Oftentimes people are dying while we live about them, amongst them, in front of them. Oftentimes people are almost dead when I meet them, thus the meeting is quite one sided. Oftentimes people die on the ward – families request this more often than you would think. I have not yet seen the exact moment when this happens, nor do I really believe that death happens in any one moment; I take it to be more like a process, a steady progression in gradual increments towards the place where change ceases.
Every morning that I work the ward I have a stroke list, of all the patients currently on the ward, which I use to keep track of who needs testing and who to leave alone, for a multitude of reasons. Some health related; it’s bad practice to test someone who is medically unfit, as their cognition is unlikely to be at a post-stroke baseline if their body unwell. Some behaviour related; understandably, people become disoriented, confused, agitated, aggressive even, when living on a ward, and in these situations it is also bad practice to attempt testing. Then some are deemed ‘inappropriate’ because the patient is categorised as End Of Life. Is the official reason because we are respecting their last days living or is it an acknowledgement that investigation will be fruitless no matter what? I have never asked.
Tacked on to that is sometimes ‘Last Days of Life’, in which all medical efforts are palliative and geared towards promoting comfort, rather than on improving health. It all makes sense and it is kind and it is right, but it still strikes me, strikes me and moves me and is still.
When death is far away, as it usually always is, it can become magical, unreachable, inconceivable; it can be poetic it can be beautiful even – it can be a brutal and black full stop and it can be a golden question mark and it can be a long night and it can be a final and free morning.
When death is an old and tired human tucked away in a side room staring into the walls – it loses all external qualities. Death suddenly just is. Just a part of life on the ward; make the sure paperwork is done, make sure the family is informed, make sure no one bothers this dying human while they are busy making death.
It is strange how we laugh about it – the amount of jokes that doctors and healthcare professionals of all walks of life make about death and the dying first startled and somewhat disgruntled me; I suppose my warm sensibilities lend me to outrage and disgust in the face of mocking the dead and the almost dead, but I feel that I am coming to understand the drives behind it, and that I have shed such naivety. Those who confront, walk with, talk with death on a daily basis have every right (to my mind) to laugh at it, to make jokes at the expense of those in the last days of their life. Surely (surely!) it is the only thing we all have in common – the destination that we are all propelled towards, the place that we will all one day know.
If we didn’t laugh, just what would we do? If we didn’t take it in stride and walk with it, just where would that leave us – and where would that leave it? Would we be rendered unable to communicate about the end and thus to appreciate the middle – would it retain and expand upon its mysteries, would it become obscured under a shroud of untouchable, unspeakable, unknowable?
I no longer feel that ‘if we didn’t laugh we would cry’ – it’s not a case of cloaking pain with humour. Witnessing death doesn’t always hurt, it isn’t inherently sad, it isn’t intrinsically painful. It’s a case of acknowledging it, and integrating it with life: if we are laughing about it, it is real; if we are laughing about the same thing then you see what I see, you know what I know; if we are laughing about it, then it is okay to laugh, it is okay to feel; if we are laughing about it, we are definitely alive.
I have no conclusion, and I hope you’ll understand my present disinterest in favouring, elevating or attributing significance to conclusions. I have been writing – now I will stop. And that is okay.