Speaker 1: The process of dying can be incredibly peaceful and comfortable
Speaker 1: enough to be bearable, and frankly, you can't always say
Speaker 1: that about the process of giving birth.
Speaker 2: Welcome to the one you feed throughout time. Great thinkers
Speaker 2: have recognized the importance of the thoughts we have. Quotes
Speaker 2: like garbage in, garbage out, or you are what you
Speaker 2: think ring true, and yet for many of us, our
Speaker 2: thoughts don't strengthen or empower us. We tend toward negativity,
Speaker 2: self pity, jealousy, or fear. We see what we don't
Speaker 2: have instead of what we do. We think things that
Speaker 2: hold us back and dampen our spirit. But it's not
Speaker 2: just about thinking. Our actions matter. It takes conscious, consistent,
Speaker 2: and creative effort to make a life worth living. This
Speaker 2: podcast is about how other people keep themselves moving in
Speaker 2: the right direction, how they feed their good wealth. Thanks
Speaker 2: for joining us. Our guest on this episode is Catherine Mannix,
Speaker 2: who spent her medical career working with people who have
Speaker 2: incurable advanced illnesses, starting in cancer care and changing career
Speaker 2: to become a pioneer of the new discipline of palliative medicine.
Speaker 2: She has worked in teams in hospices, hospitals and patients
Speaker 2: own homes to deliver palliative care, optimizing quality of life
Speaker 2: as death is approaching. Catherine is qualified as a cognitive
Speaker 2: behavior therapist and started the UK or possibly even the
Speaker 2: world's first CBT clinic exclusively for palliative care patients. Today,
Speaker 2: Eric and Catherine discuss her book With the End in Mind, Dying, Death,
Speaker 2: and Wisdom in an Age of Denial.
Speaker 3: Hi, Catherine, Welcome to the show.
Speaker 1: Oh all right, Hi, thanks revising me.
Speaker 3: I'm really excited to talk to you today. We're going
Speaker 3: to be talking about a subject that is heavier than most,
Speaker 3: but not maybe as heavy as we make it out
Speaker 3: to be. I'm hoping as we go through this conversation
Speaker 3: because we're going to be talking about death, and we're
Speaker 3: gonna be discussing your book, which is called With the
Speaker 3: End in Mind. But before we do that, we'll start
Speaker 3: like we always do with the parable. In the Parable,
Speaker 3: there's a grandparent who's talking with their grandchild and they say,
Speaker 3: in life, there are two wolves inside of us that
Speaker 3: are always at battle. One is a good wolf, which
Speaker 3: represents things like kindness and bravery and love, and the
Speaker 3: other is a bad wolf, which represents things like greed
Speaker 3: and hatred and fear. And the grandchild stops and they
Speaker 3: think about it for a second. They look up at
Speaker 3: their grandparent and they say, well, which one wins? And
Speaker 3: the grandparent says, the one you feed. So I'd like
Speaker 3: to start off by asking you what that parable means
Speaker 3: to you in your life and in the work that
Speaker 3: you do.
Speaker 1: I love it. It's pterrible and I'm struck by it
Speaker 1: often in my work. So in my life, I think
Speaker 1: it's easy for us to catch ourselves out feeding the
Speaker 1: needia wolf, and often that's the bad wolf, that's the
Speaker 1: wolf that comes from past us. So sometimes it's really
Speaker 1: important to notice that this thing that I'm doing to
Speaker 1: make myself feel better is actually feeding my fear, is
Speaker 1: feeding my worry and concern, and it's really your way
Speaker 1: from being confident that taking courage and feeding the fear
Speaker 1: and doing it anyway really in the end prevail. And
Speaker 1: I think if we do that cycle often in love,
Speaker 1: I hope what we do is we start to wear
Speaker 1: the footsteps past the bad wolf store and towards courage
Speaker 1: and towards feeding in a monements and holding life in
Speaker 1: a way that's trusting.
Speaker 3: That's beautiful. It makes me think of the idea of avoidance.
Speaker 3: Right when you avoid what you fear, you strengthen it.
Speaker 3: You're suddenly sending the message to yourself, I can't handle this.
Speaker 1: Yeah, right. And so in my work, of course, I
Speaker 1: meet lots of people who are maintaining their peace of
Speaker 1: mind about the fact that their death is approaching by
Speaker 1: using the really really helpful and it is helpful technique
Speaker 1: of complete denial. So if you don't believe the thing
Speaker 1: is true, you don't have to feel any of the
Speaker 1: difficulty motions. And it's almost a point of equipoise, I suppose,
Speaker 1: between the wolves, because it's so easy to slip sideways
Speaker 1: into fear and despair in one direction. And yet if
Speaker 1: you're able to open the litigat denial just enough to say,
Speaker 1: is there a little bit of this that I could
Speaker 1: deal with today, then you're stepping up in encourage and
Speaker 1: or stepping out, perhaps towards the arms of other people
Speaker 1: who aren't prepared to help to hold you and to
Speaker 1: help you to face the difficult place. And so maybe
Speaker 1: one of the other things to think about with the
Speaker 1: metaphor of the wolves is that wolf's working pacts and
Speaker 1: the re living community, and the people who are facing
Speaker 1: the ends of their lives, sometimes tragically are alone. But
Speaker 1: that's really ran. Mostly there's a small group to an
Speaker 1: army of well wishers and supporters who, confronted by the
Speaker 1: person's denial, don't know how to be. And by enabling
Speaker 1: them to start a conversation that requires courage, that requires tenderness,
Speaker 1: and I've written separately about that, then we've moved them
Speaker 1: into a place where the pack is surrounding the wolf
Speaker 1: and moving them in the direction of their good wolf,
Speaker 1: their courage. They're facing their fear, they're having more information,
Speaker 1: because information, in the end is the light, isn't it
Speaker 1: that shines into the dark place? I says, Okay, that's
Speaker 1: what it looks like, right, Okay, how do we do this?
Speaker 3: So you have a wonderful story in the book about denial,
Speaker 3: but I don't want to go there just yet. I
Speaker 3: kind of want to start at the beginning a little bit.
Speaker 3: You say that we all bring our own ideas and
Speaker 3: expectations with us in any encounter with the big questions,
Speaker 3: whether that's birth, death, love, loss, or transformation. We frame
Speaker 3: things through the lens that we see it. We see
Speaker 3: it mirrored to us, and we think that's what it's like.
Speaker 3: And you say that death has sort of fallen out
Speaker 3: of the big questions, right, You said it's become increasingly taboo.
