The practical guide to watching someone die

"I just thought he'd close his eyes and peacefully fade away". These were the words my best friends girlfriend said on Sunday, explaining how the experience of watching her partner die had traumatised her. As I pondered the events of the terrible day, it struck me that nothing had prepared me for the experience. When my eldest daughter was born, in the run up to the birth, I attended NCT classes with my wife. The idea of this to ensure I was mentally prepared for any challenges facing us. Being prepared for the experience enabled us to have a mostly positive experience. I am not someone who found the birth experience  "wonderful", I attended out of a sense of duty. I was glad that I had bothered to get the practical advice before, so I understood the process. It occurred to me that I really wish I'd prepared myself in a similar manner for the experience of watching my friend die. We approach death from a different perspective. We all hope that if we pretend it isn't happening, it may go away. We feel that if we talk about the practicalities of the event beforehand, we may in some way be betraying the person we love.

Let me advise you of the lessons I have learned in the aftermath. This isn't comprehensive or definitive. You may well feel there are many things I've missed or many things I've got wrong. If that is the case, please leave a comment. Please not that to comment on this blog, you must be a registered blogger.com user. If you want to advise me of something privately, you can email me using the link in the top right hand link. I am sure there are all manner of organisations who can help. As I've not had experience of any, I can't recommend them.

General advice for everyone in good health or bad

We are all going to die and none of us have a clue when this will be. Please consider doing the following if you have not yet done them.

1.Make a will. If you walk out the door today and get hit by a bus, if you have no will, you will leave a messy and difficult situation. You can buy a "make a will" pack from WH Smiths. If you have a simple estate this will do. If your estate is large enough to fall into the inheritence tax, get some professional advice as to how to deal with this.

2. Make a "living will". This is a document that advises the hospital and doctors and your relatives what your wishes are, should you become to ill/injured to make decisions. Typically the things you may wish to put are whether you would like doctors to not intervene to keep you alive, if you have no chance of recovery. Typically this is called a "DNR" (do not resuscitate) request. This means that if you are fatally injured, the doctors will make you comfortable but not aggresively intervene to keep you alive as long as possible. It avoids putting a terrible burden on your loved ones of deciding what to do in a difficult situation.

3. Make a file of all your financial affairs. Have a single point of reference for any financial arrangements you may have. Bank accounts, shares, Insurance policies, title deeds for homes.

4. Keep a list of anyone you'd want to notify. For example, if you belong to a golf club or yoga class, but your partner hates golf/yoga and doesn't know any of your friends there, make sure that they have a contact for someone there. There is nothing worse for people than finding out that they have missed the funeral and have no chance to pay their respects. It is also bad for a grieving person to be challenged with "why didn't you tell us".

5. Make sure your loved ones know who you may want to share the moment with when you die.

Advice for people who are expecting an imminent bereavement.

1. Engage a funeral director when it becomes clear someone is likely to pass away soon. This may sound grim, but it means that you will not have to deal with it when you are in a state of turmoil. If you are not personally able to cope, ask a friend to help. The funeral director will have to be engaged and they are sympathetic and helpful. Don't feel embarrassed to get "shop around" as funerals can be very expensive. The cost of the funeral can be reduced by having a service early in the day, for example a 9.30 ceremony is significantly cheaper than one later in the day. Discuss these options if cost is a problem.

2. If you are on benefits, you can claim for the costs of the funeral, up to £2,000. Check out this webpage - http://www.direct.gov.uk/en/Diol1/DoItOnline/DG_4017717 For many people, the cost of holding a funeral is their biggest worry. Knowing what help is available is a vital part of the process.

3. Make sure that friends and family are prepared and kept informed. If someone has a terminal illness, make sure that anyone who it would be appropriate to share the final moments with, is prepared. Ascertain whether they will be able to attend, if they get a call in work time. Keep them as informed as possible. Sometimes it is impossible for people to attend, due to work or other commitments. Make sure that you plan and let people know you may have to zoom off at short notice.

4. Give some thought to practicalities. When you get the call, you may be there for hours (days). If someone is in a hospital or hospice, you may have to sit with them for a very long time and not want to step out for food. Take something with you. Stop at a garage and get some sandwiches for later, or make some and put them in a freezer to take later. Just as a practicality, if you have medication which needs to be taken regularly, you may wish to take this with you as if you are at the hospital/hospice for hours on end, you may need it. When my friend died, we were called at around 10am and told it was imminent. My friend passed away at midnight, fourteen hours later. This is not unusual.

5. Organise a Lasting power of attorney.  Ensure that someone has arranged a Lasting Power of Attorney for Health/Welfare and Property/Finance. Ensure it is registered with all Financial Institutions and Utilities. This will save untold problems if someone is unable to deal with issues themselves. The rest of the world continues and banks, utilities etc still expect the bills to be paid by those who are suffering terminal illnesses. Ensuring someone is empowered to deal with these issues is a very sensible step.


