Woman's Hour - On Death and Dying

Episode Date: April 21, 2020

Death tolls are being reported every day but it’s still hard for many of us to talk about death and dying. We start that conversation with listeners and palliative care experts. We’ll talk about the current situation, facing death in hospital, at home or in care homes, how to do advance care planning, how best to grieve, and how at any time we can prepare for our own and our loved ones’ death.Presenter: Jenni Murray Interviewed guest: Dr Rachel Clarke Interviewed guest: Sarah Tully Interviewed guest: Dr Frances Goodhart Interviewed guest: Dr Catherine Millington-Sanders Interviewed guest: Fi Munro Producer: Lucinda MontefioreI

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BBC Sounds. Music, radio, podcasts. Hello, Jenny Murray welcoming you to Tuesday's edition of the Woman's Hour podcast on the 21st of April. Good morning. Never in my relatively long life have I ever had to face up on a daily basis to the prospect of my own death and the reality of the end of life for so many people. Since we've been aware of how dangerous the coronavirus is, we've had to listen day after day to the numbers of people who've died in hospitals, care homes and sometimes at home and ask ourselves some very serious questions. Would I be prepared to say no to being taken to hospital because

I don't want to take the place of someone who would be more likely to benefit? Am I prepared to say I don't want to be resuscitated and have I put everything in order for my family should the worst happen? How would I cope if one of my loved ones were to die without me at their side and perhaps be unable to attend a proper funeral? So many questions and so much pain surrounding the one subject that for so long has remained the last taboo, death. Well today we'll spend the next hour talking about death and why we need to learn how to prepare for it and talk

about it. But why do we find death so difficult a subject to discuss? We all know it will happen to each of us one day and yet lots of us have failed to even make the will which would make life after we're gone so much easier for our grieving relatives. Well Dr Rachel Clark is a doctor who specialises in palliative care in a hospice and also in a hospital near Oxford. Rachel, why are we so frightened to talk about death? Well, I think, Jenny, sometimes people imply that there's an easy answer to that question. They'll say, look, death is the one thing that's guaranteed to happen to all of us. So we need to just grow up a bit and confront it and stop being scared or be in denial about this. And I think as somebody who works every day with death and dying, personally, I think that that is not the right way to think about this. Of course,

the fact that we are mortal, we are going to end our lives is a daunting subject for a great many of us. We're creatures that are hardwired to live. And we love life. We love every single person that's close to us. We love all the glorious things in the world. And the idea of being severed one day from all those million things that make life worth living, I think is understandably incredibly daunting. And it's not helpful necessarily for doctors and other professionals to sort of say, look, come on, don't deny this, just be a bit braver, just about it there's an exquisite pain and bitter sweetness about the fact that we are living creatures who are destined from day one of our lives the first

breath we ever take to die because that means being cut off ultimately from everything we love in the world. Rachel we are living through extraordinary times at the moment. And I wondered what impact is what's happening at the moment, having on the way you work, when this dangerous disease can strike so suddenly and take the lives of what appear to be perfectly healthy people? Absolutely. And in some ways, everything is the same. In others,

everything has been radically transformed. So I'm used to caring for patients who are dying, but they tend to have more chronic diseases such as a metastatic cancer that has spread or heart disease, liver disease. Whereas coronavirus is an acute infectious illness. So it can hit people abruptly, suddenly, they may be frail, they may be young, fit and healthy. And sometimes it can overwhelm them, not even in days, just in hours. So we are finding in the hospital in particular, we're seeing quite a different cohort of patients who have often very abruptly become ill and maybe have gone from being breathless and struggling a little bit to breathe one day to being almost on death's door the next day. And that requires much more proactive palliative care than we might necessarily be used to all of the time. And it's meant that we've had to, in some ways, transform the way we're working, we need to be more responsive. and crucially there's this particular cruelty of coronavirus which is it's very infectiousness means we have to be incredibly careful about the visitors coming into the hospital because every single one of them is at risk of infection themselves