Speaker 1: Yeah. I think this is really interesting because it's not
Speaker 1: that we don't think about it, it's that we didn't
Speaker 1: talk about it. And the taboo is almost the thought
Speaker 1: police that if there were a third person with us now,
Speaker 1: we might now be worrying that they might be uncomfortable
Speaker 1: if we perceive this conversation, or we might be watching
Speaker 1: really carefully in case this is going to be triggering
Speaker 1: for them. So often it's a kindness that we're being
Speaker 1: careful with each other, and sometimes it's an overridingness. So
Speaker 1: I remember our coneigue coming back to work after the
Speaker 1: death of her father, and I bumped into her in
Speaker 1: the little hospital kitchen where we used to go to
Speaker 1: seek a little tea break in between really busy clinics
Speaker 1: or whatever. And it was tiny. You could only fit
Speaker 1: three people in the time, and we had to move
Speaker 1: very carefully around each other to get to the hot
Speaker 1: water boiler or the cupboard of the mugs in or whatever.
Speaker 1: So I'm welcoming my colleague back and saying, I was
Speaker 1: really really start to hear that your dad died, and
Speaker 1: it's great to have you back at work, and you
Speaker 1: know we're here. If you want back up, you tell
Speaker 1: us to let us push it. And she said thanks,
Speaker 1: and she left the kitchen area. And there was a
Speaker 1: third colleague hovering at the edge, somebody who worked in
Speaker 1: a slightly different discipline from us. And as our bereave
Speaker 1: colleague left, she came into the kitchen she history, I
Speaker 1: cannot you said the word dead to her when her
Speaker 1: father has just died. And I'm thinking, hang on, it's
Speaker 1: the thought police here. My bereaf colleague and I have
Speaker 1: just had a perfectly okay conversation. We've acknowledged her loss,
Speaker 1: re used a word about the loss. I didn't say
Speaker 1: he passed or passed away. I acknowledged that he died,
Speaker 1: she acknowledged, receipated the message that she can call on
Speaker 1: us if she wants support, but we're not going to
Speaker 1: crowd her. We're done here. But a different person who
Speaker 1: is now policing my language, a person who wasn't engaged
Speaker 1: in that conversation. And I think we see this all
Speaker 1: the time, and we see it also in the media,
Speaker 1: so on news if you look out for it, in
Speaker 1: print media, in TV news, very often the announcement that
Speaker 1: somebody has passed, that somebody has passed away. Now, in
Speaker 1: certain parts of society there's a deeper, transcendental and spiritual
Speaker 1: meaning to the language of passing. They're passing away and
Speaker 1: passing on. But largely we've grabbed onto that language to
Speaker 1: be euphemistic and gentler. But it also avoids using their
Speaker 1: language of the end of life, of the approach of death,
Speaker 1: of the doing the dying, of the being dead, of
Speaker 1: enduring being believed. And so we lonely find people by
Speaker 1: not having the courage to mention the most obvious. Mostly
Speaker 1: people think that they're currently dealing with. And it's partly
Speaker 1: because we be careful of the language, and it's partly
Speaker 1: because we awthualized dying itself, the understood it, recognized it,
Speaker 1: saw it frequently three generations years ago. I'm going to
Speaker 1: say now it's something that we don't see. It's being medicalized.
Speaker 1: It's been kind of kidnapped into hospital, into escalating and
Speaker 1: increasinglytutile medical care. So I don't see ordinarily dying happening
Speaker 1: with any regularity, and you certainly don't see it often
Speaker 1: enough to recognize that it's kind of pattern to recognize
Speaker 1: that it is recognizable that the patterns of basis are
Speaker 1: similar from person to person, that they can pace our
Speaker 1: way through it. We can realize what's happening to the
Speaker 1: person that the company good symptom control, which isn't rocket science.
Speaker 1: By the way, With good symptom control, the process of
Speaker 1: dying can be incredibly peaceful and comfortable enough to be bearable.
Speaker 1: And frankly, you can't always say that about the process
Speaker 1: of giving birth, which often is you know, it's parallel
Speaker 1: in having recognizable phases, the stages, and we can you know,
Speaker 1: name it and accompany it. But giving birth unless you
Speaker 1: really well in these times is not a comfortable process.
Speaker 1: And dying with proper simptu management is not an uncomfortable process.
Speaker 3: Yeah, it goes back to what I said earlier about avoidance. Right,
Speaker 3: if we avoid a topic, we can't say death, we
Speaker 3: empower it and make it harder to say it. You
Speaker 3: also make the point that we end up saying things
Speaker 3: like you know, you mentioned that they've passed or you've
Speaker 3: lost someone, instead of saying died or dead and that
Speaker 3: we've started to talk about the dying process in terms
Speaker 3: of warfare, saying somebody lost their battle right, which is
Speaker 3: a defeatist way of talking about this. Say a little
Speaker 3: bit more about that.
Speaker 1: I think that's a really interesting thing. And I think
Speaker 1: it might be Ronald Reagan who was culpable in the
Speaker 1: first place of saying it, you know, declaring a war
Speaker 1: on cancer, and it was about cancer. And it's largely
Speaker 1: cancer that the battle is used about. And for some
Speaker 1: people who are having treatment for cancer, vacue must if
Speaker 1: actually is quite helpful, so we mustn't throw the baby
Speaker 1: out with the baffle to hear. But for a lot
Speaker 1: of people, they are not battling cancer. They are living
Speaker 1: with cancer. Their life is not cancer. They've got some
Speaker 1: cancer in their body. It's affecting their life, but it
Speaker 1: becomes everything about them for some people in their key relationships.
Speaker 1: And the truth is that we will all die. And
Speaker 1: I know you in that. I really enjoyed listening to
Speaker 1: your interview with them, the wonderful Ala Arthur talking about
Speaker 1: exactly this, that the fact that we're going to die
Speaker 1: is given. We can pretend for most of our lives,
Speaker 1: and we do pretend for most of our lives that
Speaker 1: it isn't so. But at the end of our lives,
Speaker 1: we will not have lost in battle. We will simply
Speaker 1: have finished our lives and we have to die something.
Speaker 1: It's interesting that the battle metaphor isn't used so much
Speaker 1: for the other things that we die from. So the
Speaker 1: commonest cause of death in older people now in high
Speaker 1: level income countries, in older people in dementia. Okay, And
Speaker 1: we don't talk about losing your battle with dementia or
Speaker 1: losing your backing with heart disease. And it's offensive to
Speaker 1: dying people to be criticized for not fighting hard enough
Speaker 1: to win the battle for what for immortality? Did anybody
Speaker 1: win that battle yet? So we need to be more
Speaker 1: cognizant that there is language that is helpful and there's
Speaker 1: language that it is hurtful. And a really good rule
Speaker 1: of thumb is to ask people how they like to
Speaker 1: talk about it. They'll look a little bit surprised to
Speaker 1: be asked, but also they'll appreciate it.
Speaker 3: And you mentioned that many times the elderly, the people
Speaker 3: who are closer to death want to talk about death.
Speaker 3: They want to talk about their preparations, they want to
Speaker 3: get their affairs in order. But very often the younger people,
Speaker 3: quite often their children, don't They say no, Mom, you're fine.
