There are not many lives that have been as public as the Queen of the United Kingdom’s, and yet her death at the age of 96 seemed unexpected to some. Kathryn Mannix, author and retired palliative care doctor, reflects on how, to those experienced in the process of dying, the signs of approaching death were clear…and how this private, yet public, death has been insightful and informative to educate and reassure others.
Is it permissible to use the death of the Queen as a ‘teachable moment’ about the nature of dying? In the same way that I deliberated deeply before using real people’s stories as the basis of a book explaining the process of dying (1), I thought long and hard before I turned to social media a few days after the Queen’s death.
For people familiar with the trajectory of ordinary human dying, the health of the late Queen Elizabeth II was a real-time chronicle of that process. Ordinary human dying, whether caused by an enervating illness or simply by old age, follows an observable and predictable pattern. Over the last few years, it was apparent that the monarch’s vigour was diminishing. We observed her gradual loss of energy, the change barely perceptible at first and, as so many families realise, easier to discern in retrospect than day-by-day.
In my social media posts, I reviewed those changes in clear, unambiguous and non-sensational language, the same language I have used in conversations with patients and their supporters for decades in palliative care practice. The changes in the Queen’s energy levels were initially only apparent year by year, the rate of change we associate with a life expectancy that is still measurable in years. Later, the changes progressed more quickly: we saw that she was losing weight, walking shorter distances, adopting a walking stick for support, making fewer public appearances. Change was observable month by month, a sign that life expectancy is now measurable in months – perhaps enough months to make a year or so, but no longer an expectation of surviving for several years. Energy levels drop quickly and take longer to re-build: we saw the Queen cancel engagements, delegate duties at short notice, miss even those events that were dear to her heart. Rest, and especially sleep, becomes far more important in restoring energy between activities. We recognise this stage as being close to death.
The Queen’s death illustrated another phenomenon we recognise from our work at the ends of our patients’ lives: the importance of attending to unfinished business, of setting out future hopes, and reconciling differences. For most of our patients these are not work-related affairs (nor affairs of State), but of family. The Queen, perhaps, had both. Despite her failing energy, she held on: perhaps to see in her last Prime Minister, perhaps for family interests known only to her.
Arrangements following the death of a monarch are planned ahead in detail. There were signs that the Queen had also planned the personal details: to be in her most private home, at Balmoral Castle. Not to leave, not even for the appointment of a new Prime Minister. To have her daughter nearby. Not to have intrusive medical treatment (just as a year ago, her husband remained at home in Windsor while he died). And yet, the public and the media appeared surprised at her dying, wishing her ‘a full recovery soon’ even as her family was rushing to her side.
And so, I dared to post on social media about this very public, yet overlooked, dying. The response was extraordinary. The Twitter thread gained two million impressions over the next seven days; its slightly expanded Facebook version has passed one million impressions, with more than four hundred thousand (400k) people reacting or commenting. It seems that, despite the widely repeated assertion that discussion of death is taboo, when we lift the veil of secrecy and rumour, the public has an appetite to know more and to engage in realistic discussion about dying.
The tone of the response was interesting. Almost all comments were positive. Any negative comments were largely confined to political statements about the Monarchy, without reference to discussion of the Queen’s death, or comments that the Queen’s wealth made dying easier for her, particularly the provision of medical and nursing care at home that can be a challenge for some ordinary citizens to access. It was interesting to note that many responses criticised the mainstream media’s over-reliance on euphemisms like ‘passing’ rather than using clear ‘d-words’ and like dying, death and dead.
Comments about dying and death included many people declaring that this post had helped them to reflect on and understand their own experience with a dying friend or relative; they were interested to understand that this is a universal process and they found it helpful to know more about it. There were responses from individuals who recognised how the process described in the posts was also being experienced by their elderly parents or other people whose health is in decline, and even some who saw that their own health is now following this trajectory and that they were encouraged that the Queen had not seemed to have a lingering death. Public education, my aim in writing, was being achieved.
Ordinary dying. Even at the end of an extra-ordinary life. Thank you, Your Majesty.
1. Kathryn Mannix, With The End In Mind, William Collins 2017.
Links and resources
- Read Kathryn’s Twitter thread on this subject here.
- For Kathryn’s Facebook thread click here.
- Find out more about Kathryn’s books –With The End In Mind (translations are available in 14 languages) and Listen: How to Find the Words for Tender Conversations.
- BBC Ideas ‘Dying is not as bad as you think’ videoclip. This 4-minute video has been watched by more than 3 million people on Facebook, and is used by many palliative care professionals and end of life care supporters, doulas and soul midwives to help patients and families to understand the process of dying.
About the author
After a happy 30-year career in palliative medicine, Kathryn Mannix turned her attention to campaigning for better public understanding and discussion of dying. She writes, broadcasts and speaks across the UK and around the world. Her first book, With The End In Mind, became a Sunday Times bestseller and was shortlisted for the Wellcome Book Prize. Kathryn hopes we can de-medicalise dying, giving it back to all of us as an important stage of life. She is a patron of End-of-Life Doula UK.
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