The Life Of Bryony - The Life of YOU: What Really Happens When We Die? A Palliative Expert's Insights

Episode Date: November 22, 2024

Welcome to The Life of YOU, where we tackle life’s toughest moments with honesty and humour. In this special bonus episode, I’m joined by Dr. Kathryn Mannix, a palliative care expert with over 30 years of experience, to address some deeply personal and important listener questions about death, grief, and end-of-life care. Follow Kathryn on Twitter Find her book, With the End in Mind WE WANT TO HEAR FROM YOU Do you have a dilemma you need help with? Send it our way! 🗣️ Text or voice note us at 07796657512 (start your message with LOB) 💬 WhatsApp Shortcut: Click Here 📧 Or email us at [e-mail] SOME GREAT RESOURCES Mind UK: www.mind.org.uk Samaritans: www.samaritans.org Marie Curie (End-of-Life Support): www.mariecurie.org.uk Macmillan Cancer Support: www.macmillan.org.uk Bryony xx Learn more about your ad choices. Visit podcastchoices.com/adchoices

Seriously popular. Welcome to The Life of You, where we dig into your dilemmas and help you find solutions for life's tougher moments. And they don't get much tougher than this. Today I'm joined by the remarkable Dr Catherine Mannix. Catherine has spent over 30 years as a palliative care doctor, helping people live well right up until the end of their lives. She's an expert in navigating the complexities of death and dying and through her books and public talks she's been breaking down the fear and silence that often surrounds the topic. In today's chat, we'll explore questions many of us grapple with but rarely discuss openly. So doing the dying is surprisingly gentle. Descent down into deep unconsciousness

happens in a body that is comfortable. The Life of You with my guest Dr Catherine Manix, right after this. Thank you so much for coming on to The Life of You for this special bonus episode, The Life of You about death, essentially, a subject that you are an expert in. You're a palliative care doctor. Can you explain to listeners what palliative care involves? Yeah, delighted to. So thanks for inviting me to think about life in death. So palliative care is actually not about dying. I think that's the opening bat, that palliative care is about really good quality of life. It's about living. And usually the best way to get rid of symptoms of an illness is to cure the illness. So we meet people where cure is either more difficult or not possible and we're trying to help them

to live well with whatever illness it is that they have. So it's really important that people understand about palliative care and aren't afraid of it, that it's a right, that it's something that helps you to live better straight away, that it's not about dying, you're not obliged to die if you meet the Palliative Care team. Not that right that moment. You know, really important. In fact, if you survive, we kind of like that. Right, if you survive through the meeting, that's useful.

Actually, the whole meeting sometimes people will survive. So one of the things that's interesting is we meet people sometimes quite late in their illness, not because they have refused to see us, but because their doctors have been so worried about discussing palliative care with them that they haven't had the conversation with them about it yet. Really? So there's a kind of double set of gatekeepers. There's a belief that patients will be upset if we see that say the palliative care words. So we don't say the palliative care words so they live longer with unnecessary

symptoms than they could have done if their doctors had referred them earlier. So you wrote this incredible book called With the End in Mind that came out in 2018 and I read it at the time and was completely blown away by it because death is something we're all going to do and yet we are so terrified of it, not everywhere, you know, globally, culturally there are different places in the world that are much better at dealing with death. But certainly in the UK, we are, as with many things, quite tight lipped about it. I think that's a fair comment.

So I am going to plunge straight in with the listener questions and excitedly, excitedly seems like the wrong word. But you know, it's hard to find the language for talking about this. I have people who write to me to tell me how much they've enjoyed the book. And then they say, I'm not sure enjoyed. Is that, can we use that word? It was really uplifting? Or I say, I hope you'll enjoy the stories and then think, yeah, I'm not sure that's the right word. to say to anyone listening who, you know, the chances are, given this is a mental health podcast, you might have a huge fear of death, you know, and might even just be scared to even listen to a podcast about it, you know, and I totally get that. And I just want to say this is a safe space. And I think we are all better off for talking. As you say, this isn't necessarily about death. It's about life in death. So the first listener, I've been diagnosed with terminal cancer. And while I've come to terms with it as best

