My great-grandmother trained as a nurse at Guys Hospital in London in the early 20th Century. All was going well until she contracted what was then termed “brain fever” (probably a form of meningitis) which effectively put a stop to her nursing training. Although her eye-sight had been compromised as a result of the illness she remained undeterred from her calling, becoming both a midwife and a mortuary attendant (she laid out the dead and provided comfort to the bereaved) in the village in which she lived. I realise now she herself was an Amicus Mortis, a friend of the dying and the dead. She was also a trance medium and I fancy that as she companioned the dying when they lived life in the flesh, she also companioned them when they had divorced themselves from their mortal existence to begin their life in spirit.
I grew up listening to hilarious accounts of various ‘happenings’ (as they were termed by the family) occurring around the dead who were always laid out in the family parlour for viewing. Bodies occasionally sat up by themselves and made strange noises and sounds, garments and other items, particularly shoes, were often removed and replaced with poorer quality items by relatives, rowdy gatherings were commonplace, and it was obvious that death was very much a part of the social fabric of life.
I’ve never known this social aspect of death, this inclusiveness. All the deaths I have been involved with have taken place in hospital, and it seems that in the Western 21st Century, dying in the main occurs in medical settings; death generally appears to occur in medical settings. Somehow a social shift occurred which saw the event of death move from the family parlour to the hospital, where, according to Hermione Elliott, approximately 60% of deaths occur.[1] Atul Gawande believes that advances in medical knowledge and treatment of illness combined with the fact that decisions began to be made for patients (rather than by them) and which were based on the opinion of medical experts, accounts for the major influences underpinning the shift responsible for removing the sick from the home where illness in a sense ran it’s natural course, to medical institutions which promised the hope of a cure.[2]
There are a plethora of books in the public domain as there are social and quasi-political movements calling for a revisioning of death, or perhaps more accurately a revisioning of how we ‘do’ death. There is also a call for, and a vivification of, the voice of the patient and family in that they seek to reclaim ownership of the terms with which they die, and the ways in which family members and loved ones are supported throughout. It seems that people want to do death differently, and they want to do it on their own terms. They want access to physician-assisted or voluntary-assisted dying, voluntary euthanasia and end-of-life choices that support their own world-view, relevant belief-systems, and wishes. As Gawande notes, people want the right to end their stories on their own terms, in freedom, and with the understanding and acceptance of those terms by the medical profession.
Having experienced my own life-threatening illness and potential death, and having faced the moment in time when as I closed my eyes to sleep I truly didn’t know if when they opened again I would be here (still living life in the flesh), or there (disembodied and living life as a spiritual being in the spiritual universe), I understand the courage it takes to surrender to that unknown, to put your complete trust in an agency that you cannot see, to simply yield to the uncertainties that so often accompany death.[3] It seems to me that you can only be to others what you have lived and been to yourself, so one of the challenges of being an Amicus to others, I would think, is to first live as an Amicus to yourself.
For many people their first encounter with death is generally vicarious; it is happening or has happened to someone else. Watching someone die or seeing a body for the first time can be a shock, evoking fear, confusion, avoidance or even revulsion. People can be overwhelmed and unprepared by their emotional responses and behaviours toward the dead. At a time when everything is not what it was, and nothing seems to make sense, the challenge for the Amicus is to be the metaphorical ‘eye of the storm’; that place from which surety, calmness, empathy, wisdom and loving understanding radiate. It is the Amicus who embodies those qualities and values, lives them, and then simply by being present wordlessly emanates them from their being. Although they know not how, others are often comforted by their presence, often, with nary a word being spoken.
I would think that an Amicus complements the medical and allied health team, and constitutes a component of the holistic care required at the end of life. Despite this, the Amicus could be perceived by other medical and allied health staff as an interloper, a ‘non-professional’ and someone lacking appropriate medical credentials, skills and training. In addition, the Amicus isn’t just a “presence”; they must have relevant knowledge and experience so as to provide practical guidance and information as well. For example, how can the body be maintained if the family wish to keep the deceased at home prior to the burial?
After much pondering and reflection on the conversations I have had with others, and especially so it seems at this moment in time[4], being an Amicus is somewhat of a social imperative, and that for many reasons.
We’re taught how to be resilient, and how to grow our careers, and get along in life but death doesn’t appear to be a part of our formal education. And I’m thinking that’s why we don’t talk about it; it’s simply not part of our education and as a consequence we’re not socialised into it. I tend to think that this could well be why near-death experiences provide such a valuable education; they introduce us to an alternate perception of death, which can subsequently have a profound impact on how we live our lives. Our great challenge is to understand the meaning of death with a view to how we live our lives.
The second challenge is maintaining the integrity of our being in the presence of others, whomever they may be, and whatever the situation, with assuredness, wisdom and understanding. Many of us don’t think too much on death, and in fact to do so labels one as ‘morbid’. I have thought about death all my life. I was socialised into it as a child, and that socialisation has never stopped, if anything, it has made me realise how imperative it is that we do think about death as much as we think about life. Elliott states it beautifully, “coming to terms with death is a lifetime’s work”[5] as does Angela Tilby “what is needed here is praeparatio mortis: preparation for death, a spiritual education in coming to terms with our mortality. This is a task not for the last weeks of life – It is often too late by then …” [6]
It seems to me that it is our cosmic duty to develop our potentials and to introduce meaning and purpose to our lives. This is the praeparatio mortis that Tilby speaks of, and consciously preparing for our death is the “lifetime’s work” that Elliott speaks of. It may be a generalisation, but I feel that most people who are called to become an Amicus Mortis have lived a life of at least some preparation, and it is here that the Amicus Mortis come into their own for others who have not.
[1] Elliott, H. (20 August 2014). Death doulas complement nursing care at the end of life. Nursing Times.net. Available from: http://www.nursingtimes.net/hermione-elliott-death-doulas-complement-nursing-care-at-the-end-of-life/5073875.article
[2] Gawande, A. (2014). Being Mortal: Illness, Medicine and What Matters in the End. London: PROFILE BOOKS LTD.
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