Anna, the old woman who died half an hour ago, sits in the chair with her head resting back on a cushion, her hands placed neatly either side of her, as peacefully as if she’d just popped out for something but forgotten to take her body with her. Her eyes are half-open, and she stares through the window immediately opposite, at the dark green canopy of the evergreen oak that grows up from the nursing home car park, past her window to the storeys above.
The manager and a carer are in the room with Anna. The manager has Anna’s folder tucked under her right arm; in the left hand she holds a red DNAR form.
‘Aggie found her. They used to go down to lunch together,’ says the manager. ‘She’s terribly upset, as you can imagine.’
‘So who was the last person to see Anna alive?’
‘The hairdresser. Half an hour! If that! She is dead, isn’t she?’
‘I’m afraid so.’
‘Poor Anna. It’s all so – sudden.’
The manager suddenly looks pale and tearful. The carer passes her a tissue.
‘Sorry,’ she says. ‘Do you mind if I just step out for a few minutes? I could make you some tea if you’d like?’
‘That’d be great. We’ll do the paperwork and then liaise with Control about the next step.’
They leave the room and quietly shut the door behind them.
The light in the room suddenly increases threefold as the clouds break and the sun shines through. It throws everything into sharp relief, especially the little collection of things on the window-ledge: a silver framed photo of an elderly man in a yellow cardigan, two miniature porcelain cottages, all arranged around a bonsai tree in a shallow ceramic dish. Unlike the oak outside, the little tree is blackened and leafless.
There’s a knock on the door, and the manager comes back in with a tray of tea. She sets it down on a side table, then perches on the edge of the bed and helps with the paperwork, calling out drug names, the dates of operations, hospital admissions.
‘It’s the first time I’ve been in a situation like this,’ she says. ‘You know – not really doing anything.’
‘I know. It feels odd. But good, I think. It couldn’t be more peaceful. Usually it’s the complete opposite.’
The manager finishes her tea and then holds the empty cup tightly in her lap like she’s appreciating the warmth.
‘Is that Anna’s husband in the picture?’ asks Rae.
‘Richard – yes. I never met him. He died a while before Anna came here. Looks like a nice chap, though.’
She puts her cup back on the tray.
‘Maybe she’s meeting Richard right now,’ says the manager. ‘I don’t know what you think, but I believe in heaven. I don’t mean big white gates and all that, but some other place, where you all meet up again. I couldn’t believe when you died that was it, none of this meant anything. I know when I was ill it was God that kept me going. Sorry if I’m talking too much.’
‘No, no. I don’t mind.’
Rae tidies up the equipment and puts the bags aside, ready to go.
‘I think there’s an afterlife’ she says. ‘Probably nothing we’d recognise. Something purer, less human. It’s just a feeling.’
‘I know what you mean,’ says the manager. ‘Did you see that programme last night on bugs and parasites? It was amazing. Kind of disgusting, but amazing too. When you see how these things are put together. I mean, the big stuff you can understand, but when you get down to it, all the cells and atoms, floating around in space – well, there has to be a creative force behind all that, surely? I mean – what else could it be? It stands to reason.’
‘I read this interview with a palliative care nurse,’ says Rae. ‘She told this story about a patient with dementia who was absolutely raving right up till the end. The curtains had been pulled round, and the nurse stepped outside for a second to get something when she heard the woman suddenly talking in a voice she hadn’t heard before, all calm and low, you know? – full of sense – like she was talking to a whole load of people who’d suddenly turned up. And when the nurse pulled the curtain aside she found the woman had died.’
I finish my tea and put the cup on the tray next to the manager’s.
‘Thanks. That was great.’
‘You’re very welcome.’
‘I’ll make the call.’
Rae and the manager sit quietly whilst I dial the number.
I think we'd all like to go like Anna.Quiet,peaceful and at ease.
Pretty much ideal, really! I think the increasing use of DNAR is a positive move.
DNAR? I don't know what that stands for. How do you feel, Spence, when people are talking about afterlives and such? Do you just keep quiet, or what? I'm sure it comes up on at least a semi-routine basis for you, but I also gather from previous writings that you are atheist/agnostic/non-believer, so that would rule out an afterlife right? Just curious as to how it affects YOU as the people who are more immediately affected reason through things.
