Saturday, 18 August 2018

Bedside Manner

The Beloved acquired another book about The End. Sallie Tisdale's Advice for future corpses (and those who love them): a practical perspective on death and dying. As all my readers will indeed be a corpse at sometime in the future, then Tisdale is addressing us all. Personal exceptionalism allows us to believe, when young, that other people will of course die, but we will live forever. That is why young men do daft things with guns, knives and cars if they can get them or with sharp sticks, fists and stones if technology eludes them. I've written about 17 y.o. me trying to break the speed-limit if not exactly the sound-barrier in my mother's ancient Vauxhall Viva. No imagination, the youth: possibly because they have only limited experience to inform them.

Tisdale's book is not really talking about recklessness inviting death in the young because they are only a minority of the dying demographic. In The West, life expectancy at birth is 80 ± 5 years which means the most people die in the fullness of their years; often because the meat-machine and its exquisitely sensitive mechanisms for maintaining homeostasis just crocks out. Kidneys, lungs, sphincters, heart, liver, pituitary: one of more of them will get flaky. Far too many people die in hospital where the default position is Fix It. In America, this culture can rack up quite stupendous bills over the last 3 months of life. In Ireland, the same futile interventions occur but the state indemnifies the family for most of them. Nobody is presented with the choice of either trying a fantastical course of therapy on granny to buy another six weeks or putting both grandchildren through college.

The chapter on communication is peppered with things not to say at the beside of the dying:
Don't say I told you to quit smoking
Don't say Please eat; if you really wanted to get well, you'd eat.
Don't say Why didn't you call me first?
Don't say Don't talk like that; let's talk about something happy
Don't say Our neighbour's cousin had this and she's grand now
Don't say Get real; my mother had this and she was dead in a month
Don't say This is a blessing in disguise
Don't say If I were you . . . nor Why don't you . . .
Don't say I'll pray for you nor God has a plan
Don't say I see you're at the bargaining stage [as in K├╝bler-Ross]
Don't say You should read this great book on mindfulness and cancer
Don't say Don't leave me

Actually a lot of it comes down to shutting your own nervous and anxious gabble and listen to the principal actor in the drama. There may well be desires, fears and needs that cannot be easily articulated. Allowing these drivers to be expressed can be a big part of achieving closure. Closure is often desired or required before exit. A delayed departure is annoying in public transport and also in the hospice: if it's not going to get any better [and that's the difference between a nursing home and a hospice] it may be time to stop wringing the hands and listen to Lady Macbeth
I pray you, speak not. He grows worse and worse.
Question enrages him. At once, good night.
Stand not upon the order of your going,
But go at once.

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