Some musings

‘Mortui vivos docent’
(The dead teach the living)

You never forget your first.

His was the last bed on the left, at the very end of the ward. As a medical student, he had been allocated to me at the start of my first clinical attachment and it was up to me to get to know him and familiarise myself with his treatment. He didn’t say much. Maybe that was because of the no doubt awkward way I spoke to him as I dutifully asked him how he was each day and tried to prepare myself for the questions that would later be asked of me on the weekly teaching ward round.

Or maybe it was because he recognised what I hadn’t, that he was becoming increasing frail and was no longer able to do what once he could. Maybe it was because he was aware of what I was not. Maybe it was because he knew he was dying.

And so it was that when I arrived one morning at his bedside with all the paraphernalia necessary to take his blood, I was surprised to find his bed empty. After waiting the few minutes it took to establish that he wasn’t visiting the bathroom, I asked one of the nursing staff where my patient was and was rather taken aback to be told that he had died in the night.

Thinking back it seems foolish now but I don’t think I’d appreciated then that medicine couldn’t always make people better and that even those in hospital sometimes died. Over the ensuing 35 years I have of course realised the truth, the lesson of that autumn morning in 1987 being repeated with disturbing regularity. Perhaps it needs to be because, though I hope I’m not as naive as I once was, I sometimes wonder if medicine and the world in which I practice it, is. Perhaps more so than it was back then.

Now don’t get me wrong medicine should indeed make every effort to alleviate suffering and prevent untimely death, but to imagine that it will be wholly successful in such endeavours is simply unrealistic. Furthermore, busying themselves in trying to do the impossible, those charged with delivering healthcare won’t have time to do what medicine actually can.

But even though I played no useful part in his final days, at least my patient died in a bed on a ward where those looking after him weren’t too busy to notice. In that respect he was fortunate, receiving what some are now in danger of missing out on.

Writing in the BMJ this week, one time GP, John Launer, reflects on the decline of the NHS that has taken place over the last decade. As one who is getting older he says ‘I’m frightened that I’ll end my days on a ward where the staff, however hard they try, won’t have the time or resources to give me the care I need, either to cure me or to relieve my passing.’ [John Launer’s full article can be read here]

These are sobering words – words which, as well as his own fears describe the real death experiences of far too many others. And something needs to change if it’s not to become the experience of far too many more. We need to recognise that the NHS is becoming increasingly frail and is unable to do what once it could. We need to be aware that the NHS is dying. And rather than allowing those in power to complete a DNAR form without consulting with those who love it most, we need to start caring for it better.

What then must be done. First, and perhaps foremost, investment in the NHS is undoubtedly required if it is become once more what it was before, somewhere where one could have confidence that you’d be treated well, not only as a patient, but as an employee too. Only then will there be the workforce necessary to deliver the care that is required.

But equally important will be to recognise that death is not avoidable and that irrespective of how many pills it encourages us to pop, medicine will never be able to give us the eternal life it persists in trying to deliver. Furthermore, we need to stop compounding the suffering that some people experience by slavishly trying to prevent what has, for them, already become both inevitable and imminent. Manage this and not only will many be spared an undignified end but those we need to be there to tend the sick will find they have time to do what really needs to be done and, what’s more, be able to do it well.

Best of all, when our time comes we too may be afforded the very great privilege of being allowed to die, not on a trolley in the corridor of an A&E department, nor indeed in a bed on a hospital ward, but in our own homes surrounded by those who we love, and are loved by, most.

Because for my last death, such would be the one I’d choose.

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John Launer’s BMJ article can be read here

To read a review of Dr Lucy Pollocks excellent book entitled ‘The Book About Getting Older – for those who don’t want to talk about it’, click here

Other related posts:

To read ‘The Dead NHS Sketch’, click here

To read ‘The NHS Emporium’, click here

To read ‘Bagpuss and the NHS’, click here

To read ‘With time running out’, click here

To read ‘Wither tomorrow?’, click here

To read ‘On Approaching One’s Sell By Date’, click here

To read ‘General Practice – is time running out?’, click here

To read ‘Paddington and the Ailing Elderly Relative’, click here

To read ‘Friday, Bloody Friday’, click here

To read ‘On being overwhelmed’, click here

To read ‘On Not Remotely Caring’, click here

To read ‘Contactless’, click here

To read ‘An Audience for Grief’, click here

To read ‘The Abolition of General Practice’, click here

To read ‘Vaccinating to remain susceptible’, click here

To read ‘The NHS – the ‘S’ is for service, not slave’, click here

To read ‘General Practice – still a sweet sorrow’, click here

To read ‘The Life I Lead’, click here

To read ‘When “Good enough” isn’t good enough’ click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘Something to reflect on – are we too narcissistic?’, click here

To read ‘Too busy to be happy?’, click here

To read ‘On keeping what we dare not lose’, click here

To read ‘Health – it’ll be the death of us. Is there institutional arrogance in the NHS?’, click here

To read ‘On being crazy busy – a ticklish problem’, click here

To read ‘From A Distance’, click here

To read ‘I’ll miss this when we’re gone’, click here

To read ‘Don’t forget to be ordinary, if you want to be happy’, click here