THE FACTS OF DEATH

In modern Britain, dying is almost

unmentionable. A. N. Wilson

confronts his own terminal illness

IT IS not easy to accept that one is suffering from an incurable disease. Long before mine was diagnosed — and my condition is terminal, inoperable, irrevers- ible — I had half recognised it. Since it is a hereditary thing, I should have been ex- pecting it. But it is only this year, with the death of my father and, as it happens, a large number of acquaintances and friends, that the reality of my plight has begun to sink in.

The medical profession do not exactly deny that I am incurable. But such a denial is to be inferred from almost all their pronouncements. Their panicky little pamphlets about heart disease or cancer suggest that with a little bit more self-discipline, we might all be immortal. Terrify- ing statistics are thrown at us, comparing the numbers who smoke cigarettes, eat butter, or die on the roads. But these statistics are no more nor less terrifying than the regular columns at the back of the Times each morning. The condition from which I am suffering has reached 'epidemic' numbers of which Aids, lung cancer, and alco- holic poisoning constitute only the tiniest proportion. Mortality, that is what I have inherited from my parents.

One of the most striking, if not eerie features of life in the late 20th century, is how cleverly we disguise this fact from ourselves. Ours is the century in which the largest number of people has died. Europe has been strewn with corp- ses. And yet, how seldom nowadays we see them. I know many people who have reached the age of 40 or 50 without having seen a single dead body in the course of their lives. In earlier generations, this would have been quite unthinkable. Not only would they have been shown the dead bodies of their parents and grandparents, but almost certainly they would have seen neighbours' and friends'. In the old days, if You died in hospital, they brought the body home, as a matter of course. Now what happens? It has become a matter of in- terest to me what will actually happen to my body when I die. Dying — the spell before we actually turn into a stiff — has become a fashionable area of concern. For this, very largely, we have to thank the hospice movement. Pioneers at such places as St Christopher's Hospice, St Joseph's Hospice, and Michael Sobell House have created an atmosphere in which ordinary members of the nursing and medical pro- fessions in National Health hospitals can recognise the need to prepare for death and find how this is best done. In Oxford, Mother Frances Dominica at Helen House has established a hospice for dying child- ren, and rediscovered what was familiar to the Victorians, that children are often better at dying than grown-ups. All these are admirable institutions and develop- ments. They concern themselves with pre- paring the families for a person's death and with relieving the patient of pain.

All well and good. But when I come to lie in my hospice, having, I hope, patched up old quarrels and made my peace with God, I shall still find it hard to envisage my body as a corpse. I know it will happen. This hand, writing an article in the Specta- tor, will be stiff and waxy. My features, only half recognisable, will be stiff. What colour or vivacity my face possesses will have ebbed away.

And what will they do with it? That is the question which haunts me. That is the area which we most successfully manage to conceal from ourselves. It is one thing to prepare ourselves emotionally and spir- itually for the great unknown. It is another to entertain theories about the passage of the soul from this world to the next. But somewhere — on a pavement, in a shop, at the bottom of the stairs, or in a hospital bed, there it lies. The thing which once was me. the various other effects. Sometimes of course a ring doesn't come off the finger that easy. In which case you have to break the finger.' Crack! Collapse of sensitive Special Constable.

Most of us will hope to meet the end in hospital. In my experience, doctors have very little to do with the different aspects of dying. It may be they who diagnose the patient's condition and do the clever op- erations. But dealing with a patient in his last hours, knowing what to do with the corpse, and having to tell the family are all left in the hands of nurses; very often girls of less than 20 years of age. I went to see a staff nurse at a moderately big teaching hospital, and she agreed to let me sit in her seminar for student nurses on the subject of dying and bereavement. She was a pretty, elfin woman of 23 called Melanie. Her audience, all female, was aged about 18. All of them discussed the subject without callousness or breeziness, or false sentimentality. I was impressed by the fact that Melanie's eyes filled with tears at several points during the hour. All the girls admitted to being profoundly shocked by their first glimpse of a dead body, not least when the bodies did not look very dead. Sometimes the colour, and even the ex- pression, lingers in a face for several hours.

Although, or perhaps because, they are dealing with it all the time, the nurses seemed unable to recognise that we are all, at varying degrees of speed, turning into corpses. `With a normal patient, you put your head round the door and make jokes and that,' said one big pretty girl. 'But not with a patient who's terminally ill.' Perhaps if she recognised that we are all terminally ill, she would not be able to do her job.

We impose a lot on these girls. An extremely common phenomenon among nurses is the feeling of irrational guilt when a patient dies. They are often much closer to a patient than the family in the last few weeks and days; and as well as developing a deep bond with them, they are also responsible for administering the drugs. In cases of hopeless injury or incurably ad- vanced diseases the dosage of painkillers will be stepped up. A narcotic such as diamorphine will eventually kill the pa- tient. Many of these girls revealed sensa- tions of ill-founded guilt when they had been the last to administer the dose.

When the end is come, it is usually the nurse who has to tell the family. In two cases close to me, a distraught nurse at the other end of a telephone has said that the patient has 'slightly collapsed' when they were actually dead. 'I had a call the other day about a patient who'd died,' admitted one of these student nurses. 'I said, "Hold on a moment, I'll get Staff Nurse." They must have thought I was really stupid.' Melanie told her girls that they must prepare for these moments, They must have a set form of speech. And they must be able to tell families straight out that the patient is dead. Easier to say than to do, I would think.