as I can, my family hasn't. They're either telling me I'll pull through or just refusing to talk about it altogether. I'm 65 with a wife and two young adult sons and I want to spend the rest of my life focused on my quality of time with them without avoiding difficult subjects or emotions. How can I help them feel more comfortable talking about death and dying with me? I feel like whenever I try to be direct they just shut down and that's from Stephen. Oh Stephen, that desperation to have a conversation out in the open and people start saying oh can't we talk about something more cheerful or don't be so

negative and in fact all of this campaigning and the storytelling and the book and everything else comes from my own sense of desperation on behalf of people like Stephen who are trying to get the conversation going and other people are resisting it. So first of all, I really hear what you're saying. It's a thing. Things that people have found helpful first of all is to actually make an appointment with your family to have the conversation instead of every time they come, you try and have a go, everybody closes you down, then it's all a bit awkward, somebody gets grumpy, somebody gets upset, you feel frustrated. To actually say to individual members of the family, listen, I will feel easier about this

if we can have at least one conversation about it. How would you like to do that? Because it might be that some people in the family are, let's get everybody in a room and talk about it type of people and other people are going to be, if I've got to do that, I just want to do it one to one. I don't want other people seeing me get emotional or doing their usual big brother sister, little brother sister, whatever it is thing that they do that gets on my nerves when we try and talk about serious things. So you might need to pick off individual members of the family one at a time to say, this is an invitation from me to help me feel better by knowing we've talked about it, but

I want to do it in the way that feels the least difficult for you. So I guess the options are for the people who want to meet together, we'll do it together. If you'd rather do it just one to one, then we can do it one-one. And I would like to do it, well, this is a good time of year because it's, you know, late autumn. I would like to get this done before Christmas so it's not hanging over our Christmas or, you know, any time of year. I would like to get this done over the next few weeks because it's hanging over me. It's upsetting me. This is the thing that you can do to help me with a situation that's difficult and we're all in that situation. And when they say, oh dad, I'm sure it's not as bad as all that, rather than arguing with

them, just say, well, you might be right, but in my head, it's as bad as all that and it will help me to be able to talk about it. That's great advice. Obviously, Stephen's talking about adult sons. I wanted to ask you quickly about telling young children, what if you are in the unimaginable situation of having young children and suffering from a terminal illness? How do you talk to them about it?

Because from what I can gather, there is no right or wrong way of doing this. The only kind of hard thing that people seem to say is just don't do it before bedtime. Yeah, and don't not do it. If there are young children in the family, whether they're your children, they're your grandchildren, they're nieces and nephews that you see very regularly, you're the next door neighbour who babysits sometimes, if they've got a relationship with you, they will know that their grown-ups are upset. They've got antennae for this stuff.

Because of the way the world works for little people, when things are bad that are going on and they don't know what's going on, they assume it's something about them or caused by them. So their grownups will be upset. They don't know what's going on. I must have done something wrong. I must be in some kind of trouble or there's something about me that they don't want to tell me. So we really have to make them safe by saying, mommy's upset at the moment because granddad is so sick, for example. And I want to tell you a little bit about what's wrong with granddad. Granddad's got a sickness that's called, I don't know, chronic bronchitis. It makes his chest really bad. Sometimes it's hard for him to breathe. Sometimes it gives him a bad cough. And as Granddad gets older, it's going to get harder for him.

And soon we think Granddad won't be well enough to stay alive anymore. We think Granddad is going to die and we'll be very sad when that happens. But he's not dying yet and he's not dying today. And we still love going to see him and he loves seeing your pictures or hearing you sing your songs or whatever it is. So we can do normal things with grandad but we've got to also talk about what's happening to grandad. During the phase when a parent or a grandparent is actually dying and they're becoming not strong enough now to get out of bed anymore, they're not

always awake all of the time, if that happens behind closed doors then children's wonderful imaginations fill in all of the gaps. Maybe they won't let me see grandpa because he's turned green, he's turned into a dragon. You know, who knows what's going on in their heads. So to be able to say, well, we're going to pop in and say hello to granddad, he's probably going to be very sleepy, but he can hear your voice. So say hello and tell him your news. And then I'm going to sit in here with granddad for a while. I leave the door open, come in and out as much as you want to, so they can choose how much time to spend there or not. And it's really interesting watching what children choose to do. And some of them feel that they're drawn to that space, that something