Speaker 3: You're fine, mom, Or you know that's a long time
Speaker 3: down the road, dad, we'll talk about that later. And
Speaker 3: you say that you've seen again and again. People see
Speaker 3: death in a sense almost sneak up on them, meaning
Speaker 3: they thought they had time to do that, They thought
Speaker 3: they had time to have the meaningful conversations. They thought
Speaker 3: that there was more they would be able to do.
Speaker 3: And once the person starts entering a dying window, they
Speaker 3: are less. I don't know if this is how you
Speaker 3: would say it. Less here with us.
Speaker 1: There's an interesting thing. So the trajectory of dying is
Speaker 1: it's slightly different in different conditions. But for most of
Speaker 1: us in our lives, there's a periods in our lives
Speaker 1: when we're well and we're healthy, and our life expectancies
Speaker 1: measurable in decades. And even though I am now in
Speaker 1: my self, I believe it. You know, I still go
Speaker 1: out running slower, I don't go as far. My times
Speaker 1: get worse gradually, gradually, but it's showing me that our
Speaker 1: body is slowing down at a rate of decades to
Speaker 1: decade rather than year to year. I'll come a phase
Speaker 1: perhaps when the illness or the illnesses that will eventually
Speaker 1: end our lives declare themselves, when we'll start to notice
Speaker 1: that the trouble with my hearts online months, or the
Speaker 1: cancer I've been having treatmentfore, or whatever it is, is
Speaker 1: starting to limit me now and I can notice the
Speaker 1: difference from one year to the next. And so now
Speaker 1: we're measuring life expectancy, probably still in years, but not
Speaker 1: probably in decades, and as time goes by, that kind
Speaker 1: of failure of energy and difficulty doing things is noticeable.
Speaker 1: Within one year, it's a noticeable length pine month. We're
Speaker 1: measuring now in months, perhaps in a month to make
Speaker 1: a year also, and gradually that trajectory changes, and always
Speaker 1: people think there's more time than there is. So given
Speaker 1: that we're all mortal, I think it's really really helpful
Speaker 1: if we stop talking about dying long before we need to,
Speaker 1: because our families generally are not upset that our death
Speaker 1: is imminent. If we stop the conversation earlier, so my
Speaker 1: family know what kind of funeral I'd like, and what
Speaker 1: kind of language I'd like, and much more importantly than
Speaker 1: my funeral, preferences my living while I'm dying, preferences where
Speaker 1: and who the important people are, and what are the
Speaker 1: important things to have completed pied there, and what the
Speaker 1: noises around me should be. Some people may end up
Speaker 1: my playlists. I'm a fan of thoughtful silence a lot
Speaker 1: of the times, So I don't want nursing stuff that
Speaker 1: I don't know to play their radio tunes at me
Speaker 1: while I'm in that important time of my life, you know.
Speaker 1: So these are the sorts of things for people to
Speaker 1: start to think about when they gather for a family gathering.
Speaker 1: And there's a really lovely game and I wish I
Speaker 1: could remember and if I can remember us sending people
Speaker 1: to show notes. They came for somebody in the USA,
Speaker 1: which was for Thanksgiving dinner, to ask the people around
Speaker 1: the table three questions and it was their desert Island.
Speaker 1: That's probably not doesn't translate acros the Atlantic. We have
Speaker 1: a show called Desert Island Discs the seventh It does
Speaker 1: American to a desert island. Right, So their Desert Island
Speaker 1: books or discs or whatever. They're absolutely favorite dinner and
Speaker 1: their favorite pizza topping. Yeah, and everybody, this is the
Speaker 1: gathering of the people who are closest to us. In families,
Speaker 1: they get each other's answers, and they never get each
Speaker 1: other's answers right. And then you turn the questions over
Speaker 1: and the questions are are those ends of my care questions?
Speaker 1: And you think, if people don't even know each other's
Speaker 1: favorite pizzas or things, how are they possibly going to
Speaker 1: guess the answers to these questions. And so it's an
Speaker 1: invitation when the family is cavered, and because it's a
Speaker 1: little bit funny that we've all got these questions so
Speaker 1: wrong to just maybe take two or three of those
Speaker 1: questions and have a think about the answers, not because
Speaker 1: we need to, but because we actually, right now, thank goodness,
Speaker 1: don't need to. But it's a gift to each other
Speaker 1: that we have.
Speaker 3: It's interesting because when I think about death, of the
Speaker 3: question to me would be, well, you want to be buried,
Speaker 3: you want to be cremated, you want to and I
Speaker 3: usually say, like I could care less. However, you make
Speaker 3: the point that there's a lot of time up towards
Speaker 3: death that I may care a lot about. So, for example,
Speaker 3: in my case, since I have mesophonia, aversion to sounds,
Speaker 3: no one should be allowed to chew in the room
Speaker 3: where I'm done, where I'm dying, each your food in
Speaker 3: the hallway, I can't move and I'm just you know,
Speaker 3: I'm tormented by sounds like that. You say in the
Speaker 3: book that there's usually little to fear about death and
Speaker 3: much to prepare for.
Speaker 1: I think that we fear it so much that we
Speaker 1: don't start the preparations, And it's absolutely the other way
Speaker 1: around that, actually, So first of all, the intention of
Speaker 1: the book is to decatastrophize dying and re familiarity people
Speaker 1: with its predictable and relatively gentle processes, and then to
Speaker 1: start to think about, well, if that's what's going to happen.
Speaker 1: Now you know that it's likely to be like that,
Speaker 1: let's think about where might that be able to happen.
Speaker 1: It doesn't help to happen in the hospital. It doesn't
Speaker 1: have to happen in an intensive care unit. You might
Speaker 1: no longer be able to manage the stairs in your home,
Speaker 1: but you might really love snuggling down in your big sofa,
Speaker 1: or you like envisage that. Actually, when I get to
Speaker 1: the end of mine life, I'm going to go and
Speaker 1: be careful by my daughter. Really have we discussed that
Speaker 1: with your daughter, because the last time I looked, your
Speaker 1: daughter had three dogs, two criquetes and five children under
Speaker 1: the age of ten. How's that going to work for you?
Speaker 1: Or where's the bathroom in your daughter's souse relative to
Speaker 1: the bedroom that you would use? Which if the kids
Speaker 1: won't be able to use their own bedroom for the
Speaker 1: duration of the time that you're living in their own
Speaker 1: And it's just meant to stop people from making assumptions
Speaker 1: and is there two have those conversations and if you
Speaker 1: know the process, then you can work out, Okay, how
Speaker 1: much of that process? Could I actually live just in
Speaker 1: the place that I normally enjoy living and have control
Speaker 1: over my life? What extra help might son need? Where
Speaker 1: could I get that help? Is it going to be
Speaker 1: from friends and neighbors? Can I come from service as
Speaker 1: I pay from what will the state? Probably for me?
Speaker 1: Lots and lots of things to think about. And then
Speaker 1: that particular thing that you have said about the soundscape
Speaker 1: around us, or about the way we're touched or the
Speaker 1: way that we're held. There are people for whom touch
Speaker 1: is really triggering that they had experiences in their lives
Speaker 1: that have been terrible for them and perhaps spent a
Speaker 1: lifetime mending as lest they can from that other people.
