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TRANSCRIPT: What Happens As We Die: Kathryn Mannix

Here is the transcript of Kathryn Mannix’s TEDx Talk titled ‘What Happens As We Die?’ at TEDxNewcastle conference.

Listen to the audio version here:


Dr Kathryn Mannix – Palliative Care Physician

Human beings are the only animals capable of contemplating their own mortality, and they’ve been doing that for thousands of years. And yet somehow, in the very recent past, we have lost the practical wisdom of what happens as people die. I think that that’s a problem. And if you agree with me that it is a problem, then we have to work out what we’re going to do about it.

When she was in her mid-twenties, in the 1920s, my grandmother was already deeply familiar with the sequence of events that happened to a human person as they were coming to the end of their life. And that’s because, as a woman, and it was usually women’s work, she was doing what women had done for centuries. Looking after people at the very end of their lives, in their own beds, in their own homes, supported by their own people, because a hospital had nothing to offer once a person was so sick that their death was imminent.

And yet, when I reached my mid-twenties, in the 1980s, I had none of her wisdom and understanding and knowledge of dying, and that was even though I’d just finished five years at medical school. As a newly qualified doctor, I’d spent five years being trained to stop people from dying.

And actually, if a death happened, it was a thing that was seen as a medical disaster. It was a thing that was embarrassing. It was a thing of which we do not speak.

Why the difference? And why within just a couple of generations?

Well, think about what happened to medicine over the course of the 20th century. It was not worth going to the hospital when you were dying in the 1920s. But by the 1960s, 70s, 80s, and onwards, think of the fantastic progress that had been made, so that people who were so sick that they might die, of course, we took them to the hospital because there were antibiotics. There were really clever anesthetics that allowed surgeons to spend a long time unpicking things during operations.

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There were new and very sophisticated treatments for cancers, for heart failure, for kidney failure. There were intensive care units. There was transplantation of organs, some of that pioneered in this very city. Medical progress was astonishing. Taking dying people to the hospital very often saved their lives, and that is fantastic.

And yet, by taking dying people out of home and putting them in the hospital, we changed our understanding of the process. We lost our ownership of the process, and we gave it to healthcare, and we forgot what dying looked like.

So, having been qualified for just over four years, I find myself in a new job. Having originally intended a career in cancer medicine, I have spent the last four years choosing to train in the places where the most sick people were.

And then I realized that actually what was really interesting to me was the detective journey of symptom management and the emotional integration of feeling well enough to live a little bit during the very end of life, and I went to work in a hospice. But I have been working in a big teaching hospital, I had learned a lot of medicine, I had seen a lot of dying.

We had a patient in the hospice. She was a memorable woman for many reasons. She had been a member of the French resistance during the Second World War. She had married a British airman, she had come to live in England, she had never lost her French accent. She had a cloud of glorious white hair, like a halo. She had piercing brown eyes, the kind of gaze that you feel a person can see your soul. She was self-contained, she was a little bit aloof. In fact, she was a little bit scary.

One day, she told the nurse who was looking after her that she was terrified of dying in agony because if she were to die in agony, she might despair in God. And if she were to despair in God, as a French Roman Catholic, her belief was that that would be a mortal sin, so she would not be able to go to heaven, and heaven was the place she knew her husband was waiting for her. This was a profound existential distress.

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And my boss said, “Well, we need to go and talk to her. You should come. You’ll find this interesting.” I was 26. Do you remember 26? It’s that kind of age, the last age when you know that you know everything. So I went along wondering what I might learn because I thought I was quite good at pain control.

That conversation changed my life, it changed my career, and it’s brought me here. Sitting on her bed with me on a little footstool so I can see him and her and the nurse sitting on the chair, he said to her, “I’m concerned that you’ve got worries about what might happen if you’re dying,” and she said yes. She knew him well, she trusted him.

And he said, “I’m sorry to hear that, and I wondered whether it might help you if I describe to you what usually happens as a person is dying.”

And I’m sitting on the stool of all knowledge thinking, “Well, you can’t tell her that because I’ve seen lots of dying and I know they’re all different.” And she said, “Yes, please.”

And he said, “Well, I’ll describe what we usually see, and if it gets too much, you tell me. I promise I’ll stop. The thing that’s really interesting, Sabine, is that as people are dying, it doesn’t really matter what the illness is that they’re dying from, the pattern of events is very similar. We see people becoming more and more tired. It’s harder and harder for them to find the energy to do things. In fact, they recharge their energy not so much by eating and drinking but by sleeping. And as time goes by, what we see is that people sleep more and they’re awake less, and if they want to do something important, they should take a snooze before it.”

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