Dying matters. It’s time we started talking about it


Scarlett Nash, palliative and end of life care facilitator at The London Clinic, on why it’s so important that we begin a practical, honest conversation about dying

Dying is inevitable. It happens to all of us. Yet, in my experience, most people shy away from talking – or even just thinking – about it.

I’ve spent over a decade working with hospices, hospitals and the community to address the elephant in the room. The fact that people don’t like talking about dying, I can empathise with completely. Life, after all, is about living. But modern medicine, no matter how advanced, can only help so much. Every life will run its course.

People can be surprised that I’m so matter of fact about dying – but talking openly about death makes it so much easier when the time comes, not only for ourselves but for our loved ones too. My aim is to show that this doesn’t have to be a depressing subject, just a practical and honest one.

Helping the grieving process
The deaths I have supported have either been gradual or very sudden. Although what we die from is out of our control, I have witnessed the most moving and ceremonious deaths, which were driven by the patients’ calm and measured attitude towards the inevitability of dying, and how engaged they were in their discussions. Many families I have supported after their loved ones have died remain eternally grateful that they were accepting of their fate as this, in turn, helped their grieving process hugely.

On a practical level, when we refrain from talking about dying and aren’t properly prepared when it comes, all our choices and the resulting admin, like financial affairs and funerals, are left to the people we love. The kindest thing you can do for them is to help them prepare for your death.

This preparation doesn’t need to be all doom and gloom. You can have a laugh approaching this subject with your loved ones, break the ice. Why not use the next roast dinner to understand what your parents or best friends would want when their time comes? I recently sent my family and close friends my wishes and I honestly feel like a weight has been lifted.

Scarlett Nash and Kimberley St John

Scarlett Nash (left) with her friend Kimberley St John, who died last year

Supporting loved ones and staff
The London Clinic, where I am currently stationed, is extremely proud to be able to deliver palliative and end-of-life care for our patients. We were so honoured when these services were rated outstanding by the Care Quality Commission during its most recent review in 2016. The patient is at the centre of our care, but rarely does it stop with them. It’s also important that their loved ones are supported, along with the staff who are looking after the terminally ill.

We also have an important role to play in opening up conversations around dying. This year we took part in Dying Matters Awareness Week for the first time. Occurring annually, the Dying Matters campaign works towards shifting the conversation about dying, death and bereavement, from one that may be considered negative, into one that is positive and encouraging.

The way I see it, we’re exceptional about talking about birth: the due date, the parents’ birth wishes, the baby shower. So why don’t we apply the same effort in making our wishes known in death? We should be celebrating each person’s life when they leave this world and giving people an exit that’s aligned with what they would want.

For some, this will be in the writing of their wills combined with an advanced care directive and advanced care plan (effectively documenting their medical treatment and wishes). For others, it may be as simple as ensuring their favourite song is played at their funeral or the type of service they would prefer. Personally, I’ve insisted that everyone has to wear sparkles at my funeral and must have a boogie afterwards to my favourite playlist.

A good death
Having nursed the dying for many years, I can share that there really is such a thing as a ‘good death’. But we have a huge part to play in that while we are still living.

Like many, I experienced a personal bereavement just last year. My dear friend and remarkable palliative care nurse Kimberley St John died very suddenly in July 2020, aged just 32. Her pioneering successes in her career were and are truly inspiring, including the Let’s Talk campaign, which speaks to many of the points discussed here. She left us with many messages, but the one that stood out the most was: “None of us know how much time we have left. Use it wisely.”

I feel it’s the duty of all of us to carry this message forward.