This achievement, combined with better nutrition, public health and medical advancement, radically increased life expectancy. Custom, language and expectation also developed around this time on how to behave after a person had died. Households would demonstrate their mourning with drawn curtains and clocks stopped at the moment of death.
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Mirrors would be covered to prevent the spirit of the dead person becoming trapped by their reflection. Women were expected to wear black mourning dress, sometimes for as long as two years. Men wore black suits. These very public displays of mourning continued until the First World War, when the country was forced to face death on a massive scale. It was quickly realized that an entire population clothed in black did little for public morale, nor did it encourage young men to sign up for military service.
What are palliative care and end of life care?
Death and dying became a private affair, spoken of in whispers or behind fluttering hands, and kept separate from the ritual of communal remembrance services. Although severely frowned upon by the establishment, many of the bereaved, particularly heartbroken wives, mothers, sisters and daughters, found solace in the rapid rise of spiritualism, through which they believed they could communicate with the departed spirits of their men-folk.
By the Second World War, there were significant advances in science and medicine. More than ever, the sick and injured turned to doctors to save their lives, with death increasingly taken out of the home and put into hospitals or care homes. Doctors used medication not just to prolong life, but also, with the help of narcotics, to make the dying experience much less painful. Within this focus on life — as opposed to death — arose a denial and ignorance of dying.
Thankfully, witnessing death was no longer part of growing up for most children, but nor were they encouraged to know about it or speak about it. This is mainly, he says, because of a highly positive development: most people do not die until old age, most children do not grow up witnessing their siblings or parents die, so most enter adult life largely ignorant about death. In addition, with the end in much of Europe of nearly two millennia of Christianity as the dominant ideological culture, people can struggle to find words for what is happening beyond medical treatments.
Into this vacuum comes medicalization. Death is now hidden away in hospitals, hospices and nursing homes. So people latch on to medical language to try to make sense of what is happening. However, this is different in Ireland and Northern Ireland, where there are still unbroken Catholic and Celtic traditions. Therefore, the language the Irish use around death and dying is a combination of spiritual and medical terminology. My own mother certainly turned into a catalogue of symptoms.
She slowly disintegrated physically over several years until my father could no longer cope, and she was admitted into a local care home where her health continued to fade over a further three years. During this time she grew increasingly fearful of what was happening to her, but never dared to confront it, or herself. It played havoc with her peace of mind. I was with her when she died. It was truly awful to witness this gentle, kind, loving woman who had given birth to me, shouting out in confusion and fear before finally giving up her struggle to stay alive.
No art of dying well.
What are palliative care and end of life care?
Although a Christian, she had never found what might help to soothe her way. My consolation is knowing that I was there to hold her as she died, and to wish her well. The short answer is, mostly, through the media. News bulletins, television soaps, films, newspapers and novels ply us with accounts usually of either over-romanticized deaths or overly horrific images of what it is like to die.
Now amplified by the internet, the media pump reports of disasters into our homes 24 hours a day. Gruesome images and harrowing stories are retold hour after hour. If we miss them on a multitude of satellite news channels, we can even download them onto our mobile phones.
As a result, whether we like it or not, all of us are affected by what we see and read in the media. Some say that high-profile media deaths, particularly when they happen in local neighbourhoods, can make people reassess their own lives, and often bring communities closer together.
The murder of two girls by their school caretaker in Soham in was one such example. Death happens to others, but not to us. A more recent example concerns the Big Brother television celebrity Jade Goody, who declared her intention to die in the public eye. Yes, many terminally-ill people do suffer, but our palliative care service is highly developed in providing pain relief to help soothe those in physical and spiritual distress. I would have liked to have heard more about that.
Other celebrities, such as BBC radio presenter Gloria Hunniford and actress Sheila Hancock, have used the media in a far more measured way to tell their stories of how they coped with personal sorrow. The aim of these two autobiographies was to help others who have been similarly bereaved. Both books have been bestsellers. However, when left to their own devices, the media do seem to be guilty of ignorance — or dare I say, laziness — in the way messages about death and dying are portrayed.
