A Conversation with Dr Anna Holmes about the Art of Dying

 Issue 31, August 2010

GP, Dr Anna Holmes, speaks with John Kleinsman about her experiences of treating the dying and shares some insights about the privileges and challenges of this work.

Anna, tell me about your work with people who are dying.

Through general practice I have been dealing with people for a very long time. What happens when people are dying is interesting. I believe that all major life transitions, and of course dying is the last of our transitions, take us back to a fundamental question; the meaning and purpose of life.

I recall visiting a patient who was dying in her home. Her imminent death was unexpected having previously been told that her tumour had been cured. She was very much at peace. I noticed a painting in her room, a triptych, which focused around an obvious Christ figure, and I commented on it. She said to me, "Painting is one of the things that I enjoy doing." I asked her what the painting was called. She looked me straight in the eye and said: "Who do people say that I am?" I realised at that point that through the title of the picture she was saying, "This is the question I have too." Since then I've heard the same thing expressed in different ways from so many people who are dying; "I've changed so much. I'm frail and I'm weak. I was always in charge of my life ... how can I find meaning when I hardly recognise the person I am?" It seems to me that the search for meaning is universal.

There are many things we can do for people who are dying. The most important thing is actually being there, staying with and accompanying them. That can be quite painful at times, because when we accompany someone who is dying we are actually being confronted with our own mortality. We have to come to terms with that while, at the same time, not abandoning the person who is dying.

I think that fear of abandonment is the worst thing for people who are dying; it's the thing that makes people most desperate. I wonder sometimes if it is the thing that most drives people to want to suicide. Many of my patients have talked about this. They say, "Since I became ill I have started to wonder if cancer is a catching disease. People I know see me coming and they suddenly cross the road". I recall one doctor sharing how desperately alone they felt while grieving, to the point of being overwhelmed – "it's like having a skyscraper on your head." The aloneness was made much worse by friends avoiding the subject and not wanting to talk about it. They resolved the dilemma by having three sentences that expressed a sense of pain, loss and sadness. Sharing this with people would get the conversation going.

So those who are dying are often healing those around them?

Indeed. This is something that, in my experience, happens often. There are many wonderful stories about patients whose suffering and dying becomes a healing event for a community, for their doctor or for their family. One person I heard about was described as changing from being anxious and frail to someone who gave out such a wonderful sense of love, peace and joy. Everybody wanted to be there and look after them because it was so life-giving. That sort of transformation is a lovely thing to reflect on.

I often recall the words of Sister Paula Brettkelly who had such a strong sense of how her journey with cancer could help others. She spoke about the wonderful freedom that she experienced after she found out she was dying; a freedom from social conventions and from all expectations that allowed her to explore so many things, especially the spiritual dimension of life. She referred to the process of dying as a spiritual journey that called for courage; a journey of possibility and a journey of gift-giving to others through her dying.

If people who are suffering are to become healing events for their families, their doctors, the community, they have to have a great deal of self awareness.

What about those caring for the dying?

It is extremely important that those of us who work with and accompany people who are dying are also extremely self aware. We carry our own wounds and suffering – if you are suffering yourself you can still work with the dying but you have to be particularly self aware.

I think this also applies to the families and loved ones of those who are dying. My own experience is that families sometimes want the pain to be taken away regardless of what the patient wants. Sometimes they are trying to overcome their own guilt or distress at not having been there sooner. It is important in those circumstances to very gently get people to look at whose pain it really is.

Being there for people at the end of life isn't easy and I think it is important to recognise that. But it's also important to realise that it is the greatest gift we can give to one another. We don't always think about just what gifts are available in this situation.

Dr Anna Holmes is a GP who has been working in palliative care for 10 years. She tutors at the Otago Medical School and has a long term interest in the connection between spirituality and health.