For people facing the end of life, having open, constructive conversations about dying is vital, but establishing that dialogue isn’t easy. With so much emphasis on saving lives, sometimes the medical profession can overlook the importance of improving lives – especially if there isn’t long left.
“It’s easy, especially for healthcare professionals, to want to fix it all the time,” Keith Mitchell explains. “But some things we can’t fix. So if we can’t fix it, how can we make it as good as we can for those people? Really we want to emphasise the importance of a ‘good death’.”
It’s a beautiful May morning at the Force Cancer Centre, and the veranda doors are wide open, letting in the sunlight and fresh air. Based at Royal Devon and Exeter Hospital (RD&E), the centre is shaded by trees and surrounded by beautifully landscaped gardens. Inside, a team of volunteers welcome everyone with a cup of tea, a biscuit and friendly smile.
Keith Mitchell, clinical lead at the centre and RD&E hospital, explains each of the centre’s facilities, from the private rooms for counselling and holistic therapy, to the airy meeting spaces, where group support sessions take place. The walls throughout the centre are decorated with bright paintings, patients’ art therapy work, Keith says. There is nothing that feels clinical about the Force Centre, nothing that seems unwelcoming.
Patients can relax in the garden at the Force Cancer Centre
“It’s all charity run,” says Keith. “It’s a space for the people of Exeter, from the people of Exeter, and it's their contributions that help keep it going.”
Keith began his career in psychiatry, training in mental health nursing before going on to general training. Over the course of his career, he has worked in a wide range of departments, including casualty, coronary care, diabetes and genetic research. Now he is working with a team of medical professionals and volunteers at the Force Cancer Centre, helping anyone who has a cancer diagnosis, as well as those people caring for them.
While many of the patients who use the centre will be successfully treated and go on to live long lives, some will be coming to terms with a non-curable diagnosis. Keith and his team strive to prepare these patients for the end of life and help them make the most of their final days.
“Everybody’s going to be different,” says Keith. “With some people I can have a quite frank discussion and others, you know that the time isn’t right. But sometimes the time will become right and it’s making sure that you fire those warning shots, you make them feel comfortable, so that they can talk about it. And it’s better if we can get them talking about it earlier, if possible.
“The first thing people ask when they’ve been given a diagnosis that we can’t cure, is ‘How long, doc?’ But they don’t understand the significance of knowing. We don’t look at life as dates in calendars – you live from day to day.
“So how can we get people to think differently? To get the cup from being half empty to being half full, to grasp that moment and live their life as they would normally do? It’s about living with a diagnosis instead of dying with a diagnosis.”
The reception at the Force Cancer Centre, where patients can have a cup of tea and chat with friendly volunteers
However, Keith has his sights set not just on encouraging dying patients to talk about end of life issues – he wants everyone to think about how they want to spend their final days, and what will happen when they die.
“We’ve got to stop thinking about end of life as something that we should only talk about if we’ve got a life-limiting disease,” he says. “When I worked in casualty, a lot of people went to work and never came home. The family never had a chance to say goodbye and have those intimate conversations.”
Keith Mitchell and colleague Sue Bignall at Royal Devon and Exeter Hospital
“It’s an opportunity to let people know that you don’t have to be dying to think about dying matters,” he says. “We wait until we’ve got a serious illness and then decide, ‘I’d better do a will.’ But if we did it much earlier, there’s so much more we could be doing with that time.
“I usually start the ball rolling by talking about what’s important to me,” he explains. “I want Monty Python’s ‘Always Look on the Bright Side of Life’ when I’m being carried in to the funeral service. I’m always smiling. I’ll be cremated and my ashes will go into one place, so that people can come and talk to me when they're having a bad day. When the curtains draw around at the end of the funeral, they’ll play David Bowie’s ‘Ashes to Ashes’.”
Keith has also been visiting hospitals across Devon, highlighting how all healthcare professionals can play a part in starting important end of life conversations.
“It’s our responsibility to empower. We’re good at disempowering people – we’ve got to hand back some of that ownership to them and give them permission to talk about it. We need to normalise the conversation, instead of making it a taboo subject.”