There are many stories in palliative care – life stories, experiences of care for patients, their relatives and professionals – and then sometimes the stories that may not be entirely true but nonetheless valuable. Today, for our new Creative Corner blog series, Joseph Hawkins shares the little known fable of the Great Depression and reflects on storytelling in palliative care, in all its guises.
In a kingdom no more than five strides away from our own world a Great Depression rules. The depression’s name is George. He’s great in name and indeed his size is quite tremendous. However, it is his effect on others that is truly remarkable. For when he appears, he simply sits and waits and all around can do naught but watch him in mounting dread and fear. When he comes, they know that he will presage the passing of the person with whom he waits. ‘George’, they cry, ‘why don’t you have some nibbles?’ But George simply stretches, languidly spiralling his great furred limbs and purring to himself. Then, within days, or even hours the personage is no longer. Deceased and gone, they depart this world.
So great is George’s potency that he had more than once appeared minutes after the death, on other occasions the persons survived for many months or years. Yet always would they die.
Truly George had a remarkable and terrible gift. Life in the hospice was good to George, so good that he died there himself. So ended the tail (tale) of George.
Human beings are undoubtedly more complex than cats, and yet we imagine and project upon things and animals around us as floridly as ketamine addicted laboratory monkeys seeing Planet of the Apes for the first time. Pierre Boule actually imagined and wrote a book about this very topic. I believe there have been some films since. It is with wonder then that I observe those whose imagination stops when it comes to discussing dying. I often speculate silently, is it that dying is imagined as so vertiginous a cliff of terror that the vertigo of possible consequences of speech renders the sufferer mute to all discussion? Or is it simply that the fantasies of far away eternity are too wonderful to turn away from, such is the warmth of their ethereal embrace? I realise that the reality is that both and neither are true and that we each hold the secrets of our fears closer than our loves. Yet despite this I suspect that when it comes to talking about dying it is understanding the difference between hope and despair, and properly assuaging or protecting each, that means the difference between a successful discussion about death and a rejection of the very subject.
George the cat (the Great Depression) is a fictional feline. Yet for all his lack of material substance, the legend of his tail (tale) is a very familiar one. We are very good at telling ourselves lies, at spinning a narrative from chance. It shouldn’t be a surprise if a cat in a hospice decides to curl up on a very still and dying person’s bed. They likely have many to choose from. Yet the idea that the cat understands something we can’t see and chooses the dying person precisely before their death is a very human narrative. There are times when reflecting these narratives in a conversation about illness helps the listener to better understand the message. When a person comes with a story that makes sense of the chaos of life and sickness, it is often best to agree with the narrative that has provided them internal clarity. It is to this that we then add detail and when discussing what is to come and how the story may end. But life is rarely a fairy tale – and its ending is just an ending, there is no epilogue. So when we talk of dying we must tread the line between cradling the gentle message of what will come without hiding that the story has an end without sequel. This is a hard skill and one that takes years of practice. Yet when it comes down to it people love truth more than fiction, at least in relation to their own life.
About the author
Dr Joseph Hawkins is Consultant in Palliative Medicine and Clinical Lead for End of Life Care at Ashford and St Peter’s NHS Foundation Trust. He has a degree in medical journalism in addition to medical qualifications and postgraduate degrees. He enjoys spending time with his family. He adds ‘In life I suspect that there’s a joke behind most things and try not to take anything too seriously although I frequently find myself wanting in that pursuit.’ ORCID ID: 0000-0001-6715-9540 Twitter: @JoeHawk75825077
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