You are dying.
This is something no-one wants to hear, but it is true for you as much as it is for the critically ill patients I treat each day in hospital. Many of them are much closer to the end than you are, however, life is unpredictable, chaotic and sometimes cruel. Few of us will die at the time of our choosing.
I work in healthcare where miracles occur on a daily basis, but where we are also surrounded by death. Death was not always a medicalised experience - for centuries people died at home, within families and communities, meaning that we were all exposed to it as a process and an event from an early age. People died surrounded by the things and people they loved. These days a large proportion of the population are brought to hospital for their final weeks, days and hours.
People's wishes at the end of life vary and not everyone wants to die at home: some are comforted by the hospital environment; some want to live in denial until their last breath; some will suffer pain, nausea or indignity; we cannot all expect a spiritual and transformative experience. But too often investigation and attempts at treatment take priority over care despite people's wishes for peace and dignity. And so people spend their last days surrounded by unfamiliar equipment and professionals, and are cut off from the things and people they love. We can do better.
For those not working in healthcare it can be difficult to engage with these emotion-laden subjects, meaning many wait until the last moment to even acknowledge that death is a possibility. This can be damaging, with wishes unknown, plans never actualised, questions never answered and things left unsaid. Death is inevitable but a bad death is not. We need a common language to articulate our questions, our fears, our wishes, and words are not always easy to find.
I've chosen to lead a death cafe to celebrate this year's Creativity and Wellbeing Week (a festival led by London Arts in Health Forum) because the arts and creativity, in all forms, can help us make sense of death and grief. They hold something crucially valuable for those of us who work in healthcare yet also for everyone who is losing or has lost a close family member and friend. The arts can guide us in finding space for our emotions and existential concerns, and bring this most hidden of human experiences back into the land of the living.
Artists and death
Over the years art has helped me to reflect on and process my emotions caring for the dying. My experience has primarily been with visual artists, many of whom have used their practice to explore their own mortality or grief. One of my personal favourites is Skull of a skeleton with burning cigarette by Van Gogh. I like to think of it as a cautionary tale, an early public health message on the dangers of smoking, still a major cause of death and disability today.
Frida Kahlo used self-portraits to explore many very personal experiences including illness, miscarriage, and death. Thinking about Death is a self-portrait from a time when she was ill and predominantly bed-bound. In this painting, death, symbolized as a skull and crossbones, is on her mind, literally in this case, appearing on her forehead. She is also surrounded by lush green plants, which may symbolise new life, since rebirth after death was a concept central to Mexican culture.
Damian Hirst is well known for his self-stated "obsession with death", although he saw his works such as The physical impossibility of death in the mind of someone living as "a celebration of life rather than something morbid." His work is not to everyone's taste, but I find many of his pieces evocative, in particular Let's Eat Outdoors Today, a huge glass box containing a barbecue and set of table and chairs, set up for a meal. Maggots hatch into flies which feed on the remnants of the meal, and there is a blue electric light, in which many of the flies meet their demise. Being confronted with decay in action forces the reality of our mortality into our consciousness which can be uncomfortable. But I come away not frightened or defeated, but instead invigorated and in awe of my living, breathing body.
Emma Kisiel, a contemporary photographer, elevates road kill to high art in her series At Rest. Dead animals are photographed where they were found, surrounded by flowers to create beautiful memorials. She states this expresses the sacredness of the bodies of animals hit by vehicles while crossing the road and addresses "our human fear of confronting death and viewing the dead".
A Creative Death
There are many examples of people using personal creativity to facilitate a more enlightening and meaningful end of life period. Arts therapy has been central to the hospice movement for years. But there are also a growing number of people exploring and extending their creative outlets, without a clear therapeutic aim. People nearing the end are in a liminal space between life and death, where there is the potential for transformative experiences as well as intense grief. Engagement with artistic practice can create space to make sense of loss and mortality, can empower those losing their ability to make an impression on the world to make connections, and can enhance autonomy at a time when this is fading.
Art can be many things: imagination, beauty, reflection, provocation, emotion, therapy, inspiration, experimentation, agency, connection and communication. We need all these things when facing death, dying and grief.
By Dr Laura-Jane Smith
Laura will be leading a free death café to explore some of these themes as part of Creativity and Wellbeing Week's programme on Friday 16 June, the festival's dedicated day for exploring the arts and end of life care.