Today, the conversation in our practice was mainly about end-of-life conversations. Asking and assessing what people understood about allowing natural death or those very clinical words ‘do not resuscitate’. Particularly in general practice, talking about death and dying is as fundamental as talking about life and living.
Perhaps, after this pandemic, talking about end-of-life will feel as it should – empowering. Observing end of life is like watching an hourglass lose the last grains of sand. Knowing people helps to discuss wishes for those last few years, months, weeks or days.
I remembered my Mum, who loves gardening and cooking. She would buy end-of-season flower beds that looked weak and vulnerable, almost dying, but she would get seeds and nurture them. With a bit of love and time, they grew. My Mum used to say: ‘don’t pick an apple off a tree at night when it’s sleeping – it’s not ready to be picked. When it’s ready, it will fall’.
It reminded me of the nursing home I look after with my colleagues and the vulnerable patients I see. End-of-life conversations and planning can be done with respect and kindness. Often, people seem surprised as to why we’re asking their plans or wishes. It’s a fine balance.
Observing end of life is like watching an hourglass lose the last grains of sand
One case stood out to me. On the way home I delivered medicines picked up by our receptionist, as the pharmacist couldn’t deliver anymore. The clock was striking 8pm, and residents stood at the doorstep clapping and banging pan lids. The patient I was visiting had mesothelioma of the lung, and just a few days or weeks left to live. He stood with his hand on his heart mouthing: ‘thank you’. He was deaf so a phone call was hard, and had deteriorating vision and no smartphone, so I couldn’t do a visit on a video call. So, it felt good to do a palliative care visit, even if it was through the window.
One of my favourite books is A Fine Balance by Rohinton Mistry. As a GP, it’s about knowing when life is coming to an end, when there’s more life to live, and having those conversations. Setting the scene is really about understanding each other and their lives.
These conversations don’t need to be difficult, and they need to happen. They can be hopeful, about valuing and respecting the end of life too. Rabindranath Tagore, a Bengali poet and philosopher once wrote: ‘Death belongs to life as birth does. The walk is in the raising of the foot as in the laying of it down’. It’s a fine balance gathering the information, understanding the evidence with compassion and getting clinical decision-making right, remotely or face-to-face. It’s also a privilege.
Dr Salma Ahmed is a GP partner at The Jubilee Street Practice in Tower Hamlets, London