Thoughts from Dr Ali Gray

On Death and Dying

This Mothering Sunday, with the coronavirus looming on the horizon, I find myself thinking about my mother, Doreen who died 18 months ago. Doreen was a real character, she could be prickly, had very strong opinions and was never frightened of letting them show, she ‘did not suffer fools gladly’. She was also intensely loyal and reliable with a strong work ethic, who showed love in practical caring. If you ever wondered where I get my strong character and tendency to judgmentalism it is directly through genes and environment from Mum. I can even trace my studying of psychiatry to her influence. Mum went back to university when I was 7 years old – which scandalised my paternal Aunt and Uncle who lived next door, they gave her no support. I had to go to friends up the road after school. Mum studied education and was one of the first in the UK to study dyslexia. I can still remember her telling me about how some people’s brains are wired differently, such that one man stood up to give a speech and read confidently

“A what, B what, the Tea mother.”

That started a fascination in me with how brains work, which led eventually to my career in psychiatry, and on to my elder daughter’s study of clinical psychology.

Mum and I could always talk, and as she began to deteriorate physically, with an auto-immune liver disease we talked more and more about her thoughts on life, death and resurrection. She had come to a living and active faith in her 50’s, indeed she had tried to stop me going to church age 11y, “because it was getting too serious.” We laughed about that at my ordination. We talked openly, and were able to establish Mums views about what she would want her end of life to look like, acknowledging that sometimes it can’t be as we would wish it to be. Having seen too many people struggling in the trap of a foolish promise I avoided saying that I would look after her at home to the very end, and we were both clear that if she needed much care she would have to go into a nursing home. We organised her will, her funeral plan and lasting power of attorney so that as and when she could not make her own decisions my brother and I could make financial and healthcare decisions on her behalf.

So over the last 18 months of Doreen’s life we had fun, we got out to places, she dined with friends, even in the last month we took afternoon tea in a local church hall and made the most of the time. Eventually her heart failure meant she needed to go into care and for the last four days of her life she was in a nursing home. She accepted this with a quiet grace that was so different to her normal spiky personality. I was privileged to spend the last 48 hours with her, and am very grateful to family and to hospital colleagues who covered for me to enable this to happen. Mum said goodbye to the family, and stayed with her as she slipped into unconsciousness, as I read from Romans 8, and she eventually died several hours later.

For I am sure that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, nor height, nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.”

It was a blessing to have had that experience of a quiet peaceful death, so different to most of the deaths I have witnessed as a hospital doctor. Her funeral was fun, with many memories of Doreen and she is still kept in our conversations to this day.

I am glad that my mother isn’t alive at this time. That sounds harsh, but it is the honest truth, because we in the UK, in Germany, and in many parts of the US are just two weeks behind Italy in terms of coronavirus impact. In Italy, Spain and many other less well-resourced places, families are unable to be with their loved one as their final hours approach, many people are dying alone. Funerals cannot be held; coffins are collected by the army. You may comfort yourself by thinking Italy is a strange case, but they have a strong and well-resourced health system which has simply been overwhelmed by the number of people needing to go on ventilators, the number dying. This is why we need to stay home, to slow the spread of the virus, so that you or your loved ones won’t die alone as the staff rush to try to save the next person. This is why we need to stay home, to minimise the risk of young doctors and nurses giving up their lives as they do their duty.

It is time to face the fact that some of us are going to die over the next few months. We need to be prepared. We can prepare spiritually by ‘keeping short accounts with God’, using this extended Lenten time to examine ourselves and address our many faults, and turn again to the God who holds us in existence, for forgiveness and renewed eternal life. Reconcile with family and friends, heal divisions, make peace.

“My sheep hear my voice, and I know them, and they follow me; and I give them eternal life, and they shall never perish, and no one shall snatch them out of my hand. My Father, who has given them to me, is greater than all, and no one is able to snatch them out of the Father’s hand. I and the Father are one.” John 10: 27-30.

And we can prepare practically.

Is your will up to date? Have you had the difficult conversation with your loved ones? If, God forbid, you were to get badly ill with the virus would you want to go to hospital, or would you want to stay at home and take your chances there?

Have you set up a power of attorney or whatever it is called in your country; if you can’t make choices for yourself what is the local system to ensure that your financial and healthcare wishes are followed?

If your heart stops would you want the medics to try to restart it? You have to know this is not like on the TV, it is a distressing process, and there is a very big difference between those who have an abnormal rhythm of the heart walking down the street age 50 and those whose heart stops when they are very ill in hospital. In the latter case it is very unlikely that resuscitation would bring someone back to a quality of life that was acceptable to them, but in many jurisdictions the medics have to try unless you have a valid “Do Not Attempt Resuscitation” form.

It maybe that it is impractical to set up a formal power of attorney at present, particularly if you have to go to see your doctor to formalise it, but you can certainly talk with family and friends and record your wishes. Another option is to write it down, ideally get someone to witness it and send copies to your trusted people. One of the most difficult things about my job in liaison psychiatry (being the psychiatrist in the physical health hospital) was helping families decide how to proceed with care when someone was unable to decide for themselves, and family members thought differently about what should happen next. Talk about it, write it down, do it now, whatever your age group! You will spare your loved ones much agonised speculation whether the end of your life is next month, in ten or in fifty years-time.

We need not fear death, as Jesus told his disciples

“Let not your hearts be troubled. Believe in God; believe also in me. In my Father's house are many rooms. If it were not so, would I have told you that I go to prepare a place for you? And if I go and prepare a place for you, I will come again and will take you to myself, that where I am you may be also.”John 14:1-3

We know that this virus mostly kills older people, but younger people are still dying. We know it mostly affects people with other illnesses, but perhaps you have an undiscovered illness. Perhaps now is the right time to be reminded that we will all die, and then make preparations to make it easier on all those we leave behind.

When we are all meeting together face to face again, be that in six months or two years, you may recall how Ali risked upsetting and offending people by making them think about death. Be assured of God’s promises that we will meet again, at the end of time at the great banquet in the new heaven and earth.

“Then I saw a new heaven and a new earth; for the first heaven and the first earth had passed away, and the sea was no more. And I saw the holy city, new Jerusalem, coming down out of heaven from God, prepared as a bride adorned for her husband; and I heard a loud voice from the throne saying, “Behold, the dwelling of God is with men. He will dwell with them, and they shall be his people,and God himself will be with them; he will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning nor crying nor pain any more, for the former things have passed away.” Revelation 21: 1-4.

The Revd Dr Alison J Gray,

Malvern, UK.

23/3/20

 


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