Let’s start talking…
For both personal and professional reasons my mind these last few weeks has been much occupied by thoughts of death and dying.
Now before you scroll away stay with me for a while …
It’s always struck me as a strange indictment of our modern living how uncomfortable we are as a society with talk about death. If sex, politics and taxes were the Victorian taboo then death has surely been added to the modern dining table no go areas of conversation. Why is that I wonder? Is it because death has to some extent become a stranger, an occasional visitor we keep standing at the doorstep of our experience?
A hundred years ago, certainly in a Scottish context, the immediacy of death was intimate. Most people died at home, in their own bed, own street and own community. Scottish traditions such as the ‘kisting’ where the remains of the deceased remained in the family home until the funeral and where ordinary living continued around about, made death feel a more natural stage. The average Scot at that time experienced the death of a close family member at an early age but today for many folks their first encounter with bereavement is often in their late twenties.
In December 2015 the Strategic Framework for Action on Palliative and End of Life Care 2016-2021 was published by the Scottish Government. It has a set of ten commitments of which the sixth states:
‘Support greater public and personal discussion of bereavement, death, dying and care at the end of life.’
Later the Strategy describes the danger of the over medicalisation of death –
‘Social and cultural change has resulted in a ‘death-denying culture’ and the medicalisation of death. An entire generation has come to expect that all aspects of dying will be taken care of by professionals and institutions, potentially undermining personal and community resilience in coping with death, dying and loss as part of the ‘cycle of life’.
The Strategy is a real opportunity for us to change the way in which people are supported at the end of life and also to change and challenge popular attitudes to dying and bereavement. In my work I speak to many frontline staff in care at home, housing support services and care homes who day in and day out are engaged in support for individuals who are at the end of their life. Their work is irreplaceable and their contribution to ensuring that people spend their last few days in dignity, with appropriate support and the management of pain and distress is critical.
At times, however, the role of social care staff whether in a nursing home or in the community, is not always appreciated or valued. Yet this is perhaps the most important work any of us can undertake on behalf of another. It is work which has a value beyond calculation but it is also hard, emotionally draining and challenging.
Over the next few weeks and months Scottish Care staff and members will be involved with other health and social care colleagues in working to try to make sure that all staff, whatever their role, feel a sense of support and training to enable them to do this work as best as they can.
One of the first challenges in that is for us all to start talking about death, being open to discussions about mortality, and to help one another to become communities where grieving and bereavement are at the heart of who we are and what we do. There is a terrible conspiracy of silence around death and that silence has to end for the sake of us all.
If we do not as a society and community start considering death and what it means for us all then we are left with a lot of people struggling to cope and all the negative health impacts that result. One of my favourite poems around grief is Nobody ever told me. It highlights just how hard it is for people to talk and be open in this area but equally how the work of the new Strategy is essential in getting us all to share, talk, reflect and be comfortable with mortality.
Nobody ever told me.
Nobody ever told me
it would be this hard;
that I’d wake up in the morning
and think that you were there
lying beside me in our bed;
that I’d walk down the street
and recognise your shadow
following me in the sun;
that I’d listen to the radio
and hear your voice
inviting me to sing;
that I’d sit in the park
and watch you go by
in a group of strangers.
Nobody ever told me
it would be this hard;
that I’d wonder why I should
get up in the morning;
that I’d think making plans
was a children’s playground game;
that I’d rage with anger, red and raw,
at your leaving;
that I’d wonder was it me
who did something
that made you go away.
Nobody ever told me
it would be this hard.
Why can’t someone tell me instead
how I can stop crying
and dam the tears from soaking my pillow?
How I can start again when all I want to do
is rest in our lost togetherness?
How I can ‘move on’ when I only want to settle
in the place of our memories?
And please someone tell me
when will this time come,
the time they all talk of
in easy careless cliche,
the time which they say
will heal all things
and help me to live again?
Donald Macaskill
