Dealing with Death.

Written and published on the blog on 31st March 2025.

This title is a pun, I may as well confess now. I’ve started on a low- the title ‘dealing with death’ sounds like I’m going to write about emotional and psychological coping following bereavement or one’s own knowledge of mortality. I’m instead going to write about how people engage in bartering with the mortal coil. I come across a small but attention grabbing group of patients every day who wish to deal with death, they often see me as the intermediary. I don’t claim to have such powers, if asked I would deny any suggestion of collusion with the omega to everyone’s alpha. Unfortunately I am not asked and were I questioned on this topic I suspect that I wouldn’t be believed. Denial is the best way to confirm people’s beliefs, if popular politics are anything to go by. 

When I talk to people I spend a reasonable part of any discussion getting a sense as to how they think about the world, themselves and illness. These form the magical triad of all things most relevant when it comes to death. *. The world is how we see medicine and things remote but personal to us. Are they fearful of treatments-due to experiences, media or a general and healthy sense of paranoia? Within the world do they see their part as a leading or as a supporting role and has the world been kind to them? 

Contrasted with this is the consideration of the person. Does this individual with whom I speak to today see themselves as philosophical, or as kind or do they not consider such things? It can be awkward asking such questions and so I find myself inferring from statements and cues the direction of internal monologue of the individual. Each statement ideally cross referenced as I speak and observe. Silence and a smile are often the best tools at this point. Illness often sits within the tapestry of self- those who see their illness as persecutory will often be those who view themselves as the main character, trying hard to correct the faults (so many faults), of those around them. Of course some people are simply afraid. They have no deeper associations beyond having never been able to express or weigh the gravity of their own demise. 

I have found that often the best way to manage those who attempt to bargain with the concept of the unknowable is with gentle persistence and forewarning. Once I understand that I might be in a consultation where the recipient of information is unlikely to welcome such information then I can start to break it down. Each participle of data regarding the possible consequences of known illness can be signposted and summarised until their appearance within the landscape of the conversation is no more remarkable than a roundabout on any UK road. 

I am not an omniscient teller of fortunes. Sometimes I think it is statements like this last one that highlight how hard life is for many. Because it can feel like the person delivering bad news has a Pandora’s box of hurtful information. That this can’t possibly be true, that such information exists whether given voice or not, is rarely seen as the point. However, keeping perspective is perhaps that key to managing such discussions. When being accused of divine insight I find it best to confess human frailty. I may be wrong, we all are at times. A future that may not be desired is undesirable, there is no escaping this. Yet a future unknown and unplanned is almost always going to be harder than one which is planned for, no matter how hard the planning may be. 

*I say most relevant to fend off the pedants here; there are many considerations but a consultation can only include so much at initial meeting.