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My brother’s happy death was the kind we all wish for

It was a significant contrast to the sad, hasty and solitary deaths so many people are subjected to, not least on the Liverpool Care Pathway

By on Monday, 5 November 2012

A volunteer tends to a patient in Pennsylvania (Photo: PA)

A volunteer tends to a patient in Pennsylvania (Photo: PA)

Last Thursday, All Saints Day, I sat down to write a blog about the Liverpool Care Pathway (LCP). Since I had last written on this topic there have been an alarming number of newspaper articles describing the sadness and anger of relatives when a dying family member has been put on this “pathway” without their knowledge or consent. The LCP grew out of the hospice movement and its original purpose was sound: not to make inappropriate medical interventions when a person was obviously dying and to alleviate any pain during this process. However, it seems that this good practice, now standard in most NHS hospitals, has been abused. There are too many stories of imminent death being diagnosed wrongly, food and water being withdrawn too soon and drugs being deliberately administered to induce speedy unconsciousness for a deep disquiet not to be felt by members of the public. Indeed, the widow of a man who chose to commit suicide in the Swiss clinic Dignitas has added fuel to this general concern; interviewed on the Today programme recently, she made it clear that not only is euthanasia a good thing but that, through the LCP, “it also happens over here, but quietly”.

Even more shocking than widespread fears that all over the country, with an increasing number of frail, sick, elderly people in hospital, the LCP is being used as a covert method of euthanasia, was the news, given headline coverage in the Telegraph, that “the majority of hospitals in England are being given financial rewards for placing terminally ill patients on a ‘pathway to death’”. According to the report, “almost two thirds of NHS trusts using the LCP have received payouts totalling millions of pounds for reaching targets related to its use”. It seems that in some case “trusts are given specific targets to ensure a set number of people who die in their hospital are on the pathway”. A consultant geriatrician was quoted as demanding that “there should be questions in Parliament as to who instigated this policy and the cash payments should be stopped. You can’t pay people to use a certain protocol that everybody knows to be lethal.”

As I wrote at the start of this blog, I had sat down to write it, with the righteous indignation of Melanie Phillips’s own article on the subject, when the phone rang. It was from my niece in Ireland, to tell me that my older brother, Johnny, who had been taken into hospital a few days earlier with what they thought was a problematic lung infection, was not responding to treatment; he was now in a very critical condition. I instantly dropped what I was doing and caught the next plane to Cork. I arrived late the same night. Early the next morning, All Souls Day, I went to the Bon Secours hospital where he was lying in the intensive care unit. There was my dear brother, only a year older than me, who had stayed with me only a fortnight before and with whom I shared so many memories of the past, now lying helpless and struggling to breathe, with an oxygen helmet on his head and surrounded by bleeping and flashing machines.

But he was also entirely conscious and completely at peace. The first thing he said to me, with a wry smile (he had been an army officer for 30 years and had always described himself as a “bluff soldier”), was: “I think courage and dignity are required right now”. The second was: “Do you remember Churchill’s last words?” I quoted them. We had both shared a great interest in Churchill’s life and I was always looking out for memorabilia relating to him to give to Johnny. I reminded him now that my best find had been a 1940s biscuit tin at our local waste disposal dump, decorated with key quotes from Churchill’s wartime speeches.

The third thing he said was: “A friar in sockless sandals came round earlier and, to use an old-fashioned word, he has shriven me.” He then told me the hymns he wanted at his funeral, the simple inscription for his grave – no mention of honours or rank – and the words for a memorial card. They were from St Thomas More and Johnny recalled his own father, to whom he had been very close, telling them to him: “Do thou pray for me and I will pray for thee, that we may meet merrily in heaven.” The word “merrily” particularly mattered to him. He always had a great, if sometimes mordant, sense of humour, and heaven had to be a merry place. When someone replaced a blanket over his feet so they wouldn’t be cold, he said with a characteristic smile: “Don’t worry, they will be the first to burn”.

