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Together in the darkness
"Oh Death, where is thy Victory?" sings the choir, and I look up wearily from my notes and mutter, third bed on the left, behind the curtains, oh, and down in resusc. (the driver from that last car smash did not make it ...).
Like an undertaker, Death has been my business for the last forty years. I have fought it, tooth and nail, thumping silent chest, stemming catastrophic haemorrhage, and even blood-letting in the middle of the night as flabby hearts were overwhelmed by the volume of blood they had to push round an ageing circulatory system. Sometimes I have won, and been rewarded with that sweetest of all gifts: lovers reunited against all odds. And sometimes I have lost, and gone sadly to bed leaving the nurses to tidy up the corpse and comfort the weeping.
The odd thing is, I suppose, how little I am interested in the philosophical side of death, in the "Four Last Things". For me, what matters about death is the fighting, the accompanying of the dying, the comforting of the bereaved and the rehabilitation of those overwhelmed by loss. The other issue which burns within my heart is the way in which fear and embarrassment so often prevent us from giving those facing death the help they so desperately need and deserve.
The problem is, we are all so afraid of death: but then we would not be human if we were not, for death is the great unknown, the best-kept secret, the land from which no one returns, and any other cliché you can think of. We are afraid of death because it is the essence of being human to cling to life and the most primitive fear of all is to be rejected from the tribe, to be thrown outside the city walls with the gates bolted against us. We should not be ashamed of this fear, because that is how we are made, but we should learn to use our fear as a resource for others.
A couple of weeks ago, I took part in a pilot study of a programme designed to teach doctors how to break bad news to patients and relatives. After a period of discussion and didactic input, we set them to role-play themselves and their patients. It was an illuminating exercise, and one which left me perplexed and saddened. These were highly experienced, mature doctors who cared deeply about their patients and yet, watching them role-play this everyday task of telling people that their child had died, or their cancer had come back, I was struck by their lack of warmth. It was as though they were spectators rather than participants, and they did not see it as part of their role to enter into their patient's world. The problem is, that if a person is experiencing great fear or pain and another human being comes alongside but refuses to share the pain, then the pain is not only not relieved, but it is made worse because the sufferer feels rejected.
I came away from that teaching session weary and disturbed, questioning my own way of working and whether I was asking too much of my colleagues, that they should open themselves to the sea of pain in which they spend their working lives. On the one hand it seems too much to ask of doctors and nurses that they should render themselves vulnerable to such pain and yet, the more I get to know dying patients, the more I realise that what they really want is that their carers should really care about them.
It is quite illogical of course. We are trained and paid to diagnose and treat disease, to relieve pain and to ensure that, when our efforts are defeated, our patients have as "dignified" a death as we can stage-manage. Is it, or is it not, asking too much of doctors and nurses that they should lower their defences so as to have empathy with those they treat? It is important here to be clear on the difference between sympathy and empathy. Sympathy is being sorry for and is a cheap grace. Empathy is feeling with and is a very costly grace indeed. Carl Rogers, the American psychotherapist, defined empathy as "entering into the world of another as if it was one's own, but without losing the as-if quality".
Here, I believe is the secret to pastoral work with the dying and indeed all who suffer: one must enter into their world, share their darkness, feel their pain, but keep very clearly in one's mind that they are patients, not family. This is, for me, the only way I know how to survive living, as someone once described it, "on the margins of the bearable". Even so, it is an expensive business, taking much time and energy and there are days when it feels almost too heavy.
People often ask me what sustains me in this sort of work, and I rack my brains for something intelligent and meaningful to say. It would be too easy to come out with the pious clichés, "It's my faith . . . prayer . . . God", although ultimately I believe this is, for me, the key. Or is it? If I stopped believing in God would I no longer be able to sustain this work? I suspect that I would just carry on as other unbelievers do, tearing the feathers out of my breast until the blood flowed.
And yet my belief in God does sustain me mightily. First, I believe very firmly in an afterlife, so that when a man, woman or child dies, I am not sorry for them. I believe that they are somehow with God, alive and vibrant, more themselves than they have ever been before. So it is not death that hurts me. What hurts is sharing the pain of those who have lost someone they love. There is no short-circuiting grief: it must be experienced and endured and most of us need help with it.
I suppose what helps me to help grieving people is the sense of being somehow working with and on behalf of God. There are a number of versions of the story of the statue of Christ with the arms blown off and the message stuck on: "He has no hands but yours". I suppose I believe that somehow my hands are his and that I will do this work as long as he sustains me.
That is talking in religious language. The other side of the coin, inseparable from the spiritual, is the purely human side of caring: the hours of television watched, the clothes bought, the heart poured out to friends, therapists, and colleagues. And of course, there is the shadow side of caring, the backbiting and the jealousy, the feuds and the misunderstanding, because so often pain is expressed as anger and we are all so bad at communicating with each other, because, surprise, surprise, we fear rejection.
So what is my message? What is the doctor's view of death? One point is, I think, that we should accept that the thought of death is fearful, because that is the way God made us. And having acknowledged that, we should realise how afraid others are and have the courage to walk beside them, touch them, hold their hand. We must learn to listen to other people, to their fear, their anger, their despair. And when I say listen, I mean listen, because people do not want answers, because they know in their hearts that there are no answers, that this is the ultimate mystery.
The last thing I would want to say is that, of late, I feel less fearful of death. As I get older, there is a certain peace, a certain laughter and a joy in the emergence of the generations which follow me. I have a feeling of nostalgia as though I were coming towards the end of a wonderful holiday. Holidays have to end. My life will surely end. Someone else will live in my flat and look out on the sea as I do, watch the waves crash against the breakwater and wonder at the beauty of the sun on the sea. I do not know what lies beyond, and I do not think anyone else does either. I believe in life beyond death, but I may be wrong: I do not think I believe in re-incarnation; but I suppose I could be wrong there too.
My hope is that the life to come will be wonderful beyond my wildest dreams and that if there is no such life then that death will be like falling asleep for the last time. But I suspect that, when the time really comes, I shall be very scared and I hope that someone will have the courage to share my pain and fear.
Sheila Cassidy. "Together in Darkness." The Tablet (February, 2003).
This article reprinted with permission from The Tablet.
Dr. Sheila Cassidy is a palliative care physician at Plymouth General Hospital in England. She made headlines in 1975 when she was arrested and tortured in Chile for treating a revolutionary, a story which she recounted in the autobiographical classic, Audacity to Believe. She has written a number of other books including Faith in Dark Places and Good Friday People.
Copyright © 2003 The Tablet