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Attending to the fact—staying with dying
  1. Professor R MacLeod
  1. Professor in Palliative Care, South Link Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand;

    Statistics from

    H Elfick, D Head. Jessica Kingsley, 2004, US$14.95, pp 127. ISBN 1843102471

    Janet Frame, the great New Zealand writer and poet who died last year, wrote about people who commit suicide: “It is hard for us to enter/the kind of despair they must have known”. Hilary Elfick and David Head have provided us with a book that allows us to enter somewhat into the world of palliative care and see elements of despair but also of joy, sorrow, relief, confusion, and a whole range of other emotions.

    This collection of poems by two people working in very different areas of hospice care illustrates at times quite graphically and almost brutally, but at times quite beautifully, the many facets of what it is like to be in a world with those approaching death. Some of the poems are harsh and almost confrontational, some are gentle and quiet. Individually each poem stands on its own, and collectively they provide a comprehensive and compelling view of the enormity of the range of emotions and experiences as life is ending.

    These authors write about their own experiences of witnessing the plight of people approaching the end of their life, but also they seem to manage to get inside the heads of those who are dying. The poems reflect such careful observation that they give voice to those who are dying: “Don’t to talk to me/when I am curled up crying./Don’t ever ask me/to try and explain/… The only way/you’ll reach my sadness/is hold me closely/—just now and again” (What I meant). A number of poems illustrate the pain and anguish of grief, but at the same time give comfort by talking about so many aspects of living: “for what we stitch and weave with love/is always smaller than the love itself” (Letting go). Much of the writing is so exquisitely crafted that it is easy to picture what the poets were seeing: “I watched the lift of longer hair above your forehead/spiked with sweat into curving thorns” (Hair). “The centre of your chest is ridges/and furrows pitted and smooth/like Passchendaele grass covering/shreds of heroes of your youth” (Your ribcage). “Dreamed-out eyes: one almost, one two-thirds shut” (In the viewing room). Scenes are described that will be easily recognised by those involved in such care but which could be almost shocking to those who are not.

    In this world of modern medicine, where so much is focused on the biomedical approach, this book would be a wonderful addition to anyone or to any institution hoping to help people understand what it is to be in the world of the dying. It will be invaluable not only to undergraduate but also postgraduate students of all disciplines who want to try and understand how that world is formed. One of the particular benefits of the book is that there is a complete lack of emphasis on some of the medical or nursing process. This must be a reflection of the experience of the authors who adopt an entirely non-medical approach. One of the poets has worked in hospice chaplaincy for 15 years and the other has been a hospice trustee for 20 years so their combined experience is extensive. They are also acute observers of the human condition. They illustrate the value of learning from those whom they’re caring for: “Alongside your discerning ear my own became attentive./I learned to hear and look and taste, forgot how to evade,/slipped off the habits that wrapped truth in palatable words.” (Elegy for a tutor).

    This is not a book to be read in one sitting. It is a book to be dipped into and returned to again and again. It is a book that the wider public should have access to as it will go a long way to dispelling some of the fears and myths about life in a hospice. Having this book available for patients and families to read should ease and comfort some of those going on that journey toward the end of life. Emily Dickinson wrote: “Because I could not stop for Death—he kindly stopped for me”. What these authors have done is to provide momentary stops on the journey to look, listen, and feel what it might be like to be dying. It is a wonderful source of illustration, education, and, in a somehow strange way, comfort.

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