Thinking back to the recent Australian Palliative Care Conference in Melbourne, I was reminded about one of the plenary speaker’s reflections on the first time she, as a doctor, saw a patient after they had died. It prompted me to reflect on my own experience as a nurse, and ask the question – more broadly: who cares, after death?
Death ends a life – not a relationship. So the saying goes.
This may resonate with some of us reading here, through the experience of loss, grief and bereavement. And for those interested in an personal account of the physiology of grief, you may wish to read Arthur Kleinman’s article from The Lancet entitled: Culture, bereavement, and psychiatry. As a psychiatrist and medical anthropologist, he eloquently shares a revealing story of continuing relationship with those who have died, and yet continue to live on in our lives. He also warns of the potential for ‘pathologising’ grief, which is a whole other post for another time!
What I am interested in here is who cares, after death? In the immediate and physical sense, as well as in the longer term – and more psycho-social-spiritual sense? Of course, I can only speak from my own experience as a nurse and member of the broader community.
As a young child I remember finding a dead rabbit whilst walking to school, and coming back in the afternoon to bury its body with care and respect. Perhaps having pets is one of the first and most common opportunities for children to be exposed to death and learn about – or at least begin the journey of coming to understand it. Sadly, I don’t remember much of when my grandfather died. I was 9 year old, but suspect that my parents may have ‘sheltered’ me from living that experience more fully. As a parent now with young children, I sometimes wonder how I will respond for them. I would hope they will be given an opportunity (at least a choice) to care, instead of being crippled by fear; to understand that the landscape of death does not have to be a lonely wilderness bereft of active love and care.
As an adult, my exposure to death and the experience of dying has come through a professional role, working as a nurse. Whilst training as a registered nurse, my very first ‘clinical’ placement was at residential aged care facility. At commencement of the morning shift, I was allocated to care for a resident who had died at 3am that morning. Let’s call her Dot. I was very fortunate to be guided by a nurse with great experience and compassion. We spoke softly to Dot, explaining what we were doing, as we gently washed her body and dressed her as we would any other day – in preparation for her family to visit. Then, in what was by far the most profound ‘teaching’ instruction I ever received in three years as an undergraduate nursing student, I went to the garden to pick a flower and placed it on Dot’s chest. Naturally, her family were sad – but comforted in every way possible.
Looking back nearly 10 years now, I still find that this was one of the most powerful experiences of my clinical career. The nurse referred to it then as performing ‘last offices’ (a somewhat dated term); I’ve come to know it as after-death care – but some even call it ‘after-life’ care. Whatever it is labelled, this early experience helped prepare me for the more confronting experiences to come, placing bodies into bags and escorting them to refrigerated storage awaiting collection by funeral directors. Saying goodbye – after having spent much time as a caring companion; in both the clinical and humanistic/spiritual sense.
Looking back, the only thing I would change would be to have invited Dot’s family to either join us, or to have had the opportunity in private, to provide that after-death care for Dot. This human and very intimate experience should not belong solely to clinicians, who sometimes (paternalistically) believe their role is to ‘protect’ families and friends from the impact of death. I feel that our role, as professionals who are invited into the lives (and deaths) of others, is to provide clinical guidance and support where necessary, and above all, compassionate care that affords respect and dignity for the living, the dying, and the dead; appreciating that informal care of the dying existed in communities long before our current health professions or clinical facilities did.
Who cares, after death? Whole communities do – just as it ‘takes a village’ to raise a child. But I would be interested to hear from others; what other peoples’ experience has been. Have you been involved with providing after-death care? You might be a health professional, or you might not… What was that like for you? If not, is it something you would, or would not, do?