What will happen whilst I watch my friend die?

1. I've seen the process only once. I am sure that every experience is different. For me it was harrowing. My friend was 47 and did not want to die. He fought cancer until the end. Several times he stopped breathing only to rally himself, grab a few breaths and then settle down. This went on for hours. He didn't open his eyes whilst I was there. He was too sedated to say anything or give any message. He just looked awful and watching him fight to the end was horrible.

2. Be prepared to see distressing changes in the physical appearance of your loved one. As my friend struggled, his appearance changed. His colour became a sort of yellow green. His legs turned white. It was shocking and alarming. It hadn't occurred to me that these changes would take place. Be prepared for such changes. At one stage, I went for a cup of tea. When I came back, it looked as if a completely different person had taken their place. If you haven't seen someone for a few days, be prepared for them to look completely different and for it to be shocking, when you arrive.

3. Be prepared for other horrible things to happen. The most distressing was the awful smell given off by the body as it was shutting down. This is indescribable. The worst period was several hours before my friend died. Strangely this went when he passed away.

4. My friend passed away whilst people briefly left the room. The hospice nurses said this happens quite often. People sometimes don't like to pass on with people there. Be mindful of this. If you need to leave your loved one alone, tell them they will be on their own for a couple of minutes. If this is how they want to go, give them that opportunity.

5. Be prepared for people to say and do things which you'd rather not see or hear. People get into a highly emotionally charged state. They sometimes feel the need to say things which may be shocking during the process. This is actually a good thing and part of the process of reconciliation. None of us have the right to judge anyone for anything they've done. You may not like what you've heard, but if it is important for someone to share it, that means they needed to and need to move on. Don't judge.

6. When someone dies, the body is still warm for a while after. This may seem obvious, but my friends partner was shocked. She expected him to be cold. She had trouble with this as a part of her wanted to believe that this meant he was still somehow alive. The body becomes cold in the way a hot water bottle does, over the course of an hour or so.

The aftermath.

1. Don't be afraid to cry, to hug each other to hold hands or to show affection. This helps. Keeping a stiff upper lip will not help anyone. Talk. People are weak, numb and vulnerable. Support them

2.  Don't judge people by their actions after. Immediately after a death, people can do strange things. Drink too much, talk too much and all manner of other things which may be shocking. A partner may be devastated and be unable to see any point to life in the immediate aftermath. This is when they need companionship and company. The things they need most are sleep, company and food. They may feel they need drink (or stronger things) to an extent which worries you. Remember that if someone is an adult, even if they are bereft, it is their choice. Support them, but be honest. Don't say "no, you mustn't do that" but say "I'm having a cup of tea, why don't you?". If someone is hitting the bottle, this isn't necessarily the worst thing. Just make sure they are OK. Make sure they have a full fridge and lots of snacks. I made sure we got a full stack of provisions and snacks. I also bought a couple of bottles of wine for my friends partner. In hindsight, I should have bought one bottle and a  couple of bottles of mineral water. This isn't a criticism, but when people are upset, they tend to drink what is there. I would do the same in there shoes. I certainly would not buy anyone a couple of bottles of vodka now, but I didn't realise that before.

3. Give people time. Don't say "I can only stay for half an hour", stay until they don't need you any more. If you can't stay too long get a friend to take over. Work with your friends friends. If you are the partner, ask your friends/family to rally around and support and share time. Be practical, it is far better to have a few people come one at a time than five people turn up at the same time and then all go, leaving someone alone. Work together to do this.

4. People these days have messy lives. People have ex's who may have issues with the new partners. Try and work together to make sure that everyone gets the support they need. Sometimes people may want to attend a funeral who may cause an issue. Try and make sure that this is managed by friends as much as possible. All I can really advise is sensitivity.

5. Counselling is a good thing. If you have a trauma and you are not Superman or Superwoman, you WILL benefit from some help. This may be a chat with friends, but you cannot expect friends, most of whom have little or no experience of what you feel, to be able to help or understand. That is where a counsellor may help. It is there job. If your gas boiler breaks down, you call a professional, don't you? Don't feel ashamed to speak to someone who is a professional counsellor, if you've just suffered the worst day of your life. It is there job to help you. Take it and accept that we are lucky enough to live in a society where we are able to seek professional help and not feel embarrassed. 

I hope something I've written here is of use. I've avoided the religious and spiritual aspects of death as these are all personal. If you believe, speak to your priest, rabbi, Imam etc if you think it will help. It is there job to help, so don't be ashamed. Even if you are not practising, but have a belief, they will be happy to help.  Most of them are very good at it. I am not sure where Athiests, agnostics and other assorted non religious go, . Please feel free to advise by leaving a comment.

*** This blog was first published on 24th April 2012. Due to the responses and advice of kind people it has recently been updated.