Speaker 1: They need to understand that and how they are to
Speaker 1: be touched people who obviously, this is an absolutely great
Speaker 1: example of something you would never guess from having conversations
Speaker 1: with a person, although if you've lived with them from
Speaker 1: Lomula though.
Speaker 3: People in my life know you guys really know. Yeah,
Speaker 3: and so to hundreds of thousands of podcast listeners.
Speaker 1: But you see, because I didn't know I was drinking
Speaker 1: tea with the microphone open. That's fine, but it didn't
Speaker 1: occur to me, and it would have occurred to me
Speaker 1: had I known. So these things, aren't they of thinking
Speaker 1: about what do I need to know about this person?
Speaker 1: Is that there's a psychiatrist in Winnipeg and Canada, Harvey
Speaker 1: choching Off, internationally famous for his working paratan En of
Speaker 1: My Care for Dignity Therapy, and he has this question,
Speaker 1: what do I need to know about you as a person?
Speaker 1: Panel does that I can give you the very best
Speaker 1: care that matches your needs. And that's the conversation in
Speaker 1: which each of us would discuss some things that would
Speaker 1: be very very similar for a person to person and
Speaker 1: then there's individual things with it. Oh right, okay, I
Speaker 1: was going to unwrap my cheese sandwich and sit next
Speaker 1: to Eric so that he didn't feel lonely while he
Speaker 1: was waiting to go in for that scam. That's not
Speaker 1: a good plan. I'm not going to do that now.
Speaker 1: Or oh, you know, for a Catherine's eyeing in that
Speaker 1: room and it's completely silent like the grave. I'm must
Speaker 1: be terrified there. I'm going to put some cheinerful music on.
Speaker 1: Go what do you need? Not? What do I think
Speaker 1: you need?
Speaker 3: I want to pause for a quick good Wolf reminder.
Speaker 3: This one's about a habit change and a mistake I
Speaker 3: see people making. And that's really that we don't think
Speaker 3: about these new habits that we want to add in
Speaker 3: the context of our entire life.
Speaker 2: Right.
Speaker 3: Habits don't happen in a vacuum. They have to fit
Speaker 3: in the life that we have. So when we just
Speaker 3: keep adding I should do this, I should do that,
Speaker 3: I should do this, we get discouraged because we haven't
Speaker 3: really thought about what we're not going to do in
Speaker 3: order to make that happen. So it's really helpful for
Speaker 3: you to think about where is this going to fit?
Speaker 3: And what in my life might I need to remove.
Speaker 3: If you want to step by step guide for how
Speaker 3: you can easily build new habits that feed your good Wolf,
Speaker 3: go to Goodwolf dot me, slash change and join the
Speaker 3: free masterclass. One of the things that I think is
Speaker 3: hard about this planning is it seems relatively straightforward to
Speaker 3: decide what you want to happen once you die. My partner,
Speaker 3: Jenny's mother passed coming up on two years now, amazingly
Speaker 3: from Alzheimer's and we took care of her for about
Speaker 3: six years. And one of the kindest things she did
Speaker 3: for us was when she was diagnosed, she took me
Speaker 3: to the funeral home and we did all of it.
Speaker 3: It was just done, you know. We just said to
Speaker 3: the funeral home, come get her and do what she said.
Speaker 3: You know, we had like two decisions to make, So
Speaker 3: that seems straightforward to me. What does not seem straightforward
Speaker 3: and I've got an aging mother eighty one years old,
Speaker 3: and what makes the planning hard, I think is I
Speaker 3: don't know what's going to happen. I understand what's going
Speaker 3: to happen in the last weeks of her life. I
Speaker 3: understand that we've had Barbara Carnes on who does the
Speaker 3: sort of thing you do here? I think she's here
Speaker 3: in the US, and so I recognize the patterns of
Speaker 3: the dying process. It's that time before that. Is she
Speaker 3: going to have a stroke and need to be in
Speaker 3: a nursing care? Is she going to get dementia and
Speaker 3: that's going to be a different thing. Is she going
Speaker 3: to just I don't know what it means to die
Speaker 3: of old age. When they say that, I'm like, what
Speaker 3: does that even mean? But that's the plan in that's hard.
Speaker 1: You're absolutely right, And I think that if we think
Speaker 1: about the planning as a list with tick boxes, the
Speaker 1: list would be open, it wouldn't it. So I think
Speaker 1: we can turn the conversation a different way. We can say,
Speaker 1: at this stage and all of our lives, what matters
Speaker 1: most to us? Where do we get our joy? What
Speaker 1: brings us peace of mind? What are the conditions that
Speaker 1: help us to feel satisfied and calm and at peace
Speaker 1: during and by the end of each day? What matters most?
Speaker 1: Or we can have those conversations, and actually they're delightful
Speaker 1: conversations to have because they're about the things that bring
Speaker 1: us joy. They're often about the people whom we love,
Speaker 1: who we're thrilled to see or to hear their voices
Speaker 1: if they're far away. And that means that if in
Speaker 1: the future there's some kind of medical event that makes
Speaker 1: it difficult for the person there to express their wish,
Speaker 1: like they have a stroke, for example, instead if I'm
Speaker 1: your mother's doctor, as she's had a stroke, heave an offend.
Speaker 1: Instead of saying, what did your mother say she would
Speaker 1: want to do about sheep feeding, having a ventilator, of
Speaker 1: living in a rehabilitation facility, Yeah, yeah, yeah, I can
Speaker 1: say to you, explain to me what matterisms do you want,
Speaker 1: because then I can talk with you about all of
Speaker 1: the treatment options we have. And what we can do
Speaker 1: is we can wrap the treatment options that are most
Speaker 1: likely to match what matters most to her. We can
Speaker 1: wrap those around the care that we give her. So
Speaker 1: it might be for example, I have I looked after
Speaker 1: a lovely, very elderly lady with terrible respiratory disease who
Speaker 1: was on oxygen at home, and part of my work
Speaker 1: was to be a cognitive behavior therapist. And originally I'd
Speaker 1: seen her because she used to get parosystems of panic
Speaker 1: when she lost to bratt. She always thought this was
Speaker 1: the time I'm going to die. And she learned to
Speaker 1: use copnitive therapy skills to manage her panic. She was
Speaker 1: gorgeous and I loved her, and she came to my
Speaker 1: clinic one day, and she always had this attitude that
Speaker 1: doesn't really matter how long I live. Now that I'm aged,
Speaker 1: it's the quality of my living what matters supposed to me.
Speaker 1: And that's an important question. Is it quality or is
Speaker 1: it length the time? What would you be prepared to
Speaker 1: put up with to eke out extra time compared with
Speaker 1: what you wouldn't be prepared to put up with, Because
Speaker 1: it's the quality of living means the most. And she said,
Speaker 1: you know what a wonderful thing is going to happen.
