How can our understanding of mortality shape the way we live? Palliative care doctors and death doulas share the lessons they have learned
We will all face death one day, but our attitude towards this is individual. How can our understanding of mortality shape our approach to life? Here, palliative care doctors and death doulas share what they know about the end – and how it informs the way they live.
Dr Rachel Clarke is a palliative care doctor who works at an NHS hospital in Oxfordshire and is the author of several books, including The Story of a Heart. “I have learned what matters to my patients as they approach the end of their life,” says Clarke. “All the irrelevant stuff is stripped away. No one cares about how much power they had, how big their house is, how fancy their car is, how much status they had at work. What they care about is the people they love.” In short: “The way to live a life that is rich and deeply fulfilling is to build human connections. That matters more than anything else.”
At the end of life, repairing relationships can be crucial, says Dr David Holland, a palliative care consultant who works in Norfolk. “People tend to have things they want to say, like ‘I’m sorry’, ‘I forgive you’, ‘Forgive me’, ‘I love you’ or ‘Thank you’. Not addressing those unsaid feelings can lead to people having regrets.”
“If something is important to you, do as much of that as you can,” says Holland. “In my life, I really value what I do for work. It builds me up as a person, knowing that I can have those relationships with people and make a difference to people’s lives. It is a real privilege.”
But it is important not to get too caught up in your career, says Ruby Love, an end-of-life doula in Bristol. “I’ve never met someone at the end of life who regretted not working more or not earning more money. If we can find a balance between what we need to live on and what we need to be happy, I think that is key.”
“Pleasure is a very superficial experience,” says Clarke. “It can be a distraction: you can eat or drink yourself into a stupor and have a fabulous time doing it, but it isn’t going to give you a sense of fulfilment.” Deeper experiences matter more, she says. “They are the moments of joy, awe and wonder at the world around us.”
Working with people who are dying can be emotionally stressful. Holland finds relief through cultivating a plot of land. “I have always found great interest in wildlife and biodiversity,” he says. “I really enjoy being out in nature and helping things to grow.”
“The richness of life comes from our relations with other living creatures, human and also non-human. It could be animals or birds or plants, but it is living connections with the wider world that give life meaning. The more you can pour yourself into those connections, the more likely you are to have a deep sense of contentment and happiness.”
“Most of my life was spent focusing on living without regrets,” says Tan Ming Li, an end-of-life doula in Singapore and the founder of the Life Review, a charity that helps to normalise talking about death and dying. But one day someone said to her: “If you don’t have any regrets, you are not living life enough, you’re not daring to try things, you’re just feeling safe.” This caused Tan to have a rethink. “Now, my philosophy is more about living with intention. If I get invitations, do I really want to do this? If tomorrow is my last day, how do I want to spend it?”
Tan says the secret to a life well lived is “not just about joy but what lights a fire in your belly”. For example: “I have a dog and I love grooming him,” says Tan. “It’s not easy and it takes a few hours. Could I have spent that time doing other things, which could be more productive in society’s eyes? Of course.” But she values this time with her dog and would never send him to a groomer.
“Value those small moments, like when the leaves first come back on the trees in the spring, or when you have a really good cup of tea,” says Love. “The big things are wonderful, but most of our life is the small things. So try to appreciate them.”
People often think about legacy at the end of their lives, says Holland. “I’ve had people who have wanted to hand over something important. This could be a business, memories or the building of a house.” So finish that novel, sort your family albums out, get your affairs in order.
This year, Love arranged an exhibition for a client who used to be a photographer: “It was very small and low-key, but that was something that she really wanted to do.”
Clarke advises asking yourself: have you been a part of something that connects you to other people around you? “That could be through charitable work, working as a teacher or by being a loving figure at the centre of your family. It could be through artistic or creative endeavour. It could be a craft that you love doing and giving to your friends.”