Iwas still ghoulishly interested in what actually happens when there is a death on the ward. First, the nurse pulls the curtain round the bed, and makes sure that the patient is really dead. 'I try to straighten them up a bit,' Melanie said, 'in case the relatives want to see them; and then I ring the family at once and tell them. Then, when the relatives have been told I would lay the patient out.' While they are still in the ward?"Yes. It would be wrong to say that I like this part of the job, but I feel it is a privilege. It is the last thing I can do for that particular patient, and I always feel great reverence while I am doing it. . . . It's a dreadful moment when the porter comes and takes the patient off to the morgue.'

I left Melanie hoping that she or some- one like her would be with me when I turn into a corpse. Once that stage has been reached, almost everybody is placed in the hands of an undertaker. I went to see a Mr D. because he had handled the funeral of a friend of mine some years ago. He is a raven-haired, plump sort of man who does not look old enough to have been an undertaker for 28 years. 'Do you really want to know all the grisly details?' he asked with a nervous grin and lit up a small cigar called a Hamlet. 'Well, yes please, Mr D.'

If the death occurs at home, the under- taker arrives with a van to take away the corpse. Some firms use ambulances. Mr D. uses a van. 'No,' he corrected me. 'It is based on a van.' He did not explain what this meant. Another undertaker I have asked says that they 'sometimes' zip the stiff into an airtight plastic container, as is customary in the United States. Smaller English firms would be content to cover the body with a sheet. Nothing is done to the body until it reaches the 'chapel of rest' in the back yard of the Funeral Directors. `The basic procedure is to strip the body and wash it down. Then you dress it again. Dead legs splay apart unless you tie them together. Orifices leak unless they are stuffed. The centre of a dead eye turns to liquid, giving the closed lids a curiously flat appearance. An eyeshade or a bit of cotton wool is usually stuffed under the eyelid to make the corpse look a little less dead. A high proportion of families still ask to see the 'deceased' as Mr D. invariably called the corpse. If the body is to be kept for any length of time or viewed, Mr D. recommends embalming. 'Largely for reasons of hygiene. The body is decompos- ing from the moment it dies and well,' he puffs his Hamlet, 'there's a bit of a smell. People think when you embalm the De- ceased, it's going back to the practices of ancient Egypt or something, but it's not like that at all. You make a small incision, not much more than an inch and a half in length and you drain off the fluid. Then you pump in the same amount of embalm- ing fluid.' How much?' On average, there is one pint of liquid for every stone of body weight.' One of the things many people find shocking when seeing the dead body of someone they loved is the absence of colour. The rosiest, jolliest looking man with a glass in his hand at the bar, can turn, in a matter of hours, to the colour and texture of a cheap candle: waxy and white. Embalming fluid reduces the shock for mourners by restoring a little colour to the cheeks. Does Mr D. advocate the use of make-up, as in American funeral parlours? He pauses. 'I usually add a little powder. Just to take the shine off.'

Opinions differ about how corpses should be arrayed. 'We don't talk about shrouds,' said Mr D. 'We talk about gowns.' What's it like?"Well, it's more like a dressing gown worn over your shirt and tie, that kind of thing.' Some friends of mine were so horrified at their father being dressed, as they thought, like a cheap imitation of Noel Coward, that they went to the trouble of taking off the 'gown' and dressing him up in one of his own tweed suits. Not easy to do, I should imagine. High Anglican priests are vested in the coffin, as for the altar. 'It's a difficult job:, I was told by one of them. 'You have to slit the alb down the back and wiggle the arms through. It needs at least two people to do It. It's much easier if you can keep the body upright and just pop the chasuble over its head'. The clever Jesuits, on the other hand, have an ingenious solution to this. They cut chasubles in half and lay them on top of their recumbent brethren. 'No one's going to look underneath,' the superior of one Jesuit house told me, 'and what the eye does not see, the heart doesn't grieve over.' He did not candidly, look as if he was going to grieve very much over any part of his dead confrere's anatomy. All dressed up, and ready to go, the stiff will finally be disposed of. When my father died, the village joiner made the coffin, and friends carried him into the chute. After the nicest funeral service I have ever attended, he was carried out a few yards into the churchyard and buried under the yew trees half a mile from the sea. Most of us won't be so lucky. Forty per cent go to municipal cemeteries, usually in the bleakest part of a town. Sixty per cent (and the number is rising all the time) will end i up in the crem. The only metal in a coffin due to be cremated is in the screws and nails keeping the thing together. The hand- les are either wood or plastic with a metallic finish. The directors of crems are understandably cagey about the mythology which has grown up around them. We have all heard stories of the corpse being taken out of the coffin, and the coffin resold. In most crems, this would be quite difficult, since the coffin glides down the chute directly into an individual oven (cremator as they are called in the trade). Everyone in the world seems to know someone who knew someone else who worked in a crem. We are all familiar with the stories: stiffs sitting up in the coffins in the flames; inexperienced orderlies opening the oven doors and finding that the Loved One had not been quite cooked through. By that stage, when my turn comes, I shall be beyond caring. What continues to haunt and to horrify me is the period between Melanie drawing the curtain round my bed, and the crematorium parson pressing the button. Some people will tell you that it is stupid to be afraid of corpses. On the mercifully few occasions when I have seen the dead, it has not been their corpses that I have been afraid of. It has been my own.