Tuesday, 19 February 2013

Hospices and other lessons from death

An Italian doctor once explained to me that hospices were a particularly British creation, designed to gently illustrate the inevitability of death for those getting closer to the inevitability. Hospices bring with them a new set of norms, helping the transition from what have been our everyday behaviours and thoughts. For our famously stuffy island nation, the Italian thought it a remarkably progressive approach to death. Whether or not this is so, it’s the sort of idea I’d have happily left untested, to have taken his word for it rather than to take a look for myself. This new year I had my first experience of a hospice, when I spent a few days with a relative suffering advanced cancer.

I didn’t have any pre-existing opinions of hospices, only what I’d deduced from their heroic reputation as places where humanity secures moral victories over death. The other side of the experience and I’m still not entirely sure what I think; as with many issues surrounding death, a dominant theme is a general sense of confusion for those left behind. Foremost it is obvious the patient’s peace of mind becomes the primary concern in the healthcare on offer. There is a drinks trolley, so a patient who has spent three years under a strict diet aimed at resisting the spread of cancer can have a gin and tonic again. I know of a woman who spent a year with her husband in a hospice, but for the most part, with hospices the thinking is that the struggle is over and the patient should be able to enjoy the last of their living. Despite the very human intent, however, there is no escaping the fact that hospices are still institutions. There are the endlessly repeating tiny triangles on the floor of a carpeted lobby, the disinfected smell, the corned beef sandwiches and the pneumatic mattress that hisses on the bed beneath you. That a bank can profit from making lives harder, and then sponsor the bed in which you die, seems like a particularly impersonal touch. It’s not hard to see why statistics show people prefer dying in hospices to hospitals, but most of all would like to die at home.

Since the new year, Baader-Meinhof style, hospices seem to be jumping out at me. There are the change boxes on the newsagent counters, chosen charities behind supermarket checkouts, what grabbed my attention most was a headline in a local paper, announcing that hospices had the highest satisfaction rates of any area of the NHS. Looking into the statistics, I find that 20,000 of us will die each year in a hospice, about 4% of all deaths. Although heart and kidney failure present a small minority of cases, almost all these deaths will be the result of cancer. The charity, Help the Hospices, corroborated the newspaper headline for me, they cite research showing 97% satisfaction rates amongst those whose loved-ones have received care in a hospice.

Judging by what I saw in the hospice I visited, I don’t find this surprising. The reception desk was covered in ‘Thank You’ and Christmas cards, I heard the relatives of another patient talking of how they felt the staff had become their new family. I have to agree that the staff were very attentive, they were very nice, they could have done better with my relative’s requests that his soup be bought in a mug rather than a bowl, but it would be a cruel critic that judged them for as much. At the same time, I wasn’t exactly blown away in the way the reputation might lead one to expect; to be honest, the style and standard of service didn’t seem particularly removed from that I’ve experienced and seen elsewhere in the NHS. Hospice staff have the advantage of a less urgent and less expectant working environment, but in saying so I’m not trying to either elevate the staff of the regular NHS or criticise those of the hospice.

It’s the part about expectations that I find most interesting, and the satisfaction statistic actually reinforces what I felt in a previous job delivering flowers in London. Delivering flowers involves a lot of hospitals, probably about one a day on average. Over the course of eighteen months I became familiar with both London’s NHS and private hospitals, in the latter of the two you find the undignified spectre of a cashier, and one indication of the high-end clientele is that signs will sometimes appear in Arabic as well as English. In both types of hospital, however, and overwhelmingly in the case of the NHS, I was aware that I found most of the traits that people generally bemoan the loss of from our daily lives. Of course there are also the posters that warn graphically against abuse of staff, but I never witnessed any abuse, while what I saw regularly were places where people hold doors for one another, where people take the plunge and start the conversation with the stranger in the lift, where people smile – uncertainly, but a smile nevertheless – at the unknown stranger walking the other way down a corridor. As a society we can be so disgustingly impatient where even the most inconsequential seconds and milliseconds are concerned, and in a hospital you will find people waiting two patient hours for a heart scan because they understand the hospital is short staffed. As much as it is the staff that form the atmosphere of hospitals and hospices, it’s the patients and the visitors who make them remarkable places.

None of this is very much like empirical research, and I certainly don’t say it to lessen the dedication of the staff, but even more than their tenderness I’d say something else is at play in our hospices. In hospitals people still have expectations, still have demands, patients might still hold-out on the magical disappearance of their every ailment. To paraphrase the French novelist-physician, Louis-Ferdinand Céline; they want us to make poetry from their every fart, Céline remarked that nobody ever got sick the day before a long weekend. Come the hospice it’s past that, hope fades into reality and the dark truth is that death is good for people, it brings out the best in us all, it’s only a shame it can’t happen more often and a little less painfully. If life constituted our dying at the age of forty but somehow resurrecting to live out the rest of our days conscious of that first death, I’m sure the world would be a better place for it. Hospices in particular benefit from the blessing of diminished expectations, when life becomes little more than continuing to live, and the material worries and rituals we allow to ruin so many years of our lives have all evaporated into the nonsenses they always were.

Inadvertently it’s impossible not to learn from the dying and the sick. Forget yourself, consider someone else’s situation a while and they show you what a miracle your own life is. Whether that miracle is perceived in scientific or religious sense, anyone determined to analyse all shred of beauty out of human existence should hurry up and donate their organs to someone a little more appreciative. In a hospice you see clearly how vulnerable we humans are, you become grateful for what you have, empathetic towards others, and if our society wants for many traits then perhaps we lack these two most of all. The dying give us pangs of mortality guilt, a suffering to show up our own and put it in its rightful place. It’s only right that we work hard to allow our loved ones to die with dignity, but perhaps the most fitting way to honour their memory as a society would be to try as hard to live with it. Generosity of spirit is implicit to human beings, the biggest tragedy is that we wait for death and suffering to bring it out of us.

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