process offers a calm in these stormy seas. She offers comfort to those of us who have had images of people gasping for breath and really challenges us all to have conversations with our loved ones, whilst they are well and not to try and figure out what the best thing to do or what they might have wanted in moments of crisis and panic. We need to be clear as to what sort of life they want as sometimes it is not as simple as, ‘do whatever you can’. 

Sometimes life after being put on a ventilator is not as we would wish it and that is where we need to be guided by the medical profession. In the first instance we need to reframe our thoughts about talking to our loved ones about death as, although uncomfortable, should the worst case happen it is helpful and means that, if it happens, we know what needs to be done and can fulfil our loved ones wishes.

Perhaps that is the most loving thing we can do. 

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