thank you very much for the moment do stay with us because we want to talk to you again later in the programme. But, you know, I think we've all imagined what it must be like to learn that your father or your mother or anyone with whom you're very close has become ill, has the coronavirus and is likely to die and you can't be with them. Sarah Tully sent us an email to tell us her father Bill, who was 87, had died in hospital earlier this month. We spoke this morning, and she told me what had happened. About a month ago, my dad's wife phoned me and said that my dad was very poorly. During that week, she phoned for an ambulance three times

but he didn't want to go to hospital we didn't really want him to go to hospital because of what was going on and the paramedics didn't take him to hospital but by the Friday I could hear that they were very distressed both of them and I'd tried to keep away, I live in Sheffield

and I'd tried to keep away from them in case I took coronavirus to them because at the time my dad wasn't displaying any of the symptoms he was just very ill but by the Friday it had just got too much so I drove from Sheffield to London, and when I found him in the flat, he was in a very poor state. Mo, my dad's wife, had already phoned for the ambulance,

and I tried to give him water because he looked very dehydrated. He said to me, I don't want to go to hospital. I don't feel well enough to go to hospital. I said, that's where you go when you're not well enough. But the paramedics turned up and they could see that he was in a very poorly state. I went with him in the ambulance. We got kitted up. We went to the back entrance of Whips Cross. It was very bizarre. It was like an episode of The Handmaid's Tale, you know, kind of quite surreal. I said to Dad, don't worry, I'll stay with you the whole time. We were put in a queue. It got to my dad's turn to be taken into hospital,

and that's the last time I saw him. How did you and your stepmother cope in those days when you had very little communication from the hospital and you couldn't see your father? To be honest, at times I don't think we did cope with it it was really really traumatic not having any information we didn't know we didn't even know until the monday that he had coronavirus somebody phoned us up by the by the way, I'm not blaming anybody because everybody is under pressure, but somebody just phoned us up and rather clumsily told me

that Dad did actually have coronavirus and that he was on oxygen. And to be really honest, that day and the day after, I didn't feel very well. And I really panicked. I thought, my dad's going to die. Then Mo, his wife, is going to get it and she's going to die. Then I thought, you know, I'll get it and I'm going to die and I won't see my children again.

I felt really, really panicked. But I spoke to friends and family who were brilliant. There were some neighbours where Mo lives who just were absolutely incredible. It's like the kindness of strangers. My brother was fantastic. He couldn't come down because he was a doctor and he'd been in contact with coronavirus patients. But there's quite a few things that really helped me. It's quite personal. So one of them was I found Onsted Flats and Epping Forest. And each day I went for a really long walk and looked at nature. It sounded like a hippie, but it really did help me. It kind of brought me into the present.

And if the present was that I was really upset, I just went with it. I know you did manage to deliver letters to your father. Yes. Do you think he got to hear what you had to say? Well, as well as the letter, we did two other things. We visualised him as well, which was really, really crucial. We had no idea what was going on, but we visualised him as well, which was really, really crucial. You know, we didn't really, we had no idea what was going on,

but we visualized him comfortable. I don't know if he was comfortable. I don't know if he was suffering, but we made the decision to choose to visualize him as comfortable. We also spoke to him. I'm not religious, but we kind of spoke to him, and then we wrote a letter. I took the letter to Whitscross, and like a crazy woman,

waited for somebody who was going in, and this member of staff said, you know, if I could hug you, I would, and I will get this letter to your dad. And I'm pretty certain that he will have got the letters from me and his wife. Now, your brother, as you said, is a doctor and was able to see your father before he died. What difference did that make to the family that at least one of you had managed to see him? Well, initially, it made the difference between, you know, it's kind of like small pickings. It made such a big difference. But to be honest, Jenny, it was a bit late because he'd been ill for a week. By the time my brother went in, he was in

palliative care and he was barely conscious. But he woke up for a couple of seconds and said thank you to my brother. And then my brother was able to, you know, strongly suggest that he had morphine to help him. And so it was a comfort to us to feel like he wasn't suffering so much. So yes, I guess, to answer your question, it was a comfort, even though it would have been much better when he was more conscious. What plans are being made for the funeral? Well, you know, I've had to totally reframe my view of death and funerals because the stark reality is that I don't actually know where my dad is at the moment.

