Death is one of the only certain things in life, and a visiting UK expert says it's time we demystify what happens when we die.
Dr Kathryn Mannix has spent a large chunk of her career specialising in palliative care, and the now-retired doctor and best-selling author, has spent the last two weeks travelling New Zealand speaking to doctors, nurses, caregivers and the general public about the lead-up to death.
Kathryn spoke to a group of around 50 healthcare professionals at Nelson Tasman Hospice on Thursday, and again to the general public later the same day.
Her aim is to help people to better understand and prepare for dying.
“My grandmother was born in 1900, by the time she was 23 she understood about dying, they looked after people so sick that they were dying at home,” Kathryn says.
But over the course of the 20th century, medicine got better. “We got access to antibiotics, more impressive services, machines that do the jobs of vital organs – so dying was postponed. It meant that by the time I was 23, I had no idea about what happened as people were dying because I’d never seen it,” she recalls.
Kathryn says many people have never seen anyone die, and the only thing they have to base the experience off is Hollywood and television.
“If you don’t know what ordinary dying looks like you replace that with stuff you get from somewhere else, such as Hollywood and soap opera. Of course, that’s drama, so dying becomes dramatic and what people are expecting is very different than what actually happens, and its scary.”
Kathryn says the process of dying has certain stages, much like birth.
“A midwife knows exactly what stage a birth is at because the signs are so recognisable, and they’re talked about. The process of dying is no different.”
She says dying is a process of losing energy, gradually becoming unconscious, and comes with changes in breathing, which can often be misinterpreted for pain and suffering.
The changes in breathing can be unsettling, she says, and her aim at hospice was to help the health care staff prepare families earlier for what will happen.
She says it’s perfectly normal for breathing to become shallow, faster, slower, and raspy, often with deep gasps.
“What can be seen as scary breathlessness should be looked at calmly because it means the brain is safely unconscious.”
Kathryn wants the conversation to become more normal.
“I think we need to get understanding of dying onto the curriculum for schools and I think we should be talking about what matters most to us.”
She says it means when a doctor meets someone in the emergency department who is not well enough to say what they do or don’t want, their family will know.
“I can say to the family ‘what matters most to your dad’. If what matters to him most is that he’s got the energy to hike up mountains, I might not have a treatment that’s going to make him well again. I might have a treatment that will stop him from dying right now, but he will live in a bed for the rest of his life, and they can say ‘dad wouldn’t want that’. That’s different to ‘as long as dad can see the garden from his window and the grandchildren can visit, he’ll be happy’.
“They can only tell me that if they’ve had those conversations, if we wait till people are too sick, we’ve left it too late.”
She says we should get into a lifelong practice of talking about how much treatment is too much treatment, and what compromises we would be prepared to make, or not.
“You know, the conversation about what matters to me most, that’s a happy conversation. The things that really make my life worth living, they are lovely conversations. You could do that around Christmas dinner, you wouldn’t be making people miserable.”
So, she urges people to think ‘if someone gets sick in the next year, have we had those conversations?’
