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The Ghastly Passage


Posted on 01 March 2013

henry_scott_holland.jpgWithout so much as a hint of irony, a character in one of Susan Howatch’s novels gives orders that under no circumstances should that ghastly passage by Scott Holland be read at her funeral. The ghastly passage is Death Is Nothing At All:

“Death is nothing at all. It does not count. I have only slipped away into the next room. Nothing has happened. Everything remains exactly as it was. I am I, and you are you, and the old life that we lived so fondly together is untouched, unchanged. Whatever we were to each other, that we are still. Call me by the old familiar name. Speak of me in the easy way which you always used. Put no difference into your tone. Wear no forced air of solemnity or sorrow. Laugh as we always laughed at the little jokes that we enjoyed together. Play, smile, think of me, pray for me. Let my name be ever the household word that it always was. Let it be spoken without an effort, without the ghost of a shadow upon it. Life means all that it ever meant. It is the same as it ever was.”

Whatever the merits of the passage – Dr No quite likes it, even if some see it as sentimental vaporising, which is unfair, because the passage is only a small part of a complex sermon on the paradox of death: it is both everything and nothing – the fact is that for many, the real ghastly passage is that of death itself. Dr No’s mother feared a ghastly passage, which for her meant dying in hospital, tubed up and pumped out. Dr No is relieved to be able to report that she died at home. But it was not entirely unghastly. The modern rule-bound IT-wrecked NHS, and a plod endowed with but two neurones, one in each foot and neither connected, saw to that.

In life, Dr No’s mother was huge and vital character that filled and overflowed any space she was in. Towards the end of last year, and more so in the last few weeks, the machinery that sustained that vast character started to fail. Her lungs became bound by the ties of fibrosis, and the right side of her heart became strained. When asked about prognosis, Dr No first took a quantum line, and opined that prognosis was the original piece of string, whose length is not known until it is cut. Then, as death came nearer, and the reaper could be seen flitting in the shadows, he became more Newtonian in his predictions: she could have died last night, or tonight, or in the days and nights ahead. Death, even if nothing at all, was as imminent, as it is inevitable.

The NHS responded with kit, lots of it. Contraptions abounded. Some had wheels, others had levers, and the centrepiece, a hospital bed with a mattress that rippled, had everything, even a control pad, which Dr No feared his mother, never technical at the best of times, might use to fold up the bed completely, while she was inside it. Morphine was made available, to be given as required – readers of past posts will know Dr No is an advocate of not killing, nor striving officiously to keep alive – even if not much was taken, because the piece of string, when cut by nature, was found to be short. Pathways were planned, forms filled in, care sort of coordinated some of the time, and boxes, ever so many boxes, ticked.

Among the forms was one that mattered: the DNR – do not resuscitate – order. Dr No’s mother was dying, and in the event of her collapse, attempts to resuscitate her would be both futile and burdensome, an officious yet pointless striving to keep alive. The original purple order was placed near her, at the front of her notes, and the order propagated through the system, to the out of hours and emergency services, to forestall unnecessary heroics.

Or so we thought: in fact, it wasn’t. When Dr No’s mother collapsed in the early hours one morning, her live-in carer (Dr No was at home, taking a rest after four days of chaos), previously frustrated by the dallying ways of 111, understandably dialled 999. Red lights went on, and blue lights started flashing. Paramedics were dispatched, police called to the scene, and the 999 operator gave immediate orders to start cardio-pulmonary resuscitation. Instead of being allowed, as intended, to die peacefully, Dr No’s mother was subject to the panoply of a response befitting the unexpected collapse of a fit twenty year old, all because of an IT failure. The DNR order, intended to forestall unnecessary heroics, had got lost; and the live-in carer, lest you be in any doubt about the gravity of the situation, was ordered to assault - assault, because that is technically what it was, if Dr No's mother was still alive – Dr No’s dying mother, an act as unkind as unfair to both carer and patient.

The paramedics, faced with a flat ECG and the original DNR order, did the right thing and confirmed death. Plod was less bright. Pronouncing it unexpected, despite all evidence to the contrary, he turned the death into a Coroner’s case and, as he later put it to Dr No, seized the evidence, in case of foul play. With plods like that, Dr No wonders, who needs Clouseau? The body was taken to the mortuary, but never mind that she ended up in hospital after death, for what mattered most to her was achieved: she died at home.