He died in hospital. You're supposed to register the death within a week. It's been two weeks, and the registrar is chasing up the hospital. When I went for a walk on Wanst flats which was you know kept me sane while while i was walking on one stood flats um they erected a morgue at one end um which is pretty horrific um but we've chosen to remember my dad he he died when it was a full moon, and he loved the moon, so we've chosen to remember him by the moon, and also every time we drive past the betting shop,

because he did like a flutter on the horses. But when you say you've had to change your whole view of death, what do you mean? Well, every single system and process just wasn't working. So, you know, my dad's wife, Mo, she's now grieving in isolation. You know, when somebody dies, you want friends and family around you

all the time i mean luckily i i was there for two weeks but you know when somebody dies that quite often they might die suddenly and you console yourself that they didn't suffer or it's a longer drawn out death in which case you have time to go and see them for us we had neither of those things the next thing you want is information we had we had absolute scant information um you know days and days went by and we didn't know what was happening. And then, you know, I go to quite a dark place if I'm not careful about not being with my dad when he was suffering. But the thing I've had to reframe is, you know, I've had to let go of what I can't control. My dad would have really understood

the position that we were in. And he, you know, that's the other thing I did, actually, is imagine what he would say in this situation. And he would have had quite a funny take on it really. What would he have said? Well, with the letter, when we were like weeping over the letter, he would have said, oh, don't bother.

He would have said, don't bother. Yeah. Sarah Tully, still in the midst of grief and uncertainty how are people coping with death on such a scale when it touches them so personally well rachel clark stays with us and we're joined by francis goodhart who's a consultant clinical psychologist in oncology and palliative care. Frances, how typical is Sarah's experience at the moment? I think every case is deeply moving, but I think she describes the experience so vividly and um and and i think many people will will share that that sense that the shock the isolation i think the the that sense of having to completely rethink grief bereavement, funerals, contact.

She's extraordinary in how she's been able to describe it. Rachel, Sarah mentioned that her father had palliative care towards the end. How easy would it have been to deliver it to him in such an emergency well i think um i mean so many things that we heard there were the exact opposite of what in an ideal world good palliative care would be there'd be a huge amount of communication and none of those experiences would have happened in in isolation with families separated from each other. But we've had to learn very, very quickly. And one of the things we're trying very hard to do is find ways of enabling loving relatives to make contact with their unwell patients, even if they can't be there in person. So for example,

many hospitals now, the one where I work included, we have family liaison units that have been set up just in the last few weeks who are calling relatives every day proactively to update them. And if somebody can't come in to visit a patient who is approaching the end of life with coronavirus we try to find other ways of doing that whether that's using a video call or sometimes asking family members if they'd like to write something a letter that we can sit and read at the bedside or play a favorite song or read a poem, those kinds of things. In a way, one thing might be very reassuring for listeners to know, and that is the symptoms of coronavirus at the end of life.

Typically, the most overwhelming one is the feeling of breathlessness, of struggling for oxygen. feeling of breathlessness of struggling for oxygen and we have very very good simple drugs that that work at controlling those symptoms and and we're finding we're not needing to use high doses of drugs complicated regimes it's actually quite easy to enable a patient who is approaching the end of their life to be very comfortable not not in pain, not in distress. The crucial thing is getting there fast enough. And I think in the last few weeks, we've gone through a very, very steep learning curve. I wish we'd been on top of our game straight away, but I feel as though in hospitals now we definitely are

and we're reaching out to those patients. Frances, when Sarah said, you know, she went to the hospital with her letter, she stopped this member of staff who said, I wish I could have given you a hug, but I can't, but I'll make sure your dad gets the letter. How sensitive are staff generally able to be with relatives in these kind of circumstances? Well, I think the staff are working incredibly hard at doing that. I think Rachel has described the ways in which the staff are working to provide some form of family contact, even when the family member can't be with them.

