Nobody has ever said to me afterwards, ‘I wish we’d never talked about dying’

Tackling the subject will lead to a sense of relief, says Dr Kathryn Mannix, palliative care consultant

Over a career of 30 years in palliative care, I’ve worked alongside very sick people at home, in busy hospitals and in hospices. They have inspired me with their courage and their focus of concern: not on themselves, but on their families.

From teenagers to pensioners, most are afraid that their illness and death will cast a shadow over the people they love. Yet so often, they have been utterly unable to discuss this worry with their dearest people.

They’ve tried. Uncomfortable families deflect them with “Oh, Mum! Don’t be maudlin!” or “Can’t we discuss something more cheerful?” Behind these deflections there is good intention: “I know you’re sick.” “I can’t bear to lose you.” “Let’s not talk about it and be sad.” It’s almost a sensible response, because it protects us from sadness, anxiety and anticipatory grief.

Loss, grief and separation have now been thrust into everyone’s attention by the Covid-19 pandemic. Yet death isn’t new; it isn’t optional; it never was. What is new is that we can’t continue deflecting. Being unaccustomed to its everyday possibility, we are shocked, sad and afraid. What if my grandmother, my partner, my child dies? What if it’s me?

What I’ve learnt from around 10,000 families facing death is this: not talking about it doesn’t make it go away. Silence forces thoughts about death away, but they bubble and ooze into every aspect of daily life, poisoning precious moments with that gory “what if?” The only way is to turn and face the fear.

Those tender conversations in which families tentatively explore with each other how they would like to be cared for, what treatment options they wouldn’t accept, what really matters to them, may begin with halting words and a sense of dread. But what they discover is a freedom, a sense of relief – and then the universal themes of these conversations emerge: “Do you remember when…?” “I was so grateful that you…” “I’m sorry about…” “Thank you.” “I’m sorry.” “I forgive you.” “I love you. I love you. Never forget how much I love you.”

Any of us may be sick with this coronavirus; most of us will get better. Some of us won’t. If we are so sick that the doctors ask our families “Would he accept a ventilator?” or “I foresee that a period in

ICU may leave her unable to live independently afterwards: would she accept that risk?”, will our families know what to say?

Will they know, if we don’t make it home, what we would have said had we dared to have that conversation? Talking about dying won’t make it happen. Nobody has ever said to me afterwards, “I wish we’d never talked about dying.” But I’ve lost count of those who regret their silence.

With the End in Mind: How to Live and Die Well by Kathryn Mannix is free to download in ebook format until April 7 (harpercollins.co.uk)