Kathryn Mannix works in a hospice as a consultant in palliative care. Her still small voice of calm experience exudes wisdom, humility and respect. At its most obvious level death is a sad subject because it involves the loss of people we love. But I found this book enlightening, uplifting and positive.
She observes at the outset that modern western society has turned death into a taboo subject. When people routinely died at home, everyone had experience of death and recognised it as part of life just as birth is. Now that so many deaths are hospitalised and out of sight people are frightened because, for many, it’s unknown territory. And euphemistic language – “passing away” and other coy expressions – simply compounds this. We need, Mannix argues very convincingly, to talk about death openly and honestly. It is a universal inevitability, after all. And I was intrigued by her wry observation that there are only two days in your life which don’t have twenty-four hours.
Most of With the End in Mind consists of case studies (permission sought, names changed etc) detailing people Mannix has worked with at all stages of her career – including patients with cancer, heart disease, and degenerative conditions at all ages. There was, for instance, a devout Muslim couple who rejected pain relief for the young wife, mother of eight, because they mistakenly thought that a colleague of Mannix’s had sacrilegiously suggested that he knew better than God. Mannix, who always sits down, and often drinks tea, with her patients, somehow found the tact to convince them that she and her team regarded every day as a gift from God which enabled the patient and her husband to change their minds.
Also in the mix is a sporty, youngish man, former local pin-up boy with cancer and needing help with guilt and anxiety about “deserting” his family. In the end it transpired that his sons aged 10 and 8 had worked out the truth for themselves. Or take the retired couple who both knew that the wife had cancer – and discussed it separately with Mannix – but, trying to be to be lovingly protective, hadn’t found a way of talking to each other about it. There are examples of camaraderie between afflicted families and strong friendships between patients too. Or what about the lonely man whose cat Mannix is pressurised into adopting, having taken it into the hospice each day to sit with its human? Each chapter is preceded by some general remarks which underline what Mannix learned from working with this individual and, usually, his or her family.
Death, apparently, is almost always gentle. First there’s coma. Then the breathing changes, slows and eventually stops. Now I watched exactly this process, crouched by the bedside holding his hand, when my husband died in 2019. I thought we’d been lucky that the end was so peaceful. I had no idea that this is how most lives end. It’s the norm. And that’s very reassuring. I also learned that sinking into a coma – becoming unconscious – is crucially different from falling asleep. The latter is a consciously temporary state. The former is not.
Moreover, modern pain relief is excellent. You don’t have to suffer. Neither do you need to feel drowsy. It can restore at least some quality of life in the weeks before the final decline. And that cheered me up no end too.
Cards on the table: I am in my late seventies so I suppose I’m proabably in the last decade of my life. I am terrified to think about what this involves. Letting go is not in my nature. So I deny it by racing about working, playing my violin and refusing to ease off as if I can outwit death by not giving in. I am, moreover, fortunate to have excellent health. There is nothing wrong with me at present and I am not on any sort of medication. I joke to anyone who comments on it that my robustness is down to 75% vegetables and 25% luck. But of course the suppressed, common-sensible bit of my brain murmurs that this situation cannot last for ever.
I have never openly admitted this before – especially the fear. And it feels a bit like, I suppose, “coming out” must do. Very healthy and honest. Phew!
So Mannix’s book has dented my mindset and made me feel better about life and deeath. I’m deeply grateful for that.
While I was reading With the End in Mind, I found myself sitting, chatting, in the kitchen of a family I know well. “How’s your dad?” I asked the father because I knew Grandpa had not been at all well. He stood up behind his son, 11, caught my eye and silently shook his head to shut me up. He was trying to protect the boy from the painful truth about a beloved grandparent. When they’d left the room I got talking to the wife. I told her about Kathryn Mannix and gently suggested that her husband needs to be honest with their son about Grandpa’s health and where, at some point, it will inevitably lead. Planning and saying goodbye are very important. “Oh I think they’re both in denial” she said and shut the conversation down. It was (is) a classic situation.
This book was recommended to me by a community nurse I know. She, obviously, is involved in a fair amount of end of life care, I honestly don’t think she was subtly telling me that I need to confront my own mortality. She simply knows that I read a lot and thought I’d find this book interesting, which I did.
And as for facing death well, yes, I feel much more empowered about it now than before. That’s why I think this is a book EVERYONE should read.
Next week on Susan’s Bookshelves: Uncle Tom’s Cabin by Harriet Beecher Stowe
