Consideration of death and dying may seem a bit off target for an Occupational Therapy career development blog, but I think it is important to change tack every now and again. Of course, I could argue that taking a left field view of a recent podcast I listened to might just give you the ammunition you need at interview to discuss how modern technology can have an impact on your practice. Or how something you have read recently has impacted on your work, but that might be like shoehorning a dinosaur into an egg cup! Sometimes it is just good to share something that has made you think differently. So bare with me today while we unpick some of the facts about dying for OTs.
Do 
you consider what it’s like to die in your work with patients? If you did, what would you change in your Occupational Therapy practice? I would be the first to admit I am not an expert on dying, and the myths and facts about dying for OTs are somewhat unclear. After all, I have got to this point in my life without any direct personal participation in dying. Of course, I have had friends and relatives who have died, and yes patients who I have worked with have also passed away. But how much direct experience have I got? How much understanding have I gained about the nuts and bolts? How much have I been willing to investigate if there really are monsters lurking in the dark? I came across a podcast episode in the last few months that shines a light onto one of the most misunderstood parts of life – death. Or as Barbara Karnes, a nursing expert terms it – ‘The final act of living’. There is a personal and professional part of me that has shunned the exploration of dying and I share this episode with you in case you have done the same. Even if you haven’t, there are some fascinating challenges to us all, particularly the suggestion that most of us, in the end, die as we have lived. And finally, if nothing else there is a great answer to an interview question about something that you have read recently that has interested you!
I oversee palliative care OT services as part of my day job. I have also had my fair share of experience working with patients who chose to die at home (I tend to see these as the successes?) and those that never made it home (my failures?). I am though, in no way an expert in this area and would readily defer to my colleagues who work every day in palliative care. That is perhaps why I found this podcast about the natural process of dying so powerful. It is a short hop to translate these myths and facts about dying for OTs in day to day practice.
The art of dying for OTs
If you can get beyond pondering why I was listening to a podcast called ‘The Art of Manliness’ in the first place, you will hear a heartfelt and passionate description of what will happen to us and our nearest and dearest in the last stages of our lives. Despite a very frank and honest description about what our bodies and minds go through, the discussion never feels anything other than uplifting, honest and nurturing. I was left feeling much more comfortable with what is both inevitable and natural both personally and professionally.
The discussion is broad ranging and exposes some of the myths that have come to pervade our thinking. Did you know that contrary to what Hollywood tells us it is hard to close someones eyes after they die? Would you know how to tell if someone is in the end stages of their life and why can the labour of childbirth can be related to the experience of dying? From a professional perspective there is focused discussion on how relatives and carers can do the most helpful things that are actually in tune with each stage of the dying process. Had you considered that what we try to do to prolong life, or ease suffering in the living, is unhelpful for the dying. Take the example of drinking. Health care staff should be supporting our patients to get enough to drink. The scandals of Mid Staffordshire, where amongst other horrors patients were forced to drink from flower vases due to lack of care still haunt me. As OTs supporting our patients in maintaining their ability to eat and drink independently is a fundamental part of our consideration of daily living needs. However Barbara Karnes suggests that our bodies need for food and water change in the end stage of our lives. If we apply the same rules without thinking, if we assume that if someone is not drinking then we must intervene we may be doing more harm than good. Now I am also mindful of the opposite automatic response as illustrated by the routine poorly understood application of the Liverpool Care Pathway where the outcome was that dying patients were denied fluids. Reassuringly Barbara goes on to makes it clear that if someone dying asks for a drink then they should have one. The message though is not to accept what we think we know about the needs of people who are dying. Particularly when for most of us it is outside of our professional and personal experiences.
Particularly when this natural process is sanitised and removed from our day to day experiences to happen in a hospital.
As OTs many of us may accept that death is an inevitable part of the aging process, or the natural end point of some disease progressions. However we rarely come face to face with it in our day to day work unless we are specialists working in these areas. Having a greater understanding of what happens after medicine fails, and maybe even when medicine should beat a dignified retreat is to my mind empowering and liberating. It makes talking about death and dying less mystifying, abstract and removed from our own experience.
As I say I am no expert in these areas and I’ll let the jury stay out on whether dying well is a meaningful occupation. I would want to follow up the nuggets with more information and discussion and this just scratches the service of the questions about dying for OTs. But as a first peek under the bed to see what monsters may be lurking, this is a pretty good first step.
I highly recommend that if you have a spare 20 minutes you have a listen. You’ll feel better.