Death is rarely a pleasant topic. People generally fear it, more often than not because they can’t bear the thought that they may suffer.
But Dr Kathryn Mannix, who works in palliative care and is the author of With The End in Mind, is hoping to break the taboo after an honest and open talk about the very thing we often shy away from thinking about.
Dr Mannix sat down with BBC ideas to discuss death – in particular, what happens when someone passes away peacefully: “In my humble opinion, dying is probably not as bad as you’re expecting.”
The way that we talk about death or rather the many ways that we don’t do it, she explained, is the key to the issue. We usually don’t know what to say when someone dies and are thus unable to approach the situation without fear, which is counterproductive.
According to Dr Mannix, the conversation around death doesn’t need to be uncomfortable. “We’ve lost the rich wisdom of normal human dying and it’s time for us to talk about dying and reclaim the wisdom.”
Mannix discusses the pattern of a peaceful death, comparing it to childbirth. “Dying, like giving birth, really is just a process,” she says. “Gradually people become more tired, wearier. As time goes by people sleep more and they’re awake less.
“Sometimes a visitor might come in or medicine might be due during that sleep and that is when we can discover that a change has taken place, it’s tiny but it’s really significant – instead of just being asleep, this person has temporarily become unconscious.
“When they wake, later on, they tell us they’ve had a good sleep, so we know that this coma doesn’t feel frightening. That lapsing into unconsciousness just isn’t noticed by us when it happens.
“So, as time goes by, people are awake less and asleep more until they’re eventually just unconscious all the time.”
Ever heard of the death rattle? It is associated with being scary, morbid and uncomfortable – but Dr Mannix says that’s not what the phenomenon is like and why it shouldn’t be feared.
From the perspective of the one dying, she says: “We will be so relaxed that we won’t bother to clear our throats, so maybe we’ll be breathing in and out through little bits of mucus or saliva at the back of our throat, which can make a rattly, funny noise.
“People talk about the death rattle as if it’s something terrible, but actually, it tells me that my patient is so deeply relaxed, so deeply unconscious, that they’re not even feeling that tickle of saliva as the air bubbles in and out through it from their lungs.”
The build-up to death is one thing but according to Dr Mannix, even the last few breaths drawn by someone can be a peaceful experience. “At the very end of somebody’s life, there will be a period of shallow breathing, and then one out-breath that just isn’t followed by an in-breath.
“Sometimes it’s so gentle that families don’t even realise that it’s happened.”
Dr Mannix says that as soon as conversations around death are normalised, consoling someone after they lost a relative or friend will become significantly easier.
She describes death as “something that we can recognise, something that we can prepare for, something that we can manage”. Therefore, it should be “something that we can celebrate”.”
“Dying is something we should be reclaiming, we should be talking about, we should be consoling each other about,” the palliative care doctor concludes.