important is happening. And some of them feel that the space isn't comfortable because of the emotions that are going on in the room and they'd rather not be in there. But the ones who distance themselves often pop in and out and they're just checking what's going on. So they've got some reference pictures in their head. So afterwards, when the person has died, they haven't got nothing in their heads, which they then fill with all the worst details of their imagination and the fairy stories that they knew. It's amazing advice. Welcome to the Orwell business. Billy Bob Thornton, Demi Moore and John Ham star in

a new Paramount Plus original series. The world has already convinced itself that you are evil and I am evil for providing them the one thing they interact with every day. You're all right, here we go! From Taylor Sheridan, executive producer of Yellowstone. Get everybody back! Go! You just put a giant bull's eye on this place.

We rolled the dice one last time. Landman, new series now streaming exclusively on Paramount+. Toronto. There's another great city that starts with a T. Tampa, Florida. exclusively on Paramount+. You've never flown to Florida like this before, so you'll land in Tampa ready to explore. Visit flyporter.com and actually enjoy economy. If you're enjoying the podcast, hit follow now to stay connected and never miss an episode. This one's interesting and I think this one will chime with a lot of our listeners. I have an overwhelming fear of death, so intense that I've actually called an ambulance twice during panic attacks convinced I was dying. I'm not religious so I think my fear might

come from the unknown or maybe even a loss of control. I know that death is inevitable but how can I work through this fear and find some peace with it? And that's from Gareth. Gareth, you are not alone. No. That's quite normal. I don't think anyone's like, woohoo, let's, you know. So almost all of us, probably all of us think, oh, that's going to be an interesting and slightly scary experience. But there's a proportion of us who have a fear of dying that's so profound it's got a name. It's called Thanatophobia.

Right. So it's a thing. And you can find therapists who specialize in it. Okay. That's useful in itself. Right, so even that is just worth viewing, isn't it? So people who have this kind of overwhelming fear of death, very often it's not fear about what the process of dying will be like, which is the thing that I'm trying to help people to be less afraid of. It's more about the difference between existing and not existing. And the idea of not existing is pretty mind-boggling to all of us if we try and sit with it. And in fact, most of

us therefore don't try and sit with it. But people who have fanatophobia very often find that they can't stop looping their brain around, but how will it be and how will I know, do I need to do anything to avoid it being sooner? So they're constantly vigilant for the things that might threaten their life, which makes them anxious. Right? So then what this correspondent is saying is, I have episodes where I get anxious. When we feel anxious, we make adrenaline to help us. It's our flight or fight response hormone. And what that does is gets us ready to deal with a crisis. So more oxygen through our lungs because we start to breathe more deeply and more fast. Our heart starts to beat faster and our blood pressure goes up a bit

to get all of that oxygen round to the bits of us that think in our brain and the bits of us that are going to run away or fight in our muscles. The muscles themselves start to tense up so we start to feel jittery and a bit shaky. We take the blood away from the gut so more of it can go to the muscles in the brain. So the gut starts to get this weird, sinky, butterflies, yucky feeling at the same time. If you get really, really frightened, then you start to get that pressure in your bladder and your bowels sensation. Yeah. So all of these things are just the response of adrenaline and adrenaline is our life-saving hormone. Okay. So some people feel at any minute this is going to get so bad that I am just going to collapse. To collapse and

faint you have to drop your blood pressure. Right. And adrenaline is actually pushing your blood pressure up. So you might feel as though you're on the brink of a disaster because your heart is pounding so hard and your breathing feels so weird and your mouth feels so dry and your tummy's doing all of this jiggery-pokery stuff, but you're not going to collapse. So neither are you going to die. But if you have a tendency to some trouble with your heart, for example, then you'll notice the pounding and you'll think, oh, this could be a heart problem. And then you start to be frightened about that as well. And if you've got trouble with your chest

and your breathing sometimes, then you'll notice the breathing change. And if you're a person who's got trouble from time to time with your guts, then you'll notice the kind of weird things that are happening in your tummy. So the panic that comes is because the adrenaline made us have some symptoms, which it's supposed to make us have. And then our brain latched onto some particular symptoms and thought, oh, look, there's something wrong. I knew there was something wrong. And now there really is. So that makes you make more adrenaline, which makes all the symptoms get bigger, which is what a panic attack is.