These little conversations and remarks went on for most of the day. Johnny’s children never left his side. My brother and sister joined us. A palliative care doctor came by and gently indicated that his lung capacity was decreasing and that his oxygen levels were dropping. A nurse quietly and sensitively monitored the situation, explaining to us that they would only give him morphine when his breathing had clearly become very distressed. A young lay pastor came and prayed a decade of the Rosary with us. A huge plate of sandwiches materialised from nowhere in the relatives’ waiting room. The sockless friar (a Capuchin) came back with Communion, the nurse opened a small aperture in Johnny’s “helmet” and he received a fragment of the Host with great reverence and recollection. He called for a sip of cordial and managed to suck a tiny amount with a straw. He also had a spoonful of ice cream. He made it clear that he didn’t need any more food.

At 4pm he was asked if he would now like some morphine to ease his, by now, very laboured breathing. He said “yes” quite firmly. The doctor explained that the oxygen helmet was no longer of any use and it was gently removed. The machines were then unplugged and Johnny was made comfortable. He fell asleep. We all stayed with him, talked to him, sang to him, held his hands and stroked his head until, an hour later, he drew his last breath. My younger brother turned to me and said in a voice of awe, “What a mystery death is!” I thought of a favourite remark of Johnny’s, which he had repeated to me only a couple of hours before: “There are no pockets in a shroud.” The Capuchin returned and reminded us that All Souls Day was a wonderful day to die on. The palliative care nurse wept along with us all. I remembered that Johnny had chosen St Joseph, patron of a happy death, as his Confirmation saint and had always had a special love for him. In fact he had named a succession of his boyhood tortoises “Joseph” in the saint’s honour. In his last hours St Joseph had not deserted him.

I have described Johnny’s dying in this detail – and what a privilege it was to have witnessed such a death, his last loving legacy to his family – to show the kind of experience we would all wish for: sensitive and attentive care, spiritual and medical, by all the staff and the vital opportunity for Johnny to make his own inimitable farewells. It is a memory that his children and the rest of us will carry until our dying day. It presented a significant contrast to the sad, hasty and solitary deaths so many are subjected to, not least on the LCP. Johnny died, as he said, in the country he loved and surrounded by the people he loved; “My faith, my family and my friends are what matter to me,” he told us in his soldierly fashion. In the intensive care unit of the Bon Secours hospital, with its Catholic ethos and atmosphere – a crucifix on the wall and a statue of Our Lady in the corridor – patients are treated as children of God: “Johnny is in God’s hands,” the nurse said as she monitored him. It makes all the difference – in life and in death.

And Johnny’s own last words, before he slipped into unconsciousness? “I am very happy now.”

  • Laura Miller

    Thank you so very much. My mother passed away on Holy Saturday. She was in a coma for about 1 day. All of us kids and my father were there beside her bed. We prayed the rosary and sang a song to her. She received the Anointing of the Sick by a priest and had another priest and a deacon come to visit all of us. When she passed away, my 2 sisters were there. I miss her very much and your story touched me very deeply. We all said our “goodbye’s” but she was unconscious. She is in my daily prayers and the saying you don’t appreciate them until they are gone, is very true. I was very spiritually close to her in life, and I think she is still praying for our family now.

  • Hermit

    In reality death for us does not exist. Yes, alright, we see people die and then their bodies corrupt.

    But in point of fact the dead person is dead for us who are still alive; he or she, considered dead by us, is more alive than before because his or her soul is freed from the body and so his or her intellect and will, freed from the body, take up their full capacities and start knowing in a limpid way where he or she is: if in heaven, he or she wants to remain there; if in hell, he or she wants to leave but convinced at the same time that there is no hope for that.

    So when we die we shall all experience a different life, full of energy, for all eternity.

    Blessed are we if we lead this life embraced by the loving arms of the Holy Trinity!

  • Just_a_simpleton

    Thank you for sharing this Francis A happy death indeed. May your brother rest in peace.

