April 9, 2020

“I despise the set of warlike metaphors that so many apply to cancer. [It] says that only those who fight hard against their cancer survive it, or deserve to survive it — the corollary being that those who lose the fight deserved to do so.”

I was reminded of the late John Diamond’s words when Dominic Raab described the Prime Minister as a fighter. I know Raab was simply trying to gee up a beleaguered nation worried. So we can forgive him for the callous implications of his remarks: that all those who have lost their lives didn’t fight hard enough. But the implication is there. It’s a common fantasy to which many of us succumb, in our desperate wish to have the power to stave off death.

Death cannot be fought, though. We are all dying. The only real question is how fast it is happening. All we can hope for is the deferment of our sentence, and that its approach will be benign when it comes.

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If you ask them, most people will tell you that they would like to die suddenly, at home, in their sleep. So frightened are we of death that, if we could, we would ask it to creep in unannounced. It’s not the being dead that frightens us, but the act of losing life. Or as Francoise de Beauvoir says in her daughter Simone’s memoir, A Very Easy Death: “Death itself does not frighten me; it is the jump I am afraid of.”

We want to die at home, comfortable and in familiar surroundings. We want friends and family close by to say farewell. And one of the great tragedies of Covid-19 is that it robs us of these simple hopes to make that last jump easier to bear.

The published data on daily deaths tells us only about those who die in hospital. The real number could be about 7% higher, once deaths outside hospital — at hospices and care homes — are taken into account. But still, the vast majority of people are dying in hospital, a fate only 1 in 15 of us would choose. And not just any hospital or any ward: they are treated by medics in protective equipment that might as well be a space suit. Faces obscured. Hands double-gloved; not even the comforting touch of skin on skin at the last. It is hard to even imagine how frightening this must feel like to someone in and out of feverish consciousness, or someone with dementia.

Doctors and nurses are going to heroic lengths to make this easier for struggling patients. Finding phones and tablets to bring relatives into the ward by video conference even if it’s just to say goodbye. Displaying a photograph of themselves on the outside of their PPE, to show there’s a human under all that plastic. Sharing kind words, compassion, and care that go far beyond the medically necessary. As Vice President Mike Pence said a few days ago: “They are supplementing for family.”

But still, for hundreds of people a day in our country alone, their last sight will be hospital scrubs, face masks and visors, the mottled, easy-scrub floor tiles. They will hear the endless disharmonic beeps from a ward full of monitors. Their last thought will be the desperate struggle for air as their lungs drown them from the inside, before they are sedated, tubes inserted for a ventilator, in a last heroic attempt to keep them alive.

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For most patients, it seems to be their immune response, triggering what’s called a cytokine storm, that brings their life to an end. Being a fighter is no longer any use. How can you fight your own immune system?

But the great theft perpetrated by Covid-19 goes deeper. It is not just robbing us of the good deaths we hope for. It is also robbing us of the good farewell. Funerals are being restricted to just a handful of close family members. Protections have been put in place to ensure that, for as long as possible, religious rituals will be honoured, and no-one whose religion forbids it will be cremated.

But all of us are adapting our traditional ways of saying farewell to the dead: the condolence calls traditional during Shiva, the Jewish period of mourning, are suspended, for example. In China, millions who would have visited their ancestors’ graves this weekend for the Qingming festival — an annual tradition which has been honoured for 2,500 years — were unable to do so.

Most difficult of all is the rule that if anyone in the family has symptoms of the disease which just killed their relative, no-one in the household can attend. Perhaps the most awful example that’s hit the news is of the south London Abdulwahab family, who lost a 13-year old son, Ismail Mohamed. His younger brother and sister developed symptoms — no surprise when they had been sharing a home with him. So Ismail Mohamed was buried with no family present at all.

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People, in their infinite ingenuity, are reinventing the funeral as best they can. I’ve heard tell of a family concert put on by video conference to celebrate the passing of a grandfather. I’ve seen reports of a funeral director driving the hearse round a whole village, to let every friend and neighbour say goodbye. Heroic vicars and imams and rabbis and crematorium directors are rigging up cameras so loved ones can say farewell from afar.

This process of honouring the dead spans cultures, and it spans history. One of the earliest tragedies from Greek culture is that of Antigone, who would rather die (and does) than see her brother go unburied. Each culture has its own way of doing things. Some consider burning a great honour; some consider it barbaric. Some tear clothes, some sit in silence.

But the honest truth is that none of this is any use to the dead. They are long past knowing. Funerals are for the living.

Perhaps that’s an atheist view. Some believe that the ritual process — whether it is burial in consecrated ground, burning, or the speaking of words — is essential to enable a soul to pass on to the next realm of existence. Even then, the greatest comfort, surely, is for the living, who feel reassured that their loved one has found that better place.

For all of us, a funeral confirms that our loved one mattered. We tell the story of their life and we imbue it with power and meaning. We celebrate them. We remember them. It helps us believe that we, too, matter. That life has meaning and purpose. As de Beauvoir puts it in that incredibly moving and candid account of her mother’s death, “We [are] taking part in the dress rehearsal for our own burial.”

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That’s why there is nothing more important in the grieving process than what they call ‘a good send-off’. It is a celebration of life. Even in shattering, crushing sorrow we can give thanks for their past life, and for ours, which continues.

Elisabeth Kubler Ross, the psychiatrist who identified the five stages of grief, said this: “It’s only when we truly know and understand that we have a limited time on earth — and that we have no way of knowing when our time is up, we will then begin to live each day to the fullest, as if it was the only one we had.”

Covid-19 may rob us of a good death. And it may rob us of a good farewell. But perhaps it might have one gift, to those of us who survive: a recognition that we must live each day to the fullest. That’s the only fight worth having.

Comment


  • April 9, 2020
    I have been a terminal lung cancer patient for nearly four years now, and I echo strongly the John Diamond words. The language of fighting the disease is misplaced. There is a choice to forego available treatment and accept the accelerated consequence of an earlier death, or a choice to continue... Read more

  • April 9, 2020
    I too agree with so many of the sentiments expressed. But I disagree with the final imperative. I do not wish to have to live my life to the fullest day after day. Could life please be a little less immodest and expect a little less from me. Read more

  • April 9, 2020
    I heartily agree with so many of the sentiments expressed in this piece. Thank you. The 'blitz spirit' approach in response to so much of this Covid crisis does little more than denigrate the emotional reality of the situation for so many up and down the country. I understand the temptation to fall... Read more

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