The staff are working so, so hard to give the messages, to get the messages. I'm hearing from people all the time about how they are sitting with patients, they are, as Rachel said, reading poems, reading letters from families, looking at photographs for them, of them. They are really in very short periods of time finding ways to make those connections and I think one of the things that's been said in the media a lot is that people are dying on their own and my sense is that the staff in the hospitals are working so incredibly hard to ensure that patients die with someone with them not necessarily a family member but a member of staff is by their side and I do think that's important and comforting too. Rachel you work in hospital and hospice how likely is a patient to get to a hospice if they have the virus? Well it's very interesting because

we've really in the last few weeks tried to overhaul the way we're delivering palliative care services so I work in a small charitable hospice called Catherine House Hospice in Oxfordshire. And I also work in the local hospital. And we've done really quite radical things locally. So the hospices, the GPs, the hospitals and the primary care services. In the last four weeks, we've sort of ripped up the rulebook and tried to be as responsive and as a collective team, working together to get the care where it's needed. So for instance, we have increased the number of our inpatient beds in the hospice quite dramatically and that's so that we can have patients coming in with coronavirus and we've got the capacity for them. But we've also tried to reach out in a much more energetic way in the

community so for instance we've set up a 24-7 specialist palliative care phone line so that other health professionals can call any time of night or day about a patient in a care home or in their own home and they can get advice and we're working in ways to get the necessary drugs out there to GPs into care homes so that people have what they need wherever they are. Rachel there we must end for the moment and Frances Goodheart, Rachel Clark thank you both very much indeed don't go away because we may well come back to you later in the programme. Still to come in today's programme, thinking about making preparations for your own death.

Where do you want to die and how will you let your loved ones and your doctor know your intentions? And then looking to the future, what might we learn from this terrible pandemic about how to talk about death? Now, as we heard from Sarah, her father didn't want to go to hospital, but did in the end, as he had no choice. How much control can we have about where and how we die? There have obviously been a lot of deaths in care homes, which have been reported daily, and there have been stories of GPs contacting their patients and asking them

what they would prefer, should they contract the virus. We had an email from a woman who didn't want us to use her name who explained her 88-year-old mother had received such a call. Did she want to go to a hospital if she had the virus or stay at home if she had COVID-19? Her mother became very confused and she wondered how she, as a daughter and main point of support and advice, could help her make the decision. I'm not clear, she said, on what staying at home means in relation to medical and palliative care. Well, we're joined by Annabelle, whose mother has dementia and lives in a care home, and by Dr Catherine Millington-Sanders, Clinical Lead for Palliative and End-of-Life Care for the Royal College of GPs and Marie Curie. Catherine, what needs to be considered in making this really difficult choice?

I think the really important thing is I know that we're talking about potentially planning for death and dying. But we have to remember that the majority of people do actually survive this and will either potentially develop mild or moderate symptoms and may actually never need to go into hospital. And we've got teams of GPs, community nurses and Marie Curie nurses in the community that are there ready to look after people if they develop symptoms. I think it's quite specific. So as Rachel was mentioning earlier, talking about death and dying and planning is very important. So in general practice, we aim to support people, help them prevent getting unwell. If they do, hopefully we can cure them and relieve their symptoms. But some people if they were to get so sick and were to

potentially be sick enough to die it's about having conversations early to say what would you like and potentially what would you not like in terms of treatment. In the circumstances that that we heard in in this email where a GP is ringing around saying what do you want to do if you get it do you want to go to hospital do you want to stay at home and she says I'm not clear what staying at home means in relation to palliative care how do I help my mother make a decision how does she help her mother I think it's a really good question so I think it's about considering in this time of Covid so normally when we're talking about when you'd go to hospital for treatment, this is a very different setting. As we've just heard, these are issues about thinking