Speaker 1: My granddaughter in Australia is going to get married, and
Speaker 1: I want to go to the wedding. And I knew
Speaker 1: that this woman who is using oxygen just soon help
Speaker 1: to walk from her living to her bathroom at home.
Speaker 1: On the level she is never going to be are
Speaker 1: to tolerate flying at thirty two thousand feet, that that
Speaker 1: is not the possibility. So how are we going to
Speaker 1: bring the joy of the wedding in to her life
Speaker 1: when she can't be in Australia for the wedding. But
Speaker 1: the important part for our discussion here is she's changed
Speaker 1: the parameters of what she wanted. It's not a once
Speaker 1: and for all decision. She was wanting quality of quantity.
Speaker 1: Now she wants quantity. She'll put up with any treatment
Speaker 1: to be still alive when the wedding happens. So she
Speaker 1: is still alive when the wedding happens. And this is
Speaker 1: I can't remember now the twenty early teens, long before
Speaker 1: covid Weill, skype was the thing we all used to
Speaker 1: talk to each other. So she skyped into this wedding.
Speaker 1: It's stupid o'clock in the morning in England. She's got
Speaker 1: her lovely clothes on, she's got her grandma as a
Speaker 1: wedding hat on. You know, it's fantastic. So she comes in.
Speaker 1: The next time I see her and she's gone back
Speaker 1: to we've heard the wedding. I'm going back now to
Speaker 1: it doesn't matter how long I survive. I just want
Speaker 1: good quality of life. And so it's flipped. And then
Speaker 1: the next time I see her and she's noticeably more
Speaker 1: Praille the granddaughter is pregnant. So now by right, I
Speaker 1: want to see this baby bore. Now Actually she clearly
Speaker 1: now she is deteriorating month by month. We can see
Speaker 1: that she isn't going to live long enough to meet
Speaker 1: this baby. But again, what can we do to bring
Speaker 1: the joy of that and the knowledge of that, and
Speaker 1: the grannying of that, or the great grannying of that
Speaker 1: into her heart and soul of life and into her
Speaker 1: family's life. So she gets knitting, and she's knitting fast
Speaker 1: and furious for the time that she's still able to.
Speaker 1: So there's this bunch of babycluths going to be posted
Speaker 1: halfway around the world to this great grandchild that she's
Speaker 1: never going to meet. But every time her granddaughter takes out,
Speaker 1: you know, a pair of mittens or a little cardigan
Speaker 1: or whatever, she's getting her grandmother's love out of the drawer.
Speaker 1: At the same time her grandmother's investments in her and
Speaker 1: in her child who she's never going to meet. So
Speaker 1: if we're honest about the conversations, and if we focus
Speaker 1: the conversations on what matters most, we can use those
Speaker 1: as the stepping stones for the incidents that actually happen
Speaker 1: that we can't prepare for in detail, but once they happen,
Speaker 1: once an illness declares itself, once there's a critical treatment
Speaker 1: decision about do we do this or do we do that?
Speaker 1: And the person's not well enough to say the information
Speaker 1: we need isn't a checklist or they will definitely want
Speaker 1: this or then definitely not want that. It's which of
Speaker 1: the decisions that we can make best matches what matters
Speaker 1: most to this person.
Speaker 3: That makes a lot of sense. And can I request
Speaker 3: you to be my palliative care doctor?
Speaker 1: Now?
Speaker 3: Can I make that request?
Speaker 1: Oh? Eric, you're very sweet and sadly I stopped work
Speaker 1: to do this work. I took only retirement some time
Speaker 1: ago now to do something about public understanding and dying.
Speaker 1: There was a particular incident talked about it in the
Speaker 1: book of Meeting. A family with a very very elderly
Speaker 1: dad with masses of medical notes for people who are
Speaker 1: listening to us, my hands so maybe twelve inches apart,
Speaker 1: just so many things wrong with him in his nineties,
Speaker 1: and they have none of these conversations. And he was
Speaker 1: blue lighted into hospital having CPR, almost dead, and we
Speaker 1: had to have that conversation. And they've had no preparatory
Speaker 1: conversations at all. And I don't know how many dozens
Speaker 1: or more times I'd met families like that, but this
Speaker 1: was the family that broke me. This was the family
Speaker 1: where afterwards, I mean, we gathered things together and that
Speaker 1: dad was looked at bebutifully and he died very gently,
Speaker 1: but they stayed with me. Somebody's got to do something
Speaker 1: about public understanding replying. Somebody's need to do something about
Speaker 1: the way Hollywood portrayed dying. Somebody needs to do something
Speaker 1: about the fact that the newspapers pick up the rare,
Speaker 1: the unusual, the difficult, they're true, that they're the exceptions,
Speaker 1: and now, because we don't understand dying, we grasp those
Speaker 1: exceptions and think that's the normal. And gradually, over the
Speaker 1: course I would say probably six or eight months, it
Speaker 1: dawned on me that I have many stories to tell
Speaker 1: about ordinary dying. Storytelling is our ancient way of giving
Speaker 1: each other insight information ruston one knew that it had
Speaker 1: to be stories, and I knew I wasn't going to
Speaker 1: be able to tell the stories about even some discernment time.
Speaker 1: So I stepped out of medical practice to make the
Speaker 1: space to think about how that could happen, and I
Speaker 1: miss being heart of my fantastic team, and I miss
Speaker 1: meeting those fantastic families at that really poignant telling you
Speaker 1: of people's lives. And yet this has been such a
Speaker 1: rewarding new way of working.
Speaker 3: So I have a couple questions of curiosity, I think
Speaker 3: maybe more than anything else. But I'm going to indulge
Speaker 3: myself here. When we say someone dies of old age,
Speaker 3: what do we mean just something critical gave out, but
Speaker 3: it didn't have a diagnosed disease before it gave out.
Speaker 1: That's such a great question. And around the world, I
Speaker 1: don't know. It's not always legal for a doctor to
Speaker 1: say that a person died of old age. Sometimes they're
Speaker 1: required to give a medical diagnosis. In Britain. It is
Speaker 1: legal in England and Wales, which is our area of jurisdiction,
Speaker 1: to give a diagnost to die of old age, provided
Speaker 1: it's given by a doctor who's known the person for
Speaker 1: a considerable amount of time, and so the Queen Elizabeth
Speaker 1: the second death certificate is given by her general practitioner
Speaker 1: in Scotland as old age, so old age is a
Speaker 1: death from a condition called prayerty. Now the use of
Speaker 1: the word praille in common pants. It has a particular
Speaker 1: meaning in this, and it's usually there this person, who
Speaker 1: may be aged, or who may be young and just unfortunate,
Speaker 1: has collected enough mini diagonosies, enough things not wrong enough
Speaker 1: with them to kill them. But the accumulation of those
Speaker 1: things now is a burden on their energy and on
Speaker 1: their well be And I have a colleague who describes
Speaker 1: this a little bit like paper boats. You get a
Speaker 1: piece of paper and you do those special origamy folds
Speaker 1: that we can all do to amuse a small child,
Speaker 1: and you end up with a tiny little paper boat,
Speaker 1: and it's got crisp folds, and it's got flat paper,
Speaker 1: and it sits up and you can stick it on
Speaker 1: a bathtub, or you can stick it on the river nearby,
Speaker 1: and it sits up and it's crisp and it's clean,
Speaker 1: and it looks great. As soon as it touches the water.