  • Annie

    My mother was a nurse back in the 1930′s – before penicillin and at a time when there was still a high degree of infant mortality.  She said there was a room set aside to take babies that were going to die.  In the room was a rocking chair and the nurse would sit there holding the baby, rocking it in her arms and talking and singing to it until the child died.  Even the student nurses did it – it was part of their training.  Compare that to today where babies who have survived abortions are put into empty rooms to die untouched and unloved.  

  • Jeannine

    Thank you for sharing your family’s experience. I’ll pray for his soul & for your family.

  • Patrickhowes

    Dear Francis,

    You are a gifted writer but by far your best piece yet!Inspirational and from the heart.God Bless your family1

  • Patrickhowes

    Very true

  • am-s

    Beautiful, thank you for sharing with us how death should, and can, be. How different from my own experience of losing a family member.

  • thelonghaul

    Very poignantly put.

  • Pali

    So moving. I wept.

  • Vconnolly11

    Jesus, Mary and Saint Joseph will ensure us a happy Death. Also remember the Divine Mercy at the bedside of the dying, which promise Graces to the dying.

  • JFJ

    Your articles never cease to inspire and move me.  Thanks for this.  It must have been one of the most difficult things to have written.  My prayers are with you, your family and brother.  

  • Margiemrgn

    Thankyou for sharing this .I lost my dad in May this year he was 93 but you would never of thought it ,he did his own shopping ,cleaning payed his own bills even cooked sunday dinner for my family and i .He was very independant ,Every day he would get the bus into town and go for a walk then at 3pm he would go for a few pints in the pub nothing at all wrong with him untill he fell in the rain earley in the morning after just going for his morning paper .Broke his leg we went in an ambulance to the Royal Liverpool Hospital he was xrayed straight away and we were told he would have to have an operation they bsaid the best doctor had just tryed to pull his leg back into place but it wasnt happening and they would operate the next dayobviously they never and my dads health started to fail.My dad was going through a terrible time and i didnt know where to turn until my friend told me about the palative care in the hospital she knew about it because she worked in the hospital .She took me over introduced me told them the basics and left me with them .Well it was the best thing anyone could of done for me ,them people had the ball rolling in no time in fact straight away they care not just for the sick but also you my dad would of had a terrible death only for them peoplet hey did absolutly everythink they possibly could and nothing was to much for them.In my eyes they deserve a medal but they probly wouldnt accept it they dont think there angels but i do .I didnt know anything about them and i wonder if many people do ,they should know about them because believe me they make things a lot easier for youi am an only child  and during the last 4yrs ive lost my mum my husband and my father iam 51 now and without them helping me deal with my fathers death i dont think i would be here now i wouldnt of been able to handle it on my own. Dad died of a broken leg yes i know its hard to believe as the lady said when i went for the death certificate “iam sorry but i cannot give you the certificate because you cannot die of a broken leg ??? .Well the doctor admitted it was his fault at a meeting with me and i admire him for it not many a doctor would admit a mistake like that but he did and everynight he would visit dad and ring me at home to see if i was ok. I could of suid him but what for its not going to bring dad back and i know he wouldnt want me to sui him he’s only young and i made sure it was a lesson well learnthe was a young consultant and i didnt want to ruin his life but i would just like one more thing from him and that is why didnt he report it because if he did well it would of been on the death certificate or at least something simaler about what the cause of death was . now i have therapy and iam trying tom sort my life out once more iam getting n
    there because the night my dad left he was in no pain he was peacefull i was with him and it was so lovely  and only for the palletive care i know it would of not been like that . I didnt want to be on my own because i was scared scared after what happened during my husbands passing but i had no choice the one thing i can say is it was a lovely passing all thanks to the Palletive care team at the Royal Liverpool Teaching Hospital.

  • Mary O’Regan

    Francis,  Your post on Johnny’s happy death was beautiful and like all truly great
    writing on the matter of a soul going to God, it raised us ordinary
    readers to think of the eternal.
    Ar dheis Dé go raibh a anam uasal

  • Seg810

    I will say a Hail Mary for him before I go to bed. God Bless

  • Lunarlogic

    Thank you for sharing this. It has touched me no end x