the care that we'd be receiving, we might actually be going into hospital to not be receiving care or to be receiving care, but without our loved ones. So in general practice, lots of us will be seeing people that would say, do you know what, if I were to be sick enough that I might die, I would actually like to either be in a care home facility, surrounded by people that I know and in a familiar surrounding. And if I were to be sick enough that I might die, many people might actually think I would actually rather be at home. Faced with the other alternatives of, there are lots of things that we can do in general practice to support someone through symptoms. So if they get breathless, if they have pain, there are lots of very good symptom control and drugs that we can give that can support that, as Rachel mentioned earlier.

So the difference is what would be different if you went to hospital? And so you might actually go to hospital if you wanted to receive some oxygen and if oxygen were to be helpful. If you were to be so sick, would it be something that someone would consider actually having some sort of ventilatory support, either through pressure oxygen or from a tube actually being down into our lungs. Now many people might actually be thinking I wouldn't want that so the question is why would we then potentially if you can have very good symptom control you can be looked after by general practice and the community teams and Marie Curie nurses or care home nurses actually why would you then consider to go into hospital if some of those

treatments you wouldn't actually want the important thing is is about having those um those difficult conversations early and giving people the opportunity to think through what they do want where they may want to be cared if they were to get so sick that they might actually be facing dying. Now, Annabelle, you and your mother have planned well ahead. You have lasting power of attorney for your mother and an advanced treatment plan. What have you specified for her, presumably in discussion with her? By the time we had to put in place a treatment plan um which came about actually about five years ago when my mother asked her my mother's gp asked mom if she wanted to put in place a dnr order mom didn't actually have the capacity to make the decision so it fell to my sisters and myself, who she'd appointed several years

earlier, as you said, under a lasting power of attorney. So we did a bit of research and there is some academic research that suggests DNR can result in an inappropriate withholding of other treatments. So we designed our own emergency treatment plan, which was based on a newer initiative called RESPECT, helpfully short for Recommended Summary Plan for Emergency Care and Treatment. And this is what we said. So what does this include, Annabel? OK, well, this is what we said.

So we said, in choosing how to treat our mother in an emergency, we would expect medical staff to prioritise her comfort and to focus on symptom control over any life-sustaining treatment if the result of the latter is likely to be a materially impaired quality of life or if she is likely to find such treatment or the need to be in hospital to receive it unduly distressing. In particular we would not wish her to be given an invasive treatment such as CPR and if we were writing that now we would undoubtedly add all ventilation with little or no chance of success in maintaining her existing quality of

life and how legally binding is this plan annabelle it's not it's her wishes as decided on by us, but that doesn't make it any less important. I mean, for me, I think everybody should have an advanced plan of this kind. I think it should be like a will. You mentioned wills earlier. Like a will, everybody should have one of these. And it's really important for three reasons, not just for the person whose planet is but also for their loved ones because if my sisters and i talked about this together

we're on the same page and we won't if faced with mum falling severely ill with coronavirus, be faced with an unedifying disagreement or find out in difficult circumstances about the wishes of a loved one that that person hasn't chosen to discuss. And it's critically important, in my opinion, and I'm not a a doctor from the perspective of the NHS. It's in the DNA of the NHS to try and save a person's life at almost any cost. So to help the doctors, care home staff in my mum's case and emergency services make some difficult decisions. I think it's vital that the patient's wishes are recorded and are available to those people catherine just just one final point on this there has been talk of blanket dnr do not resuscitate and in care homes what's the truth of that the truth is that that's not something that is supported. Working with the Royal College of General Practice, that's something that is not something that we'd advocate for. Everybody is an individual anybody actually finds themselves in those situations, I would be just requesting them to have a chat with their GP or their district nurse if they see them.