It actually is. So adrenaline is our friend, one of our life-saving hormones. But if we misinterpret what it's doing to us, it's an ordinary response to anxiety. It's not going to harm us, but our reinterpretation of all of those symptoms can make us feel very, very frightened and panicky. Right, next email. My mum is in her late 80s and has several health issues. She's my best friend and I feel overwhelmed

at the thought of losing her. How can I start preparing myself mentally and emotionally for her death? We've been so close my whole life, I honestly don't know where to begin. And that's from Jane. So I think this is a kind of a two part answer because the first part is I think that just as before you were a parent, for example, you thought you knew what being a parent was going to be like, and then you discovered that you could never really understand before you were a parent. I think until we've been bereaved, we just don't understand what bereavement and grief is actually about. So what's kind of optimistic for Jane managing this is that already she's saying to herself,

you know, my mum is mortal, my mum is aging, this is going to happen and I will be bereft of her and it will be really hard. And that in itself is preparation, that in itself is saying this thing is happening and it's kind of twofold thing of anticipating what the loss will be, but also making the time that's left so meaningful and special and really noticing it and making the most of it. And I think the truth is that there's very little that we can do that will absorb the impact. There isn't a parachute that we can wear that gives us a gentler landing. But one of the things that's really worth thinking about is it's really easy at this stage in the life of an older adult that we're very close to as they're gradually accumulating health problems. To be backed into a conversation by them or

by another member of the family of making promises that we might not be able to keep later on. I'll never put you in a home. Right, okay. Or we'll never let you leave this house. Yeah. And then we find circumstances become so tricky that actually... And then you feel guilty. Yeah, and then you feel terrible. So it's really, really important that the conversation

about your mum's wellbeing between now and then is centred on what's really possible. So understanding how the illness or illnesses might progress, what kinds of symptoms and difficulties they might be likely to cause, can you make any plans in advance, might need a conversation with your mum's GP of what are the kinds of tricky moments for this particular illness and do we need any medicines in the house that we can use if mum's feeling less well or are there any special do's and don'ts, is going to the hospital going to be helpful or is that just going to be a long wait for an ambulance, a long lie in an ambulance, a long lie in a trolley and then you realise

you would have been better off at home. So having some plans for what to do in crisis so that you're ready for the illness and the changes that might happen towards the end of her life might leave you with fewer regrets about the way that phase goes afterwards because nothing is going to save us from the pain of being bereaved of the person that we love. It's the other side of the coin, isn't it? And the grief will be as deep as the love is, I think. How do I cope with the guilt of feeling like a burden to my family as I approach the end? That's from Harriet.

This is so hard, isn't it? Because actually when we love people, we see what they do for us and earlier on in our lives, we do things for people who can't do much back for us because they are our children, they are our dependents, that's the way round it is. And then we move into kind of slightly more adult give and take relationships and sometimes there's more give and sometimes there's more take. But somehow we make an assumption that our role once we're adults is always to be giving and very little to be taking. So I've met lots of families who've had somebody having this kind of response of I feel really guilty, they look really tired, I'm just a burden now. And it's not that they're tired of living.

They still wake up every day glad to be alive, but they also wake up every day and look at how tired their children look or that there's a loneliness to living alone, for example, but they don't want to call their adult children because they might be busy with their own children or they might be on the other side of the world at the time that I'm at my loneliest. Is the middle of the night for you or is the middle of the working day for you? And helping people who feel guilty to understand when families say to them, actually, do you know what, Mum, we want to be able to do this for you. And for us, there is a giving back for something that we've received in the first place. And so I've met a lot of people who've learned a way of receiving care gracefully

as a way of giving back to their family by tolerating the fact that their daughters become a bit bossier than really they like, for example, and just taking it because they know there's love in it. So one of the things that I think would be really, really helpful for everybody for a family like this would be to just own up, I do feel guilty, I do feel I'm a burden, I do feel that I'm making it more difficult for you, and then really let them talk to you about how that feels for them because the truth is that it is extra work looking after you but that doesn't mean that it's burdensome extra work or that they resent it. That's

