The lessons for living we learn from the dying

If we do not contemplate dependence and loss, then we impoverish ourselves as a society

"I WANTED everybody to see that a human being can manage an illness like mine and to see that one can make the best of the end of one's life." That is how Herbie Mowes, whose death of cancer was broadcast last night in the concluding episode of the BBC1 series The Human Body, explained his decision to allow the cameras to film at his bedside.

This is an important statement coming from the man at the centre of this controversial film. At 63, he was young to be dying; he was also very unusual in being prepared to share with the public his experience of his own death. Nonetheless, many of the things he said, and did, during the months when the camera was sharing his journey, are not otherwise unusual.

I remember a TV producer some years ago who, as he was admitted to St Christopher's Hospice, told his doctor: "I've made documentaries about survivors and I'd like to do something with my illness. But how can I, when it's my head that's going to go?" (He had a brain tumour.)

In fact, his mind did not "go", although the syntax of the diary he dictated became poetic near the end of his life. He found meaning and a trust in the mystery of death, just as Herbie did. Both of these men spoke in a similar manner to that of the many other patients I have known in 50 years of being involved with the end of people's lives. We need to listen to them if we are not to miss out on much wisdom, courage and common sense.

Perhaps the chief lesson to be taken from the words of dying people is that suffering is only intolerable if nobody cares. If last night's television programme reminded its viewers that people at the end of their lives are part of us all and must not be isolated in a distant pity, or even distaste, then it will have served a good purpose.

As a society we do not care to contemplate dependence and loss; and yet if we fail to do so, we impoverish ourselves. For there are many lessons in living which the dying can teach us, if only we listen to them. Above all, they make us look at our priorities and values. As someone once asked: "Whoever said on his death-bed, `I wish I had spent more time at the office'?"

Another St Christopher's Hospice patient has talked to us about what makes good visiting of the dying. She says: "Always remember that the best gift you can give is yourself and your spare time." But she also has firm things to say about the need for flexibility regarding when to visit and for how long. It is important not to forget that dignity can be maintained even in mortal illness, if only visitors demonstrate that they recognise the essential spirit of the patient, however ill that patient may be.

She knows, of course, that visiting is not easy; but often the patient can take the lead, if the visitor allows them to. The staff at St Christopher's had to use all their skills over many months to give this patient space to be herself, free of the pressures and pain of what could have been a devastatingly humiliating illness.

Not everyone has the resilience and endurance of Herbie Mowes and our two patients; but everyone has something unique to them. And this can be summed up and fulfilled at the end of their lives, if they are paid the respect and attention that should be available to them.

Much has been learned and published on the details of pain and symptom control at the end of life. No nurse or doctor is now further from palliative care advice than a telephone call to one of the many specialists in this challenging field.

Pain can be analysed, assessed and tackled, in the vast majority of cases, with understanding concern and drugs available to everyone. Specialised treatments are increasingly available to the few with particularly complex and intransigent problems.

Above all, people facing the end of their lives need to know that this may well be its most decisive moment, for people move fast and resolve many problems in a crisis. Many families achieve long-delayed reconciliations and find new strengths at this time.

Herbie needed the skills and caring attitudes of his hospice, at-home nurses and GPs, but above all the unfailing availability and support of his wife. When he had a sudden surge of pain, that was dealt with, and we next see him in the BBC film enjoying champagne at Christmas.

Next he experiences a phase of depression and desires a hastened end to his suffering, but this passes after understanding listening. Following this passage, he looks forward to a spring that turns out to be his best ever, the beauty of each day enjoyed as never before.

As Herbie dies, and his breathing becomes laboured, his wife holds him. Some viewers may have found this distressing, but she remains calm and loving. I am reminded of the times I have said: "I believe he is no more conscious of this than he was of snoring when he was well." And had the relieved response: "He was always a noisy sleeper."

People are themselves, whatever life throws at them. Herbie shows us that a human being can make the best of the end of his life.

He was helped by his wife, his neighbours and the hospice team, but the achievement was his. If, as a result of sharing the end of Herbie's life, we can become better neighbours to the dying and the bereaved, he will have enriched us all.

Dame Cicely Saunders is the founder and chairman of St Christopher's Hospice. Founded in 1967, St Christopher's, with its emphasis on palliative care for the dying, began the modern hospice movement.