There's a very good information and support line from Marie Curie. It's 0800 090 2309 or Marie Curie forward slash support, you can actually be able to talk through those difficult conversations, the concerns that people have about putting plans in place, just having a bit of time and being able to do that with someone that knows how to do it in a planned way can be extremely helpful. It's not just about the doctors and nurses being clear, although that's helpful with the respect tool, it's excellent. There's the patient or public facing version which is mydecisions.org.uk which is respect but actually someone being able to fill it out with your family at home just being able to open up these discussions and the taboo that has previously sat behind it it's a really good opportunity whilst we're all reflecting what

we want in terms of treatment to be able to start thinking about some of those plans whether it ever comes to fruition within COVID or not it's just a very helpful mindset. Dr Catherine Millington-Sanders and Annabelle thank you both very much indeed for joining us this morning and there are by the way several links on the Women's Hour website that provide advice and support in what we've been discussing. Now, Annabelle and her mother have planned ahead, but what about the rest of us who may be much younger than our 80s or 90s and may have time to think about what kind of death we would like? Femur Roe is 34 and was diagnosed four years ago with stage four ovarian cancer. She's had to think very carefully about her own death. Fee, how have you managed to reconcile

yourself to the fact your cancer is terminal? Hi, thanks for having me. I have taken the view from day one that we're actually all terminal and what my diagnosis gave me was just this wake-up call to realizing how precious life is and actually none of us are immortal so in many ways I see it as a gift for opening my eyes to that and helping me to see how important it is to plan our death and to be really open about it so that we can live our lives in the day-to-day while we still have the privilege of doing so. Now besides having been told about the cancer and how it was progressing you had what you described as a wake-up call two years ago what happened there? Yes so on just a normal evening with my husband, we were visiting friends elsewhere in Scotland

and as we were driving home, we witnessed an attempted suicide and we witnessed someone running towards a car and it was a wake-up call for me because my husband and I are both first aiders so we were first responders on the scene and I was lying with the person who had obviously chosen to take their life and myself as someone who's living with a terminal condition and it just really made me realise how precious life is and how fragile it is and how we all walk this fine line between life and death. And it was from then that I really felt this need and this confidence around talking about death and end-of-life care

and how actually all of us, including people that are healthy, how it can be so beneficial to have these open conversations and to have this anticipatory planning and now we find ourselves in this situation with COVID-19 I think so many people are are being forced to look at their their own mortality and I think it is changing the discussions around life and death. Now I know you began an advanced care plan when you were diagnosed but haven't yet completed it why not? So I started that with my GP the first year I was diagnosed and we didn't complete it because I responded very well to treatment in that first year and I was very lucky to go into remission and since then my cancer has returned and progressed and now I choose more

to have, I've got a really open dialogue with my oncologist, a really good relationship with my husband and my family around death and dying and my plans, I'm very open about them and I've done power of attorney with my husband. I've done my will. And I've also got my funeral plans. I did them in the first year as well. So everything is laid out. And I'm very confident that everyone knows my wishes. I'm very open about them.

And I blog about them and write about them. And I don't have a DNR in place. But I really loved what was being discussed there. Everyone's looking at that in a more person-centred way. I thought it was really beautiful, really lovely. But though I've not finished it, I feel all the other plans are in place and that everyone knows where I stand on my views around...

Where would you like to die, Fi? I think it depends on the circumstances if it's um you know if advanced medical treatment is being in support has been needed at the time but um i recently lost uh one of my closest friends died of ovarian cancer and she died in a hospice and up until then i'd always thought i would want to die at home but having seen how beautiful the care and support was for her in the hospice and how it enabled her friends and family to become her friends and family again and not her carers and for them to myself included to go through that process with her and support her through this transition from life to death, I would undoubtedly pick a hospice over home because I think what a hospice gives is such a gift, like I say,

to friends and family and that it allows those roles to shift and allows the medical side to take over the carer role so that you can have that connection again and make memories and support them as a loved one rather than as a patient carer for you just just one last thing how did your family respond to you actually sitting down and planning your own funeral so in terms of my funeral i've just uh written out plans which are with my will and I talk quite openly about the fact that I don't want something depressing I want it to be a celebration of life I'd be happy for my body to be donated for medical research stuff like that's really important for me I think that's when we have opportunities as the dying to to give a gift to the living you know for further