Information for family, friends and carers at the end of life
In most cases the dying person is seen lying prone on a hospital bed in a tidy, clean ward, with perhaps an intravenous drip or oxygen tube for company and a bleeping heart monitor to lend authenticity. He or she is surrounded by quietly weeping, loving relatives, one of whom will have Days Gone By 17 turned up at the last minute for an emotional deathbed reconciliation.
The dying person, at peace at last, breathes a final farewell, followed by the gentle closing of eyes. Fade to black and cue music. It is understandable that grisly death scenes are unlikely to attract top ratings, so it would follow that scriptwriters tend to cobble together a one-size-fits-all deathbed scene which is acceptable for prime time viewing. But these unrealistic portrayals of death can be confusing, as experienced by Anne, a successful businesswoman in her mid-forties. I love them. When people die, they look as if they have genuinely fallen asleep — their skin looks the same colour and they look at peace.
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It was nothing like him. I felt disappointed in myself that I was so unprepared for my Dad to look like this. Actually, I felt really resentful and let down by society. Another disappointment was the nursing staff. When someone dies on television, the head nurse is there to give the grieving relative a cup of tea and to sit with them and talk about how they are going to cope.
Nothing like that happened. When my father died, I walked out of the hospital side room and told a nurse. It happened to be the 5th of November, so I was aware that this was going to be a busy night for the staff. She decided it was best to leave, but I refused. I knew my father would never have left us like that. My mum told me not to be so stupid. It will probably be the morning staff who will put him in a shroud and take him down to the mortuary. You go home and look after your Mum.
In films, the dying person is usually seen walking around quite happily. They have some kind of catastrophic illness and then abruptly die. So it can be hard for doctors to recognize when someone is actually going to die. When assessing patients, we have to take into consideration what the person used to do, and compare that with the help they now need to carry out everyday activities.
Also, the majority of film deaths occur in a hospital setting with patients looking coiffured. In reality, when someone is very ill, they look fairly shocking. They are usually thin, or bloated, or yellow from jaundice, and can be unrecognizable from their former selves. The media, and particularly soap operas, do provide a source of information about the D-Word. But unless we have an understanding of what really happens when someone approaches the end of life, we cannot prepare ourselves. This can add to an already stressful situation, often leaving us feeling alone, frightened and unsure of what to say or how to behave.
The following chapter looks realistically at the dying experience from a medical perspective, and provides advice and information on how health professionals broach the D-Word, and provide end-of-life care for the terminally ill and the elderly. Two-thirds are aged 75 and over. Where we die 58 per cent in hospital 18 per cent at home 17 per cent in care homes 4 per cent in a hospice 3 per cent elsewhere Hospices traditionally provide care for those with cancer. However, some hospices are now providing end-of-life care for those suffering from other forms of terminal illness.
Palliative care provides care to help relieve or soothe the symptoms of a disease or disorder where it is no longer curable. Terminal illness is best defined as a life expectancy of six months or less, whether involving a malignancy or not. The GP, district nurse or cancer care nurse will usually make sure this is done as soon as possible.
Chronic illness is a persistent or recurring illness which often results in disability and may shorten life expectancy. No one has a per cent five-year survival expectancy. Life has its dangers. But someone with a terminal illness would have a low five-year life expectancy. For a Living Will to be valid, you must be over 18 years old, and the document has to be signed, witnessed and dated while you are mentally capable.
Hospices and care homes usually instigate an Advanced Care Plan when a patient or resident is first admitted, or you can download your own Living Will see helpful advice, page If so, it is advisable to give a copy to your GP or your solicitor, as well as to any next-of-kin who need to know your wishes should an emergency arise. The Liverpool Care Pathway is a form which provides guidance to carers on how to deliver the highest standard of care to the dying in the last few days and hours of life. This, or the equivalent, is now standard practice throughout the NHS and in most hospices and care homes.
An oncologist is a doctor who specializes in diagnosis and treatment of cancer.
Related The D-word: talking about dying : a guide for relatives, friends and carers
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