Working in a hospice made Thomas Mcanea think about how he would like to die

It's an occupational hazard that both in training and during our working lives we will often be exposed to death. As house officers we can expect to certify patients, in accident and emergency we may lose patients. For aspiring pathologists death and mortality will be our daily bread. In fact, none of us are likely to escape some experience of death in our chosen profession.

I found myself considering my own death, perhaps for the first time in my life, when I went to my local hospice for a two week placement. I didn't know what to expect but thought that I would gain a useful insight into dealing with death.

It took me a while to register that all of the patients were dying. Of course there were some who were visibly very ill and looked to be near the end. However, there were others who seemed to me to be so full of life. I can't think of another way to describe how they seemed to be so positive, so friendly, and outgoing. I saw little of the fear and pain I had expected.

The patients were very positive

As the days passed I began to realise why these apparently terminally ill patients were generally very positive. The atmosphere struck me as different from anything I had experienced before. I couldn't pin it down until I asked some of the staff and the patients who talked about keeping positive and celebrating life. They explained it as not giving in to death or fear but to try to keep a sense of control and accept their circumstances. The point was made to me more than once that we are all dying, just some quicker than others.

There were days when people felt overwhelmed by circumstances, whether it was due to pain, or worries about relatives, or the unknown. There was the full spectrum of human emotion in evidence, sometimes from the same patient (or even staff member) in the one day. The support and help provided by the staff and the effect it had on the patients and their relatives humbled me. The secret seemed to be in the personal touches, in giving people a sense of control over their death, and how they wanted that to be. One staff nurse told me of one patient who had wanted her pets to be present when she died. For others it was in being able to personalise their surroundings with keepsakes from home, photographs, duvet covers, soft toys, and so on.

An important factor was the staff to patient ratio

There are far more staff members per patient in a hospice. The nursing staff had all trained in hospitals at one time and almost all spoke of how different the experience was. The system is far more informal and less hierarchical. The pace is less frenetic. I think the medical director summed it up best when I asked him what he tried to achieve. He listed three things: to keep the patients pain free and as comfortable as possible, to give them a sense of control over their own life and death, and to maintain their dignity.

When I thought about this later it occurred to me that at the end of our lives no one could wish for more. It struck me that for all the staff it was about patient first, second, and third. I realised then that if I could adopt and keep these principles true then I might make a decent doctor some day. For the first time in my life I thought about how I might like to die.

I built up a rapport

About ten days into the placement I had built up quite a rapport with a few patients. I'd spent time talking to them, listening to their stories about their youth and various experiences. I quickly grew fond of the people I met there. One day, in the course of the morning nursing duties, one man passed away quickly. The nursing staff were soon all around the man, preparing him for his relatives to arrive, still calling him by his name and treating him with the same care and respect I'd seem them do every day when he was alive.

I'd just been chatting to this man and now he was gone and I was helping to change his pyjamas. He was still warm. Some staff had tears in their eyes but maintained their professional approach and did their job.

Later over tea we were encouraged to talk about it. I wasn't sure how I felt, but I remembered feeling a bit numb and feeling very sorry when I saw how distressed his family were. I had known this man for just over a week but I couldn't escape the fact that I'd bonded with him on some level.

I guess that in the end I had one big revelation in learning to cope with death. It's something that we're probably all aware of in the back of our minds but seem to gloss over until it really matters. I learnt that it's not only how we live our lives that is important but also how we die.

For all of us, life and death matters.