Blog 2018-4 Passing to another subject …
Have you noticed, as I have, that in recent years, the language of public discourse regarding death has become increasingly euphemistic, polite, ‑--even sanitized? Almost invariably, news anchors or public safety agencies' Information Officers will speak of 'the deceased' or even 'he deceased."
TV detectives will quickly say "I'm sorry for your loss" as easily as the phrase "Thank you for your service" has become so common as to be trite. This is not to say that the intention or meaning is less heartfelt. The phrasing has become ritualized. A web search reveals that many persons find the phrase banal, but others find it a convenient phrase when they might otherwise be at a loss for words. By comparison, the other common phrase, "he passed", almost seems forthright. But where is the frank and homely honesty of "died"?
Those who are experienced in end of life care and palliative care, or who advise on 'giving the Death Tell' say that it is important in the conversation to include the words died or dead so that the family can begin to accept what has happened.
Death has always been an uncomfortable subject, Are we less able to deal with it than formerly? Perhaps, so. Families, now urbanized, no longer have many children (In the past, people might say "Mrs. Jones is so fortunate. She's had eight children, and six have survived.") and there are fewer multi-generational extended family households where one continuously sees birth, maturation, aging, and death close at hand. One might reason that secularization affects the nature and quality of consolation and acceptance. The rise of hospital-based care, extended life spans, and a 'funeral industry', have altered how and where we experience illness, injury, and death. It is no longer common for families to prepare their own dead for a service at home and burial. We are mostly removed from the intimate experience of a cycle of life and death; we do not even think of it as a cycle.
Shakespeare's Julius Caesar voiced the words:
"Cowards die many times before their deaths;
The valiant never taste of death but once.
Of all the wonders that I yet have heard.
It seems to me most strange that men should fear;
Seeing that death, a necessary end,
Will come when it will come."
Julius Caesar: Act 2, Scene 2, Page 2
To me, it seems that the important part is not Caesar's soldierly bravery in risking his assassination, but that he comprehends that death is necessary to all life, and his fatalistic acceptance.
The person greatly affected in this scene is Calpurnia, his wife, who pleads and cautions him not to go. For us, then, there are two parts, how we speak with the patient who is confronting his death, should he be aware, then telling the family what has occurred. More often, it is the latter with whom we deal. They are the ones who must receive the news, pluck up, and make arrangements. It is they who are our patients for the while.
I do not feel that we, as health professionals, become inured and hardened to what we see before us or fail to note the significance to loved ones. I do feel that we can, warmly and frankly, say "I'm sorry, but he has died." Our manner can be helpful, and our honest words can be therapeutic.
Orman, Rob, MD. The Death Tell. ercast.org. Monday, March 8, 2010.
Tom Trimble, RN
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