Dying, alone or not?

A weighty topic ...

I have a feeling that, to some extent, we all will die "alone" -- even in the presence of other(s) -- but my choice certainly would be to have the other(s) present.

I haven't yet been present at a human death, my only direct experience with death being with a lovely dog Clyde, who had been very ill, and finally took one last look into my eyes before suddenly expiring on my lap. Dogs are very expressive creatures, aren't they, and I think he realised that something drastically different was happening to him

I wasn't present for my father's death, which might have been alone in a hospital cancer ward (his earlier smoking caught up with him), and I thank that my mother was alone when she died at a nursing home in Frankston.

- - - - - - - - - - - - -  For those without access to Australian newspapers  - - - - - - - - - -

These conversations are among the hardest I have had as a doctor

         Dr. Julia Corfield (The Age - 26 August 2020) 

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It's a cold Saturday morning in Melbourne and I am a doctor at work in a palliative care unit. I have just reviewed one of my patients, whose body is beginning to reveal some of the tell-tale signs of dying.

His son stands over him and sadly remarks that “this is a bad time to die”.

 

With strict visiting restrictions firmly in place across Melbourne, there is a very real chance that his father will die alone and he knows it. This is the new normal.

In a state of disaster, there are a set of rules and visiting restrictions for families and friends of those dying in a hospital setting. These restrictions vary slightly between health services, but the message is the same: as few visitors as possible, for as short a time period as is reasonable.

 

For months now, hospital staff (myself included) have been chanting the mantra of seemingly arbitrary visiting windows, maximum numbers of visitors per patient and numbers of visitors permitted at the bedside.

In recent times, I have found myself asking questions such as “do all six of your siblings need to visit?” or “could your grandchildren say their goodbyes via FaceTime?”. These conversations are among the hardest I have had as a doctor.

 

Many find these new rules unacceptable, and with good reason. Few people want to die alone, and even fewer want their loved one to be alone in the final weeks, days and hours of their life.

However, these are not normal times, and a balance must be struck between compassion and safety. Across the world, and now in Victoria, we know that many people with COVID-19 are dying alone; but so are those without COVID-19. Both are tragic realities.

 

Under normal circumstances, achieving “a good death” is laden with obstacles, let alone in a pandemic. An inherent challenge is that a good death is an individualised experience, reflecting the diversity of the human person.

 

There are some commonalities across what constitutes a good death, and the company of friends and family features almost universally.

 

A current patient comes to mind ­ a woman in her 70s dying of lung cancer ­ who tells me almost daily that her breathing is bad but the feeling of loneliness even worse. She would like to see her grandchildren, but no children are allowed in the hospital.

 

Her brother visits, but the allocated two-hour visiting window is not long enough to fill the void created when faced with one’s own mortality. And so on. Her story is not unique.

 

Dying in a pandemic has brought with it new and more challenging obstacles, ones that make us question what it means to be human. Death is normal, but dying alone is not. So, frankly, when I hear my patients and their relatives say that it is a bad time to die, I can't help but agree.

 

Ultimately, how we live and how we die tells us about society as a whole. Today, people die alone to protect society and this at least may be a small source of solace. Their strength and determination to push forward and adapt to this strange new world is a testament to the human spirit.

 

I hope, though, that those dying in this COVID-19 world know that their sacrifice has not gone unnoticed. Every day, their struggles are seen and felt. Many have had to forgo the so-called good death, and that is the undeniable truth.

 

Julia Corfield is a doctor working in palliative care in Melbourne.

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As for me, I'd like to die with a pungent, witty observation on my lips!
Something akin to the following classic:

           Stan Cross (in Smith’s Weekly, 1933, Australia).