research my background was as a researcher so that sort of thing's important to me and i think we've i've got very open family we in the year before i was diagnosed we lost um both of my grandparents and we had um an experience there where we didn't have power of attorney in place and wills in place and having experienced how that can affect a family I think has allowed more open discussions about the importance of having all that planning in place because it makes things easier at a difficult time as easy as they can be in the sense that you know the wishes and that everything's in place so that the family can support that person through their transition. So I think that has really helped the family in that sense.

Fee Munro, thank you so much for being with us and the very best of luck. So what have we learned from the horrors of the last few weeks where we've all had to confront the possibility of our own death and that of our loved ones in the most unfamiliar of circumstances dr rachel clark is still with us rachel what do you hope we've all learned from this dreadful period i think two fundamental messages one as we've just heard so so eloquently there that it's it's okay to talk about this it probably won't distress your family as much as you might fear. And actually to calmly and reflectively have a conversation in advance

before the worst happens can avoid so much unnecessary distress and panic and hardship later down the line. And secondly, in contrast to what is so often somebody's worst fear that their loved one in this age of coronavirus is just a statistic, their death is only going to be a statistic. I hope that people are learning that to us, the people caring for these patients in hospital hospices, in their own homes or care homes, they are most definitely the farthest thing from a statistic to us. They're our patients, they're people we love, we care for. The only thing that matters to us is making sure they know they are human beings who matter all the way to the end of their life.

And that's genuinely what we all feel. So nobody is a statistics in a time of pandemic or a time of non-pandemic. I was talking to Dr. Rachel Clark. Lots of you got in touch with us this morning on email and on Twitter. Annette sent an email. She said, I'm a funeral celebrant and I'm seeing firsthand the emotional impact of the bereaved not being able to say farewell to their loved ones. The horror of being denied the opportunity to be close during their final days and moments is followed by the heartbreak of the funeral being

pared down to the bare minimum. This is followed by having to grieve in isolation when the comfort and compassion of others could bring so much comfort. My heart goes out to everyone affected by bereavement during this time, those losing loved ones to COVID-19 and under all other circumstances. Normal death and dying is still happening, and this too is not being experienced as everyone involved deserves. Henna on Twitter said thank you for touching upon the most important thing and only guaranteed experience we will ever face. Now more than ever we're being forced to

face the reality of its existence. Colin, in an email, said, I was at the bedside of my uncle in January as he passed. It was a hard experience, but one that made me a better person. Death is still a scary thing in that the other side of death is still as unknown and unknowable as ever. But the process of dying in a hospital setting is not as scary in my mind as it was. There should be no taboos.

Catherine in an email said, Obviously because of Covid-19 we're talking about death, which for me has never really been a problem. I'm 63 and made a will at least six years ago. I put together a list of friends, utility bills, emails and addresses, my funeral wishes. I wouldn't want my daughter to have to make the choices for me and I want to have my wishes respected. And then Ruth in an email said, my elderly father died, not a Covid death, but because the care home was closed, we had only very limited access to him in his last days. A 20-minute funeral with only eight of the family, social distancing, no hugs, no contact with my adult children or friends to help with the grief. Thank you for covering the plight of those of us bereaved during COVID-19 and thanks to all of you

for your responses to the programme. Now, tomorrow we'll be talking clothes. As you may know, the great British sewing bee is returning for a new series on BBC One and we'll be talking about making clothes. And then, as of last week, all IVF treatment has been suspended in the UK. What impact is this having on women who now can't start a cycle? And what

could the longer term consequences be? And if it's something that affects you, we'd like to hear from you. You can get in touch on Twitter or of course, through the Woman's Hour website. That's all for today. Join me tomorrow if you can. Bye bye. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who's faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake.

No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story. Settle in. Available now.