It comes up now and again, and I'm quite happy to chip in a view if I think it won't upset anyone. You're right - I am an atheist. As far as death goes, I think of it as a return to the state I was in before I was born. I think those questions of 'why' and 'how' are a kind of evolutionary quirk that developed alongside human consciousness. But I'm no more able to think about 'who made me' as I am about The Big Bang, or String theory (or most other scientific theories, come to that). But I don't suppose other animals worry too much about those questions - they just get on with doing the best they can as that particular animal. I think Love and Art, matters of the spirit and so on are all functions of being human - and no less important for all that. But it is undeniably frightening and confusing to live in the world. I've always seen religion as being a way people have to make it more bearable, essentially variations on those early creation myths - finding ways to explain it all to ourselves.
Of course I'm more than happy for people to believe in religion, just so long as it doesn't 'spill over' into something else - politics for example. I think when any one religion sees itself as the definitive truth it has the potential to be repressive.
I must admit I'm often a bit hesitant sharing these views with patients. Once I had a discussion and the patient became quite upset - on my behalf, it has to be said. They couldn't believe I could live a life 'with no meaning' - a prospect that seemed to cast a shadow over them, too. But I think there's plenty of room for spirituality and love and hope in a world without God. I just see it in other places.
Thanks for the comment, Cass. Very much appreciated.
Oh - BTW - DNAR means Do Not Attempt Resuscitation (or DNR in the US, I think). It means the patient (and probably the family, too) has had a discussion with their doctor about what they want to happen should they go into cardiac arrest. It's usually put in place when the prognosis for a full recovery is poor, or when the patient has so many other health problems they wouldn't want to carry on should their heart stop working.
I want to die like Anna. My granny died in 1989 when I was a year old. My dad was right with her when she died, and my mum was feeding me in the kitchen. Dad said he took great comfort in that - the circle of life. As one life ended, another was just beginning.
That sounds like the perfect end to a life, dying at home with your family around you. Like you say, 'the circle of life'.
In recent years we've drifted away from that into a full-on medical emergency for elderly arrests, when often a 'gentle passing' is more appropriate. Hopefully these DNARs will redress the balance and allow for more peaceful and dignified scenarios.
Thanks very much for the comment, PH.
Aw lovely way to go bless her.
I hope it's nice on the other side.
Thanks Anon. She certainly looked very peaceful :)
Thanks for the response. I agree with you very much on a lot of that. I remember the post, too, when that patient became so upset about your "life without meaning". I found it slightly amusing, but also sad. But I also remember my uber-Christian days when I thought the same way, so I don't blame her.
I think if I believed that someone would go to Hell (or something equally bad) if they didn't 'sign up' before they died, I'd make an effort to persuade them - or feel anxious for them at the very least!
I never mind having those conversations, though. It makes you feel more alive somehow! (But at work you have to be a little circumspect - you don't want anyone feeling worse!)
What a wonderful thing to come across a Manager and Carer who both actually do care...one hears so often about those who don't...
They were great - extremely caring. We got a good warm feeling from that home (and from the doctor, who turned up soon after...) And they made us tea...! :)
Hi spence, hope your keeping ok.
Being in the care profession, I welcome DNR`s as the trauma these poor residents have to go through can be horrendous, especially if the family are there, our youngest is 82 and 100 the eldest, I would not welcome doing CPR on any of them. Sounds awful but I would feel terrible breaking their ribs and damaging them so much, and to bring them back to what? Pain and suffering?
Life can be so cruel sometimes.
Hi Carla! Yep - all's good, thanks. Glad to have the w/end off!
Thank goodness we're seeing DNRs in very elderly patietns more commonly now. That conversation with the GP / Consultant is much more a part of the patient's continuing care - and very needed. I think in the past few years there's been an over-medicalisation of End of Life. I think the focus should be much more on making the patient comfortable, managing symptoms etc, not intrusive diagnostics and - worst of all - hugely traumatic CPR. After all, death is as much a part of life as birth. Whilst we've come a long way in obstetrics & midwifery, End of Life has trailed behind somewhat. It needs much more funding & more discussion.
Anyway, off the soapbox now. :) Have a great christmas, Carla. And thanks so much for all your support.
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