Karen Hitchcock’s dream: delivering dignity in the face of death

KAREN Hitchcock’s brisk read about the heaviest topic of all, Dear Life is written with passion and compassion in equal measure.

Only 14 per cent of Australians die at home.

A BRISK read about the heaviest topic of all, Dear Life is written with passion and compassion in equal measure. Its author, Karen Hitchcock, is a physician in acute and general medicine at a Melbourne public hospital. Moreover, she is a sharp writer, as readers of her regular column in The Monthly will attest. For years in that space she has enlightened, amused and moved us with short stories from inside the medical profession, a cloistered community for whom strong communication with outsiders is rarely a virtue.

It is to Hitchcock’s credit that she bridges that difficult gap between specialists and laypeople with a style and grace that is redolent of renowned medical communicators ­Oliver Sacks and Atul Gawande. With Dear Life, Hitchcock shows how comfortable she is with the long-form essay by writing a com­pelling account of how this country treats its elderly and dying, and how we may better ­perform this task. It is a masterful, timely achievement that will prompt much soul-searching in its readers and conversations among their friends and family, for this is one topic that cannot be avoided. One day death will claim us all, and it is important we prepare ourselves and our loved ones for this, emotionally, spiritually and physically.

My grandfather was in the final stages of ­terminal cancer as I read Dear Life, and at times it became hard to see the pages through tears. He died in hospital on Sunday, March 15, aged 82. His health had declined considerably since I last saw him at the beginning of the year, in a different hospital. As Hitchcock writes, his case is typical of end-of-life care: while surveys state that the overwhelming majority of Australians wish to die at home, only 14 per cent of the population achieve that wish. The reality is most elderly people require constant medical attention in their final weeks and hospitals ­provide the best locale for such care.

The author is no stranger to this reality, ­having watched her father and grandmother die in hospital and hospice, respectively, and having felt the terrible burden of having to make ­decisions about their treatment as the sole medically trained member of a non-medical family. “A good death — an ideal death — is pre-planned, perfectly timed, excretion-free, speedy, neat and controlled,” she writes. “Birth is not like this. Life is not like this. And yet we think we have a right to ask it of death.”

The narrative of Dear Life is split into short chapters that are peppered with references to research papers and contemporary articles in publications such as The New Yorker, The ­Atlantic and The Age. At no point does the ­author become bogged down in technical ­jargon or statistical minutiae. Her tone remains measured and warm throughout; perhaps she imagined writing it for her non-medical family. It is a wise stylistic decision, as there is much more to be gained from speaking plainly about this matter than by muddling the message with too much science, as it were.

Still, Hitchcock frequently impresses with her precise turns of phrase: “It is difficult for us to think about our own death, except as a kind of puppet show, with ourselves watching as a spectator,” she writes early on. Later, when recalling how her grandmother stopped breathing in her arms, she concludes the anecdote with this quietly devastating sentence: “And then I can’t tell you how still she became.”

Dear Life flits between wider societal ex­aminations of attitudes towards death, medical perspectives on treating the elderly and Hitchcock’s anecdotes from the field, caring for her patients and occasionally going beyond the call of duty by following up with the frail and lonely once they have left her workplace. These vivid vignettes are among the essay’s standout moments, particularly the case of Fred, an 84-year-old man who arrived in Hitchcock’s hospital soon after the death of his wife and dog, utterly miserable, essentially requesting euthanasia. Through her kind words, her persistence and optimism, the doctor turned her patient around; two weeks after his discharge, he sounded exuberant on the phone, having taken a retired show dog into his care under the proviso that it would be returned to the breeder should anything happen to Fred.

Hitchcock’s doubt, pain and empathy are all on display throughout Dear Life. One gets the impression that the author has an impeccable bedside manner and that she is just the type of physician you’d wish to care for you at any stage of your life, but especially near the end, where the gap between palliative care and a few extra years of life can be as small as a written instruction by a rushed, dismissive doctor who sees all treatment of the elderly as inherently futile.

Yet Hitchcock is not prescriptive in this text. She acknowledges the essay does not offer ­simple solutions. “My chief aim,’’ she writes, “is to strike a note of caution and to make explicit something that often remains unsaid and yet can be heard quite clearly: that the elderly are burdensome, bankrupting, non-productive. That old age is not worth living.” This duality of opposing professional views — empathy and despair for the plight of the aged — is the essay’s central driving force, and it is not wrestled with lightly. Towards the end, Hitchcock writes:

The young rule the world; we stomp around doling out mean rations to the old, the machinery of our secure, quiet bodies purring to us the myth that we will be young forever. And, one by one, my patients retreat to small nursing-home rooms and then slip away. Soon they will all be gone. And then it will be your turn and mine to sit in cells and drink the weak tea they hand out at eleven and two, hoarding biscuits in our fridges. Not dead, yet.

In Dear Life, Hitchcock has laid out her most important work to date in the type of clear, rational, respectful prose that the topic demands. As much as our natural instinct may be to avert our gaze from death, to push it from our minds at every opportunity, this essay is inspirational and aspirational in its scope. It is highly recommended to all those who hold life dear, and especially to those whose professional lives are devoted to helping us through illness and death with dignity.

Dear Life: On Caring for the Elderly

By Karen Hitchcock

Quarterly Essay 57

Black Inc, 114pp, $19.95

Andrew McMillen is a Brisbane-based freelance journalist and author of Talking Smack: Honest Conversations About Drugs.