Speaker 1: As soon as a little bit of water gets over
Speaker 1: for the lip into it, it's weakened. And gradually the
Speaker 1: weakness spreads through it, and maybe there's a big ripple.
Speaker 1: Maybe you've put it on the sea on a calm day,
Speaker 1: and then somebody throws a pebble in nearby and a
Speaker 1: big splash lands on it, and it disintegrates. So it
Speaker 1: has a sense of looking hole, looking complete, and looking strong.
Speaker 1: If you tried to tear an oregon refolded paper boat,
Speaker 1: it's really hard to tear it. But when it's on
Speaker 1: the water, it's completely vulnerable, and the water is life,
Speaker 1: and it's the next thing that comes along is the
Speaker 1: pebble that throws the water onto the little paper boat.
Speaker 1: And whatever is the weakest lenk now disintegrates and allows
Speaker 1: the other things all in sequenced to unravel. And if
Speaker 1: it had only been one thing wrong that would have
Speaker 1: been recoverable, but only been two, maybe three things wrong,
Speaker 1: it could have been recoverable. But there are so many
Speaker 1: little bits of us not quite working well anymore that
Speaker 1: we're not well enough to recover. And so it's interesting
Speaker 1: to notice that over the age of eighty, if a
Speaker 1: person falls over and breaks their hip, their life expectancy
Speaker 1: on the day they break their hip is shorter than
Speaker 1: if they've been diagnosed with lung cancer on that day.
Speaker 1: And it's not because they've broken their hip. It's because
Speaker 1: they fell and they couldn't right themself, and they couldn't
Speaker 1: catch themselves as they went down, and it's because of
Speaker 1: the way they landed, And that's all about the muscle
Speaker 1: strength and their bone strength and their coordination. And once
Speaker 1: they've suffered the injury, it's about the way their blood
Speaker 1: clots or doesn't clot. It's about whether their lungs are
Speaker 1: strong enough to be able to sustain them for the anesthetic,
Speaker 1: their needs for the operation to correct the fracture or
Speaker 1: replace the hip joint. It's all of those tiny little
Speaker 1: things that mitigate against them. If a person is striding
Speaker 1: out across the road and they hit by a car
Speaker 1: and they break their head, that's different because they didn't
Speaker 1: have befall. But there's something about the cumulative effects of
Speaker 1: aging in the body where the whole thing holds together
Speaker 1: until there's something that happens and then it just can't
Speaker 1: work any longer. So it's really interesting. There are photographs
Speaker 1: of the Queen at Bowel Moral seeing off the old
Speaker 1: Prime Minister and welcoming the new Prime Minister. And when
Speaker 1: it was announced that she was going to accept the
Speaker 1: resignation and receive the new Prime Minister at Bowel Moral.
Speaker 1: When that was announced, I said to my husband, she's
Speaker 1: going to do tarein six weeks because she can't risk
Speaker 1: going back to London. She hasn't got the energy to
Speaker 1: go to London and get back again. This is an
Speaker 1: absolute steed change in her behavior. And we've seen the
Speaker 1: change in her behavior for some times. She'd been gradually delegating,
Speaker 1: always predictedly, started walking with a stick, had the massive
Speaker 1: hits of her husband of how of ellon sixty something
Speaker 1: years they've been married. But then she started to delegate
Speaker 1: at the last minute to send apologies to things that
Speaker 1: she was actually fully expected at. So you can see
Speaker 1: that the rate of changing, the predictability is starting to shift.
Speaker 1: And then she didn't go back to London for the
Speaker 1: change of Prime ministers. And for those of us who'd
Speaker 1: been watching, the queen had been dying in clear sight
Speaker 1: for about two years, but newspapers covered it as though
Speaker 1: her death was a surprise and was quite sudden. It
Speaker 1: wasn't at all.
Speaker 3: That leads us into the idea that there is a
Speaker 3: predictable pattern. We've talked about it a little bit, but
Speaker 3: I'm wondering if you could walk us through in just
Speaker 3: a little bit more detail, what the predictable pattern of
Speaker 3: dying looks like I found this really helpful when Ginny's
Speaker 3: mom passed from Alzheimer's. Even though Alzheimer's is different than
Speaker 3: other things, the actual dying process was exactly as people
Speaker 3: sort of laid it out to be, and it was
Speaker 3: really helpful to know, Oh, here's what's happening, and then
Speaker 3: this is going to happen, and so I'd love to
Speaker 3: give listeners that information.
Speaker 1: Okay, so what we're talking about now is that very
Speaker 1: last part of living a variety of routes of getting
Speaker 1: to there. Maybe the frail person whose paperboat just folds
Speaker 1: over the previous week after looking okay ish for a
Speaker 1: long time. Maybe somebody who's been gradually struggling more more
Speaker 1: with heart problems, lung problems, accouncer diagnosis that seem really
Speaker 1: well held by treatment until relatively recently, that has now
Speaker 1: escaped whatever it is. But we're now talking about the endgame.
Speaker 1: I suppose this is the equivalent of giving birth, rather
Speaker 1: than what the pregnancy was like beforehand. So when we're
Speaker 1: down to the last few weeks and days of life,
Speaker 1: there are some consistent things that we see. We see
Speaker 1: that people lose interest in the outside world. They become
Speaker 1: more and more focused on the equaling mattering those to them,
Speaker 1: the state of their own selves and often kind of
Speaker 1: retrospect about their lives and what it's all been about.
Speaker 1: And they are doing the reckoning. Have they lived their
Speaker 1: lives according to their standards, and that might be the
Speaker 1: standards of a faithful world? That it is just evil environmentalism,
Speaker 1: whatever the thing that matters to them, the things that
Speaker 1: to them. See people losing interesting food, and that's really
Speaker 1: hard for families because we show people we love them
Speaker 1: by feeding them. All around the world, we do this
Speaker 1: people who really have no appetite left because they gut
Speaker 1: is starting to just close down if it's not doing
Speaker 1: digestion effectively anymore. So if they try and eat that
Speaker 1: meal that their daughter has slaved from now to make,
Speaker 1: it's just going to sit like a lump and they're
Speaker 1: going to feel uncomfortable. And it's so hard. But we
Speaker 1: see families playing to dis way people to eat.
Speaker 3: Can I ask a question about that part of it? Yeah,
Speaker 3: because that stopping eating is kind of a common thing.