the mind reading that we're doing. For a lot of people it's a privilege and an honour isn't it? Lots of families absolutely want to give that back to people who've looked after them and helped them in the past. So it is really important that we can talk about it because otherwise you're going to wake up every day with the gloss taken off the day because it's another day that you're being a burden. Yeah. And I think it's so important to talk about it because you do hear so often of stories of siblings, you know, families who get not torn apart, but certainly they run into difficulties

because one sibling has to do more caregiving than another or, you know, and this is why we should be having these conversations because these conversations are just really crucial. Yeah, I think so. And Harriet will be able to look at her family. She's known them for many, many years. Yeah. And she will know that some people step up more than others because that's just their natural inclination in life She'll also have some idea of the additional Burdens, maybe not the right word, but the the additional duties of each of the members of the family So she might be in a position to be able to say to somebody who's you know, lives more distantly

For example can't help with the shopping I think your sister or brother who lives closest to me is taking on quite a lot at the moment. Is there anything you could do for them? Or is there any coordination of things for me that you could do rather than me always asking him or always asking her? So you can start to allocate it a little bit.

And it is really helpful if families get together, even if what they're doing is acknowledging that this one sibling lives closest and it all lands on them. If it all lands on them and nobody appreciates it, that's much harder than if they're getting messages from their siblings from every now and again saying, hope it's been an okay week, really appreciate all that you're doing for mum, let me know when you need a weekend off. Also, I think that's another thing to say to anyone who is accompanying someone through this journey. It's like don't guilt yourself if you do need that space, because it's quite important isn't it to take time to...

Oh, it's so important and people can exhaust themselves and those of us who do caring for a living, we have compulsory rest built into our rotas. We're not great at taking it, but it is there. And when you are a carer for your family, there is no rest if they're living in your house or if they can phone you day and night any time. That's really hard going. And just having another person who can triage the calls for you to know that tonight I can go to bed at bedtime and unless there's an absolute crisis, mum is going to call my brother, my sister, my son, her sister, whoever, and they will only call me if I need to get out of bed and

go round to her house and visit. Otherwise, I will not need to be awake and worrying about mum until tomorrow morning. And just knowing that you're off call for the night can just save somebody's sanity. So it's really lovely to think that Harriet is worrying about other people and wants to try and help them to not feel burdened. But it's really sad that she sees herself as the burden rather than the task of caring for her and supporting her as something that's a family endeavour, like all the other tricky things in this family, have always been. Yeah, it is part, isn't it? It's part of life.

The last question, and this goes to, at the very beginning, you said, it can help to know that there are stages of dying. And when we talk through them, we can be less afraid. I have no idea what the stages of dying are. But this question sort of I think points to it, which is from Yasmin. She says, I don't fear dying, but I do have a strong phobia about experiencing pain or suffering. Could you share how common

it is actually to die in pain? And perhaps this is the point where we, I mean, I suppose it's very difficult to have statistics on that. This seems as a good time to say, you know, there's no perfect way to die. But, you know, I guess using the word lucky as well seems like a strange thing. But if you have a terminal illness, what can you expect at the end? Okay, so let's talk through the process, the ordinary process of dying, and then let's come back around to Yasmin and Hagee about particular symptoms and kind of add that in afterwards. So the interesting thing about the very end of our lives is that it doesn't really matter what the illness or illnesses

are that take us there. The process towards the very end of life is very, very similar. And it's similar for any animal as it's weakening towards the end of its life, which is just that we run out of energy. And it's as though the parts of ourselves that makes energy, that kind of factory is failing. We see people become more weary, they lose muscle strength, they need more rest, it's more effortful to do things that they used to do quite easily previously. And as time goes by, what we see is that they start to sleep more and it's sleep that recharges our energy more than eating and drinking. So message one is families get really concerned about people not eating anymore. Towards the

end of people's lives, they lose their appetite. That's normal. Their digestion isn't as efficient as it used to be. That's normal. And they're not going to die because they're not eating. They've lost the fancy for food because their body has started dying. It's the other way around. So if we want to do something loving rather than plonking a great big dinner in front of them, which we've prepared with enormous love and they just look at it and think, oh, I don't even know where to start. Think about tiny tastes for pleasure. What's the thing that you would really love one lick of, one teaspoonful of? Okay, so it's going to be stewed rhubarb for me, just in case you happen to be around at the time. Okay, great. Can I tell you what mine is?

