This week, former royal butler Paul Burrell revealed Queen Elizabeth II’s response to being told she was going to die – and it’s as dignified as you’d expect from the late monarch.
Upon hearing the news she had cancer and may not survive beyond Christmas of 2021, she replied with a characteristically stoic: ‘Well, that’s a shame’.
The 95-year old Queen was hoping to celebrate her Platinum Jubilee the following year, so asked doctors if they could help her stay alive until then.
In his upcoming book, The Royal Insider, Burrell claims she ‘scrupulously’ followed their orders after that, undergoing blood transfusions and even giving up her favourite gin and Dubonnet tipples to surpass the prognosis by months.
While hers was a uniquely regal situation, the way the Queen handled being told her life was ending isn’t out of the ordinary.
Marie Curie chief medical officer, Dr Sarah Holmes, remembers an older patient who, when given a terminal diagnosis, had a similarly stiff upper lip response, saying: ‘Oh well, let’s have a sherry then.’
‘She just kind of took it in her stride,’ the palliative care specialist tells Metro. ‘And I wonder if it sometimes reflects the life you’ve already had and what you’ve done, as that particular lady had done everything she’d wanted to do and tied off the loose ends.’
The fact is, everybody’s circumstances are different, which means each person will react differently.
There are some common themes though – and since we’ll all die (and many of us will lose loved ones) exploring the ways this experience typically plays out can hopefully make it seem like a less daunting process.
‘How long do I have left?’
One of the first things people tend to ask about is time; how long they might live for and whether they’ll make it to certain important milestones in life.
Dr Holmes explains: ‘Like the Queen, people have particular things that they are looking forward to in the future, sometimes quite short horizons, sometimes things much further in the future.
‘I find round about this time of year that people are often thinking about Christmas, so it’s not uncommon for us to bring “Christmas” forward so they can spend one last one with their family.
‘The other thing, it’s like the circle of life, they’re waiting for babies to be born or to see new family members – those kind of key moments are really important for people.’
Dr Paul Perkins, chief medical director at Sue Ryder, recalls helping make similar memories for patients who don’t have long left, with hospice staff planning everything from weddings to Halloween parties.
When it comes to giving exact prognoses though, both specialists agree that it can be difficult to pinpoint – and isn’t always helpful.
‘If people then don’t get the years or months they’ve been told they’ll get, they can feel cheated, or if they get more, they feel like something’s gone wrong and they’ve been misled,’ says Dr Holmes.
‘In reality, we can’t actually give a definite timescale, so I always try and avoid giving any sort of number. I try to look back over time, because the changes usually carry on at that same rate, and talk about making the most of the present and the time we have here and now.’
Support for anyone dealing with death or terminal illness
If you or someone close to you needs support with any aspect of death, dying or bereavement, both Marie Curie and Sue Ryder have resources that can help.
- Contact Marie Curie for free on 0800 090 2309 or visit the Marie Curie website to chat online.
- Visit the Sue Ryder website to access online support communities, sign up for emails, or find self-help tools.
‘I don’t want to know’
‘I’ve known people that just kind of turn their face to the wall, and as soon as they know there’s no treatment, they just almost kind of give up,’ Dr Perkins tells Metro.
‘Others just don’t, don’t believe it at all. Sometimes, you can tell them repeatedly, and they don’t seem to take this on board, and that’s their way of coping.’
Denial is a natural stage of the grieving process, so it’s understandable it’d happen when people begin to mourn their own lives.
‘There are definitely times where people don’t want to talk about it and aren’t ready to talk about it,’ says Dr Holmes. ‘We have to try and tread very softly with these conversations, so we’re not forcing that information on people when they’re not ready for it, but trying to gently bring them to the position of understanding what’s going on.’
In her view, it’s not necessarily a bad thing though; one patient she cared for had been a lifelong worrier, and was so afraid of dying that addressing the issue didn’t help at all.
Dr Holmes adds: ‘Forcing her to talk about it and face things at the end of life didn’t work for her. She just needed sort of everybody to carry on as they normally would have done with her, and that was her way of coping.
‘Usually it’s not that people don’t want the care. It’s that they may not want the conversation about what’s actually happening.’
‘What about my family?’
‘It’s amazing how altruistic we are as humans,’ says Dr Holmes. ‘So often, people immediately go to worries about the people that are left behind, worrying about others rather than worrying about themselves.’
However, the way this manifests can vary, with Dr Perkins explaining: ‘Some people are very organised and immediately produce spreadsheets and folders for their families about how things are going to be.
‘Sometimes we get asked how they should tell their loved ones, and that can be really hard and stressful, telling your kids that you’re going to die. But the advice we give is to be honest, if you can.’
Others will write cards for their loved ones to keep their memory alive, or chat to relatives about funeral plans and help them manage when they’re no longer around.
‘Why is this happening to me?’
Like denial, anger is another grief stage that can crop up when people receive a terminal diagnosis.
‘That might be that they’re angry with god, that they’ve got this condition, or they’re angry with the world, or they’re angry that they feel their diagnosis is being delayed,’ he says.
It’s also not uncommon for patients to ask why this is all happening to them, especially if they’re religious or have an illness related to things like smoking or drinking – in which case they may ‘blame themselves for what they’ve done in the past, despite the fact these things are so addictive and so hard to give up’.
Dr Perkins adds: ‘I look after the loveliest people, people that have had completely blameless lives, and these bad things happen. So much of it is just bad luck.’
‘I’m scared of what death will be like’
‘Pain is a common worry for people, but it often depends on the condition and the symptoms they’ve been having,’ Dr Holmes says. ‘So if they’ve been having a particular symptom, they worry about that symptom being more difficult to cope with. Others are very afraid of being aware as well, of knowing what’s going on when it happens.’
Dr Perkins highlights that death is an ‘unpredictable business,’ which makes it difficult to guarantee what it’ll be like for each patient.
However, he explains: ‘We can reassure them that, particularly if palliative care is involved, it can be a dignified and peaceful thing. Our job is to make sure they’re as comfortable as possible.’
Sometimes, people are so fearful that they delay going to a hospice, thinking palliative care is ‘all about death’.
‘Then they come in and go, “oh, I wish I’d come here sooner, it’s so much nicer I thought it was going to be”,’ says Dr Perkins. ‘Just under half of people end up going home or to a care home, so not everyone who comes in dies.’
As Dr Holmes noted, end of life care is about making the most of the time you have – even if it’s not as long as you’d hope for or expected.
Dr Perkins adds: ‘When people know time is short, they realise that it’s not money or possessions that matter, but relationships and love. I’ve had people where they say the last two weeks of their lives have been the best two weeks, because they spent time with the people that they love.’
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