Speaker 3: And the worry that I've had when I've been around
Speaker 3: somebody dying is that they're starving. And I mean the
Speaker 3: psychological condition of feeling like you're starving. Yeah, and it
Speaker 3: sounds like you're saying that's not really the experience that
Speaker 3: it seems like they're having.
Speaker 1: No, it's fascinating. What seems to happen is that they
Speaker 1: have a face of hunger and they no longer desire
Speaker 1: to eat. And when you face them with a meal,
Speaker 1: they can look at it. They can see it's beautifully presented,
Speaker 1: and maybe it smells denicious, but just I already feel
Speaker 1: as I've eaten, I just don't want that. So the
Speaker 1: wisdom that I give to families is go for the
Speaker 1: volume of the teaspul tiny tastes that are just for pleasure,
Speaker 1: because people don't in the main die because they're not eating.
Speaker 1: They're not eating because they're dying, and it's one of
Speaker 1: the signs that the process is evolving. So very often
Speaker 1: their taste buds will still appreciate just tiny taste of
Speaker 1: things that they've all those loved. So just in case
Speaker 1: you happen to be in tel when it's my turn,
Speaker 1: it's going to be baked rubile, please no ginger on it,
Speaker 1: but lots of sugar or elder flour, cordial and vanilla custard.
Speaker 1: Proper vanilla custard. That's my teaspoon. That's my tiny taste
Speaker 1: something for pleasure.
Speaker 3: I think I want Mikey's Late Night Slice pizza with
Speaker 3: a little bit of crush the red pepper on it,
Speaker 3: and Ginny's Banana cream pie.
Speaker 1: Okay, so that's clear. So you're allowed to teaspoons then,
Speaker 1: because that's very specific and they're not going to taste
Speaker 1: together on the same spoon.
Speaker 3: Very good now that those are going to be different events.
Speaker 1: So gradually the body is showing us that it's changing
Speaker 1: less appetite, less energy, and the energy failure is a
Speaker 1: really interesting bit because the bit that replenishes lost energy
Speaker 1: now isn't eating and drinking. It's sleep as something in you.
Speaker 1: So you will see that the person will drop off
Speaker 1: to sleep. Now, for people who are listening to us
Speaker 1: who light their afternoon nap, and I'm one of those,
Speaker 1: I'm not talking about the nap that you've planned and
Speaker 1: you're looking forward to. This is a kind of nodding
Speaker 1: off in the middle of a conversation that is just irresistible.
Speaker 1: Person will sleep for a while, they'll wake up, it
Speaker 1: will recharge their batteries, they'll have a bit of energy
Speaker 1: to do something for a while, and then they'll fall
Speaker 1: back to sleep again. So it's almost like, you know,
Speaker 1: a mobile phone with one of those old batteries that
Speaker 1: didn't used to hold its charge, a bit like that.
Speaker 1: And as time goes by, the periods of time spent
Speaker 1: sleeping lasts longer, and the periods of time awake that
Speaker 1: they buy lasts shorter. And also it's important for people
Speaker 1: not to be frightened by a thing that isn't uncommon,
Speaker 1: which is people getting a little bit stuck between sleep
Speaker 1: and awake, which has happened to all of us, where
Speaker 1: you be deeply asleep and your alarm goes to waking
Speaker 1: you because it's work time, or particularly it happens when
Speaker 1: you know you've got an early flight and you set
Speaker 1: your alarm so you don't miss it. So you're a
Speaker 1: waking at a different time from usual, and in your
Speaker 1: dream the noise that's real, that's the alarm, becomes a
Speaker 1: feature of the dream. So you start to dream about
Speaker 1: fire engines and there's a fire somewhere, and then as
Speaker 1: you waken you realize, oh no, no, I was dreaming
Speaker 1: that there's a fire. Where's the fire engine? What's going
Speaker 1: on here there's a fire engine in my room. And
Speaker 1: then you waken enough to say, no, this is my alarm.
Speaker 1: I can turn it off. But there's that moment of
Speaker 1: being trapped between the things that are real in the room,
Speaker 1: the noise, and the things that are not meaning your head,
Speaker 1: which is the dream about the fire engines. And we
Speaker 1: call this modelness denverium, and there are lots of causes
Speaker 1: for it towards the end of life, but very commonly
Speaker 1: it's just being a bit stuck between sleep and awake.
Speaker 1: And if it frightens the family and they start to
Speaker 1: be agitated, then the agitation communicates itself to the person,
Speaker 1: so they then think there's something to be frightened about,
Speaker 1: so they then become agitated too, so being able to say, oh, Dad,
Speaker 1: you're kind of talking to people in your dreams here.
Speaker 1: That's okay, it's fine. It's lovely to see them, isn't it.
Speaker 1: They'll have another cup of tea. Your voice stays calm,
Speaker 1: your meanness, faith calm. It doesn't wind it all up.
Speaker 1: So as time goes by, we find the person is
Speaker 1: sleeping more, they're awake less, and very often that might
Speaker 1: need now that they can't wake up at times when
Speaker 1: they would have been taking medications for you know, some
Speaker 1: people have symptoms like paying breathlessness. A lot of people
Speaker 1: towards the very end of their lives have no symptoms
Speaker 1: at all. And it's really important to say that dying
Speaker 1: doesn't cause discomfort. The illness that they're dying from might
Speaker 1: cause discomfort. Towards the very end of somebody's life, they're
Speaker 1: not just a sleep anymore. They're actually dipping in and
Speaker 1: out of unconsciousness. They don't know they've been unconscious, but
Speaker 1: we might notice it because a visitor came, or it
Speaker 1: was medicine time and we couldn't waken them. And when
Speaker 1: they wakened later on, they come back up from deep
Speaker 1: unconsciousness through sleep back to being awake again, and will say, oh,
Speaker 1: we couldn't waken you at all, And they say, oh,
Speaker 1: you listen and tried hardument So being unconscious is not
Speaker 1: something that we realize is happening to us, which is
Speaker 1: the clan's in the name space it. So towards the
Speaker 1: very end of people's lives, they're not awake, that they're
Speaker 1: not assleep, they are unconscious, and it's really important people
Speaker 1: understand that because otherwise they're afraid to go to sleep
Speaker 1: a time, and sleep is your most important ally for
Speaker 1: keeping you as well as you can be. Under the
Speaker 1: circumstances when the brain lapses into complete unconsciousness, there are
Speaker 1: only two things that's don't you. One is it can
Speaker 1: still hear sound. I don't think whether it's still responds
Speaker 1: to it with misophonia. That's an interesting thing to speculate about,
Speaker 1: but we know that people do still hear sound. How
Speaker 1: we observe that people offering look more rested when the
Speaker 1: right voices of the room, or get a little bit
Speaker 1: agitated when the wrong voice is in the room. And
Speaker 1: we've seen people synchronizing their breathing to the live music
Speaker 1: being played in the room. Really interesting that in the
Speaker 1: state of deep unconsciousness, hearing is probably still connected to
Speaker 1: our emotion system and our sense have come. So you
Speaker 1: will see nurses talking to people dying people, people who
Speaker 1: have head injuries or strokes and deeply unconscious, and the
Speaker 1: nurses are still talking to them. That's why. And then
Speaker 1: the other part of the brain that's still working, is
Speaker 1: part of the controls are breathing, is now doing something
Speaker 1: that we normally never see, which is instead of kind
Speaker 1: of breathing that you and I are doing where we're
Speaker 1: not really thinking about slof breathing except I was talking about.