What's yours? Mine I think would be like a tri-tree, so. Oh, actually, do you know? I could add that to my list. Yes. Because it would be very flavorful. Yes. So, we're all salivating in here now. Yeah. You'd be very flavorful. Yes. So we're all salivating in here now. So we've got somebody approaching the end of their life

just much more tired, sleeping a lot, awake very little. Next thing that can happen is that people get stuck a little bit between sleep and awake. Now that's happened to all of us when we've been in a deep sleep, in a profound dream, and the alarm clock goes off. And what happens to start off with is the noise of the alarm clock becomes something in the dream, becomes a noise in the dream. You suddenly realize that you're in a house that's on fire or the sirens are coming, the

dream starts to get a bit weird and then you start to think, oh, hang on, is that noise here? Is that noise somewhere else? And as you gradually move towards wakefulness, you think, oh no, I was dreaming there and that noise is here. Oh no, it's the damn alarm clock and then you turn it off. But you've had this few seconds of being in parallel realities. Things that are actually happening in the room, the things that are happening in your dream, getting muddled up with each other. And sometimes we find people getting muddled in this wake, sleep, wake cycle. And if the family understands it and says,

oh, yeah, actually, mum is talking to somebody who isn't in the room because that's the person that she's currently dreaming about. That person's in her subconscious. So don't be worried about it. But if she thinks granddad's in that chair, maybe don't sit in that chair while she thinks granddad's in it. So we're not panicking. We're not thinking of what's happening.

Mum's losing her marbles. This is all terrible, we weren't expecting this. If the family's just calm around it, then we can say, and how is granddad today mum? Oh, it must be lovely to see him and allow her to experience that reality as well as the real reality. When families get anxious about it, oh my goodness mum's hallucinating, it must be the drugs, better stop all the drugs, call the doctor, now mum subliminally hears and feels the anxiety that's in the room and instead of living in these two realities quite calmly that starts to wind up into anxiety and agitation and it's hard to help her to calm down because she's mainly living in her dream world and we're mainly in the other world that she's not perceiving so closely.

So people understand emotional communication. They see us moving smoothly, talking calmly, smiling. They feel safe. They hear us start to talk very fast with very high pitch voices and we're throwing our arms around. They feel unsafe and they get wound up. So when people start to get muddled, meeting it just gently and saying, okay, this is one of the things that we were warned this could happen from time to time. We know what this is. Eventually towards the very end of people's lives, they are not just asleep, but actually unconscious all of the time. So thinking about your listeners who like an afternoon nap. I'm a great proponent of the afternoon nap. That doesn't mean that we've got one foot in the grave, okay? If you feel well enough to be tired enough to

need to sleep, then you're well enough to wake up at the other end of your sleep. Right, okay. Okay. Becoming unconscious doesn't feel like that. You don't notice it's happening to you and it just overtakes us. So once a person is deeply unconscious, their brain is only doing two things. It can hear, which is amazing and it's good science now to show that the brain still responds to sound in deep unconsciousness. We don't know whether they can hear the words we're saying and make sense of them, but those of us who've worked at the bedside of dying

people for a long time recognise that people often will look calmer when the right voices are in the room and look less calm, not if the right voices aren't in the room, but if the wrong voices are in the room. Sometimes people will synchronize their breathing to the music that's going on in the background in the room. So they seem to be not aware of themselves and their bodies, and yet they're still aware of noise. So that's really interesting. And the other thing that the brain is still doing is it's making us breathe. So we don't normally think about our breathing. And now I've asked us all to think about our breathing.

We're all thinking about our breathing. But usually we don't. We just kind of breathe in and out and do stuff around it. Unconscious people don't manage their breathing anymore. And it's just cycles that are just reflexes. So it goes from very deep breathing, which often because they're no longer aware of their body, they will breathe through their voice box. So it can be a kind of, mmm, as they breathe out. Now, if you didn't know that that was reflex breathing of deep unconsciousness,

you might worry that person was groaning or trying to speak, trying to tell you something. So it's really important, you know, that midwifery thing that we've explained this might happen in advance and now we can say this is that thing we talked about. So deep breathing that gradually gets shallower and shallower and then goes back to the beginning again. And fast breathing that gradually gets slower and slower and pauses and quite long pauses and then back to the beginning again, which means that people will see combinations like fast breathing that's shallow, which looks like panting and you could think that this person that you love is struggling to breathe or is feeling anxious and is panting as a consequence of that. Rather than knowing that this is the breathing of deep unconsciousness,

