Wednesday, 19 November 2014

Mortality: if you're mortal, this book should help. If you think you're not mortal, seek help....

This man (surgeon, researcher, teacher)

 Atul Gawande, has written a really important book. "Being Mortal" pulls together a lot of what many people have been saying for quite a long time: late and drastic medical interventions in someone's last days can be dreadful failures, in terms of what the dying person has to go through. He says a lot more than that, and he bases what he has to say on detailed accounts, including the last weeks of friends, and of his own father.

It's not always a jolly read; he goes into detail on the sort of ailments that are likely to afflict most of us as we age. One of his aims is to make us think and prepare for future difficulties, ours and those close to us; he wants to change how we view - or try to avoid viewing - the last  stages of life.

The book is about much more than medicine. He finds ways round the usual terrifying conundrums of the terminally ill, with regard to possible treatments. In doing so, he re-defines the role of doctors in such times.

Because a hospice nurse had sat down with Atul and his father and had a direct, careful sort of conversation, his father was able to surprise himself and his son with what he could still do.

"I was almosty oversome just witnessing it. Here was what a different kind of care - a different kind of medicine - makes possible, I thought to myself. Here is what having a hard conversation can do."

The conversation isn't about a menu of marginally effective and deeply horrible treatments; it's about asking the patient what matters to him, what are his fears, what is non-negotiable - all questions that acknowledge that he is going to die, and fairly soon. And then making the medicine serve those ends. 

It is very hard for doctors to do the best for a dying person if the person and those close to him can't acknowledge that they are in the last days, or weeks, or months of a life 

It's easy to say that the quality of a life is more important that it's length, at the end - unless, of course, it's your life. Here is a sensitive, emotionally honest, well-informed guide to a way through and round the horrors of futile (and very expensive) treatments. 

He writes with compassion and clarity, and he wears his learning lightly. It's a very, very good book about dying, so it's also about living.

Contemplating, through this book, the end of life has made my immediate life richer. Can't say fairer than that!

Atul Gawande is giving this year's Reith lectures, BBC Radio 4, 09:00 next Tuesday 25th November. Should be good.

Monday, 10 November 2014

Funerals: Give them what they want?

This is a "funerals" post, so if you'd like to side-step it, that's fine by me, though Andrew Marr's BBC Radio 4 programme this morning made it pretty clear that thinking about death - yours - from time to time is a positive thing to do for your life.

Anyway: as a funeral celebrant, I spend much time ensuring people - families, friends, mourners - get what they want. That is surely a large part of the rationale for a ceremony that does not need to follow the rituals and structures of an organised religion (for better or worse, of course. Come on, own up - which of us does not have a bit of an aching hole where the finer elements of those rituals used to live? Whatever we believe?)

So a while ago, that's what I did. He who had died was a big character, the crematorium was packed twice over. His family wanted to accentuate the positive, celebrate the life, didn't want it too sad and gloomy. 

After my customary warning that it would be sad, but that we would make sure it wasn't too sombre or gloomy, we went ahead and planned it.

It wasn't very sad, that's for sure.

The gathering loved it. Plenty of smiles, some big laughs. Off we went.

And I'm left thinking "was that "right?" There wasn't much mourning there, not much room for grief. Very few signs of grief. Not much acceptance or acknowledgement of the power and mystery of death to enrich our lives and help their grieving. And yet he was a greatly valued man.

Was I helping them to avoid the issue, skate in a superficial way over what had happened to them?

Maybe I still have a model of what a funeral "should" be, instead of letting it be what it is. I was pleased by how it went, but troubled by the thought that it may have lacked what many people see asone important function of a funeral - to help people through a physical loss, however much they want to enjoy memories of his life.

They got what they wanted, but probably not what what I wanted for them. I'm sure that's better than the other way round, but still...


Hang about Vicar, let me interrupt.

Having been full of life you say, I'd want a party.

Yes, but I'm full of death now and see things differently.

You say I wouldn't have wanted folk to grieve for long.

No - but with infinite death ahead of me,

a few months being alive and fed up

doesn't seem much to ask of my friends.

OK, some of you wear the bright clothes I admired -

but you lot with less taste, give us a break

and wear dark colours please.

No flowers? Donations only? Hold your horses.

I could never have picked one charity

and loved buying and looking at flowers. I'd like to give

my mourners that opportunity.

True I liked food, and would like to see most of you

tucking in. But I'd also like to do some good -

and some of you who could do to lose a pound or two

should surely be too upset to eat.

Smile by all means, remember my gaffes

and share a careful laugh -

but then it's my funeral, fuck it -

some of you ought to go home and WEEP BUCKETS.

                                                             Julie Deakin