It took a few days to extract Dr No’s mother from the Coroner’s system, because plod, after seizing the notes, then managed to lose them, but extracted she was, and without a post-mortem. Earlier this week, her body was cremated. Was her death nothing at all? Of course: to Dr No, she is still that huge spirit that fills and overflows any space she is in. And yet it is also everything, for she is gone, finally and forever. It is both everything and nothing, both brutally finite and wonderfully infinite.

13 comments:

I offer condolences on the loss of your mother Dr No.

Your mother will continue to be a ‘huge spirit that fills and overflows any space she is in’ for some time as she is as much a part of you as you are of her, and, when you are comfortable, she will slowly slip into the shadows, content to exist forever in your memories.

I am saddened to hear that IT failure resulted in futile attempts at CPR and the resulting, unnecessary, upsetting chaos that ensued. The natural end of life deserves the same respect and comfort given at its beginning – death deserves as much honour as that given to life. CPR does not honour death, affords it no dignity.

My thoughts are with you Dr No.

Anna

So sorry for your loss. To lose your mother is so very, very sad

Sorry to read of your loss.

Sorry for your loss. It's true she remains around

Dear Dr No,

So sorry for your loss. I thought something had happened as you hadn't posted for a while.

I'm not a fan of the ghastly passage myself. I think sometimes that our society has robbed us of grief as an emotion; instead of seeing it as something with its time and place, it is aberrant and everything has to be cheerful or philosophical re death. It just doesn't work like that; it will not be pushed away. But it does ease and after a while it is almost like the person comes back. Rather alarmingly, I have become more like my mother since she died - or maybe I just found her within me and didn't realise she was there all the time. What I have found to be true is that those we love never truly leave us. And in that there is consolation.

.....rather find
Strength in what remains behind;
In the primal sympathy
Which having been must ever be;
In the soothing thoughts that spring
Out of human suffering;
In the faith that looks through death,
In years that bring the philosophic mind.

My sincere condolences.

May time ease your pain.

Heartfelt condolences on your loss Dr No. Thanks for another fantastic piece, sorry that it involves such loss.

Sorry, but unsurprised , at how your mother died.

There is a sort of immortality in memories, and in the effect that the deceased has had on others, whatever else happens when the ghost leaves the machine.

Best wishes

Boots

Thank you all for your kind words.

Today is Mothering Sunday, the day we gather to thank and honour our mothers. Dr No has many happy memories of past Mothering Sundays, from early ones of gathering posies of flowers from the garden in spring sunshine, to later ones, like the one three years ago when, at his mother's house, he wrote a post about another mother he had once known, and of whom he also has warm memories; none of these memories shall wither or fade. Tomorrow, at the eleventh hour of the eleventh day, but not the eleventh month, many who knew her will gather to remember Dr No's mother, at her Thanksgiving Service. The last thing she wanted was an Auden affair, with clocks being stopped, and stars put out. So, whatever the weather may do, the daffodils are in bud, and spring is on the way. Her huge spirit will shine, and throw light on the day, and come night, her star will twinkle forever in the dark.

Condolences, Dr N.

Only just run across this, as I've been less blogospheric than usual for similar reasons - my father died a fortnight ago, late on the night of the 6th. He was a bit luckier than your mother in his end - though he was in hospital, having been sent for an ECG after 'feeling funny' that morning, it was very swift when a major infarct sent him into failure and carried him off. It was how he always said he wanted it, but the suddenness of it is still hard to deal with.

Anyway, thanks for writing this - both everything and nothing indeed. You keep expecting them to telephone, don't you, or thinking of something you wanted to ask them. But now you never can - though perhaps you can imagine it.

Please accept my sincere thoughts - the loss of a parent is devastating. They were our guiding light, our comforters and our biggest supporters.

I am saddened to read that your Mother had to 'suffer' being resuscitated when there was an active DNR - Do Not Resuscitate - Notice.

Similar events occurred with my Father.

Interesting that the Police pronounced your Mother's death as unexpected, despite all evidence to the contrary and turned the death into a Coroner’s case!

Its all the wrong way round, upside down and all to cock!

As you are fully aware my Father's case [he died in January 2006] has criminal aspects [alterations to Controlled Drug Book] but in 2010 the Police refused to investigate a crime!

As you now know, in March 2012 South Yorkshire Police began an investigation into the misappropriation of controlled drug which is still on going...

I will keep you informed.

Take care - I am sure that your Mother [and my Father] are just in the 'next room'!

I am sending you this message to deliver my personal condolences to you and your family at such a difficult time. We are just a call away for any kind of assistance that you may need.
Cathy,
Obituarieshelp.org


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