this person is completely safe, they don't know they're breathing like that. It's their brain just making their body breathe that way. So it's really important that we've explained to people in advance that that might be what they'll see and then remind them when they're at the bedside of their dying person that this is ordinary dying, this is the breathing of deep, deep unconsciousness. And if you're in the room with a person who's doing their dying, that last breath, that Hollywood moment, that EastEnders moment, is simply that there'll be a breath out and there just isn't another breath in afterwards. It's so not Hollywood, you know, there's nothing special about it, there's no sudden gasping, feeling of fading away, sudden change in pain, they don't suddenly wake up and tell you all

that you were adopted or where the treasure's buried or whatever. It's just very, very quiet. And if so much so, that all of us who work in palliative care, who've obviously worked around people at the very end of their lives, we've walked into a room where a person's been dying for the last few hours, family sitting around the bed, everybody's waiting. We walk into the room, have a look, there's everybody sitting and look at the person, you think, hmm, you've stopped breathing, haven't you? And nobody's noticed yet because it was so gentle and they're still waiting for the big finale. So doing the dying is surprisingly gentle, but it brings us back to Yasmin's question, which is all of that gentle descent down into deep unconsciousness happens in a body that is comfortable.

So our bodies know how to birth and our bodies know how to die as well. In as much comfort, the hospitals know how to make sure that you are in that safe place. So that's the important thing. It brings us back to Yasmin's question about comfort. Most people are comfortable is the important thing. A few people are not comfortable, and we have to not pretend that that isn't so, but most people are comfortable enough

and comfortable enough for their bodies to go into deep unconsciousness, at which point we think you can't feel your body anyway. But some people need extra doses of medicines. We know that it's harder to get a nurse who's qualified to give the injection at home. It takes longer than if you're in hospital. So there is some evidence that people who are looked after at the very end of their lives in hospital, the perception of their family, because they can't fill in questionnaires after they've died themselves, perception of their family

is that they were more comfortable than people who were dying at home. But when you talk to dying people about what their preference is, for many of them, their preference is that I'd rather be in a familiar place than in hospital, even if I'm not as comfortable in that place. For most people, it's a kind of trade-off for their emotional wellbeing versus a little bit of discomfort for some people.

Well, it's Katherine Mannix. Thank you so much. I'm really grateful for you coming, and it certainly makes me realise we really do have to talk about this. It's for you coming and you know, it certainly makes me realize we really do have to talk about this. It's for everyone's wellbeing, actually, and everyone's quality of life. Thank you so much, Catherine. Thank you so much for inviting me to talk death. A huge thank you to Dr. Manix, Catherine, as I feel I'm able to call her now, for joining

us today and sharing her wisdom on such a sensitive yet universal subject. It's a reminder that there's grace, actually even beauty, in understanding and preparing for the end of life. If this conversation spoke to you, please share it with someone who might need it too. And as always, don't forget to hit follow so you're with us for more important conversations ahead. And today, my weekly recommendation is really actually inspired by these conversations we've been having this week on the life of Briony.

And my weekly recommendation is to start doing an evening gratitude list. Sounds kind of corny, but I do it every night. And to keep myself accountable, which sounds very kind of corny, but I do it every night and to keep myself accountable, which sounds very kind of strict, but I share my gratitude list over WhatsApp every night with a friend who shares hers with me and it's something we do every evening. And you know, I think I really love doing it. Like today I I was gonna put, it can be little things like I got a free coffee in the coffee shop.

That goes on my gratitude list. I walked through the park and I saw a fucking Pelican. That went on my gratitude list because that is not something you see every day in London. And you know, the gratitude list can be, it can just be really simple, tiny things. Like, going to record this podcast definitely goes on

my gratitude list. And when you do it over time, me and my friend have been doing this now for I think about three years, and it really does over time, help to shift your perspective on life. And I was always very skeptical about gratitude list, but I really do think it's a really important part of my recovery. Every day is a bloody gift even the absolutely awful ones. Anyway on that note I'll see you on Monday!