Speaker 1: Of course, we are now thinking about our breathing. We're
Speaker 1: managing our breathing, so we're both thinking into microphones, so
Speaker 1: are being aware of not taking big issues sockey breaths
Speaker 1: As we do that, we're taking sufficient breath to speak
Speaker 1: a particular length of praise before we pause, take a breath,
Speaker 1: and the safe the next time brais and people who
Speaker 1: are listening to us are properly managing their breathing so
Speaker 1: their breath sounds aren't obscuring our voices coming into their ears.
Speaker 1: So during normal life, will take breathing for granted we
Speaker 1: don't really think about it, but we can manage it now.
Speaker 1: In deep unconsciousness, the brain does primitive reflex breathing cycles
Speaker 1: and they look and sound peculiar. They go backwards and
Speaker 1: forms between very deep breathing that can be sighing. It
Speaker 1: can be coming out through the vocal cords, so there's
Speaker 1: a room noise and faster but shallower breathing, which can
Speaker 1: look as over the person is breathless. So if you
Speaker 1: never seen that before then you need somebody who has
Speaker 1: seen it before to say to you, you know, this
Speaker 1: breathing is completely normal. Your dear person is deeply unconscious.
Speaker 1: This breathing tells me that they're beyond feeling distress from
Speaker 1: symptoms in their body. They're completely safe. They're dying, that
Speaker 1: they're safe, and that this is hard of ordinary dying,
Speaker 1: and it's the last part. So once the breathing is
Speaker 1: changing like this, then we might be down to the
Speaker 1: final hours. Sometimes it's days, sometimes it's really short. So
Speaker 1: this is the time if you want to be alongside
Speaker 1: the person to sit there and bring your bring yourself
Speaker 1: a newspaper, bring your slippers with you, be a good visitor.
Speaker 1: So at home, in our houses, we don't normally sip
Speaker 1: locked tight next to the person, eyeble to eyebill, looking
Speaker 1: at them, striking them. Do it not? In my house
Speaker 1: we kind of ignore each other in a loving kind
Speaker 1: of way most of the time. So how do you
Speaker 1: help families to feel peaceful around the death there? Do
Speaker 1: you remind them that actually, here we are. They can
Speaker 1: hear you, So why not chat to each other? Think
Speaker 1: about some of the funny things that have happened in
Speaker 1: the past. Think of somebody, how things that happened in
Speaker 1: the past. Just tell them they're safe, that they love,
Speaker 1: they're doing okay, You're doing a great job of creating
Speaker 1: the safe space that this person can lead their life from.
Speaker 1: What's really fascinating is how often, despite the fact that
Speaker 1: this family's had a rotor, there'd be two or three
Speaker 1: people in the room the whole time. It's the one
Speaker 1: thirty second interval where everybody got called away at once
Speaker 1: that the person stops breathing. Why does that happen? We
Speaker 1: just don't understand it, but it does seem to happen
Speaker 1: more often than can happen by a chance. Sometimes a
Speaker 1: person carries on to doing this terminal breathing for a
Speaker 1: very long time, and then the person they've been waited
Speaker 1: to arrive from around the world, they arrived, their voices
Speaker 1: in the room, and within minutes their breathing is just
Speaker 1: very gently slowed down and stop. Because there's nothing special
Speaker 1: about the last breath. It's not Hollywood. During all of
Speaker 1: the periods of breathing, usually shallow breathing, there'll be a
Speaker 1: breath out, just have another breath in afterwards. So people
Speaker 1: don't suddenly sit up and you know, tell the family
Speaker 1: secrets or whatever. It's much much more gentle than that.
Speaker 1: There are occasional times when the person will rally unexpectedly
Speaker 1: for a few hours to a day, very closely before death.
Speaker 1: But again, let's not leave those important conversations waiting for
Speaker 1: that time that's called the rally, because it doesn't happen
Speaker 1: to most people. Let's have the important conversations first. So
Speaker 1: we seem to have a little bit more control than
Speaker 1: we can understand about the moments of guast. It seems
Speaker 1: to be possible to wait for a while. It seems
Speaker 1: to be possible to wait till the room's empty, to
Speaker 1: be able to wait until the important news is broken,
Speaker 1: until the right person has arrived. But not everybody can wait,
Speaker 1: and sometimes too feel dashed around the world only to
Speaker 1: arrive and it's just a few minutes too. But usually
Speaker 1: the family have said, you know, Susie's on her way, dad,
Speaker 1: and just knowing that Susie's on her way has been
Speaker 1: the helpful part of the constellation at that time. So
Speaker 1: there isn't a right way or a wrong way of
Speaker 1: doing this. I've seen families sitting around beds, telling jokes,
Speaker 1: ripping each other the way they always have, reminding each
Speaker 1: other of childhood fights that their dad told them off
Speaker 1: about while dad's peacefully dying. I've seen families singing souls.
Speaker 1: I've seen families using whatever other sacred scriptures of their
Speaker 1: tradition because that's the way their dad would have wanted it,
Speaker 1: or that's what their family tradition is. I've seen families
Speaker 1: who just sit in silence, maybe with their favorite show
Speaker 1: tunes in the background. There isn't a right and wrong
Speaker 1: way of doing it, but always there's a sense of
Speaker 1: something very powerful is happening in that room, that there's
Speaker 1: a huge amount of love in that room also, of course,
Speaker 1: and difficult things are also in that room. No family
Speaker 1: is perfect. Every family's got those times that were difficult.
Speaker 1: They haven't gone away either. And so coming back to
Speaker 1: our wolves, we can feed that anger into the bad wolf. Oh,
Speaker 1: we can say, okay, this is lasted long enough. We
Speaker 1: can let that anger go and we can feed the
Speaker 1: good wolf even there's a deaf bet.
Speaker 3: Well, I think that is a beautiful place to wrap up.
Speaker 3: That was a very nice ending on your part. You
Speaker 3: and I are going to continue to talk a little
Speaker 3: bit in the post show conversation. I want to talk
Speaker 3: about palliative care because palliative care is more than just
Speaker 3: hospice care, and I want to explore that. I think
Speaker 3: this is a really useful thing for people to know
Speaker 3: about listeners. If you'd like access to the post show conversation,
Speaker 3: AD free episodes and the chance to support something that
Speaker 3: matters to you, go to one ufeed dot net slash
Speaker 3: Join Catherine. Thank you so much for coming on. I've
Speaker 3: really enjoyed this conversation, heavy as it is, it's been at.
Speaker 1: Treat Thanks so much for aviting me.
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