Every day, something small brings me joy, whether it’s walking my dog, drinking coffee with a friend, or my daughter, Niamh, coming back from university and eating me out of house and home. I tell my family I love them constantly, because I don’t want any regrets, and I don’t waste a minute worrying what strangers think of me.
I know how precious time is because I work with people for whom it’s running out. During my 20 years as a palliative care doctor, I have looked after about 2,000 terminally ill patients, my proximity to death giving me a unique and ultimately uplifting perspective on life.
Dying is still so taboo that I’m often asked how I can do this job, but the truth is that people’s final hours are a special, humbling time that I feel privileged to be a part of, and I have come to see death as natural, normal and often beautiful.
I realised I wanted to work in palliative care on a six-month placement to a hospice during my medical training. I relished the holistic, spiritual side of the work, focusing on patients’ anxieties and fears as much as the physical side of their illness.
After eight years as a GP, I joined Marie Curie Hospice in Solihull, West Midlands, first as a junior doctor. I then worked my way up to become a consultant and since 2015, I’ve been its medical director, heading a team of 10 doctors, looking after between 12 and 20 patients at a time.
They usually have weeks to live and disproportionately include lots of younger people – while we care for every age in the community, our hospice beds are kept for complex patients, such as parents with young children, who they don’t want to witness them dying at home.
We see every profession, from judges to factory workers. Death is a great leveller – that you’ve held an important position makes no difference when you’re dying; you’re still scared of the unknown, especially if you’ve witnessed a loved one struggle with a difficult death.
We recently had a lady with heart failure who was terrified, having seen her dad die badly of the same condition. But we reassured her that dying is generally a peaceful process, during which people get sleepier as their organs slow down and they slip into unconsciousness, able to hear and feel the touch of a hand, even though they can’t communicate.
Once people understand it takes much of the fear away, although of course, that can’t stem a sense of regret, the biggest of which is not spending enough time with their families.
Not one person has said they wished they spent longer in the office, and sacrificing family time in pursuit of professional validation is a source of huge sadness.
I remember a doctor – we are a tricky bunch, used to being able to sort things out ourselves – who talked of his regret at working through Christmases and putting off holidays with loved ones to devote himself to his job. “Looking back, it didn’t mean anything,” he said.
People regret not what they have done but what they haven’t – the birthday celebrations they missed, chances untaken. They also regret the practicalities they put off, from making wills to planning funerals. One young mother we had recently wanted to write her children cards for every marker in their lives, from birthdays to passing driving tests, but was running out of energy.
Priorities are different in final days – an 18-year-old boy with aggressive bone cancer wanted his Xbox, while an ardent Wimbledon fan wanted to spend her remaining time watching the tournament while eating strawberries and drinking Champagne.
We try to accommodate all requests – someone living with cancer is currently desperate to see her first grandchild arrive in a fortnight. We’re doing everything possible to make that happen, but we’re honest when patients ask how long they have left, based on how quickly we see them deteriorate. “You might just have one day, but every day is precious,” I tell them, because, I’ve learnt, it is.
We wrap people in love, such as the woman living with breast cancer we helped arrange a hen do for a few months ago, replete with pink cowboy hats and inappropriate balloons. Too ill to stand by the time her wedding came, we wheeled her in a bed to swap vows with her husband. She died the next day, so happy at least that the ceremony happened.
Celebrating a life well lived is important. One man and his wife in her 80s raised a Champagne toast to each other on their wedding anniversary, just hours before she died. It was a beautiful moment.
So too is creating a legacy for future generations. We helped a 32-year-old woman with pancreatic cancer record videos of her toddler learning to walk, his tentative steps around our beautiful hospice gardens etched in my mind forever.
Certainly, this job takes a toll – I remember a young woman who died suddenly, which was traumatic for her family but also for our team. We have incredible bereavement support for families and psychological support for staff but I have to be mindful of how I look after myself. I cry at the drop of a hat over anything remotely sad on television.
My husband Michael, a lawyer, is incredibly supportive, as are our children Niamh, 18, now studying liberal arts, and Kyle, 20, a medical student – who have grown comfortable hearing my stories about death and dying over the years.
Yet it isn’t all doom and gloom at the dinner table. I’d often come home and say “the most amazing thing has happened today” because despite, or perhaps even because of, the sad moments, there is reason to smile.
I once arrived to care for a man dying at home to find a tattooist and a house packed full of relatives shrieking with laughter – they were all getting matching Union Jack tattoos on their arms to commemorate him. I had a wonderful time watching Harry and Meghan’s wedding with one royalist, who dressed up for the occasion, replete with hat.
Pets often provide comfort – a lot of patients request their cats and dogs are on their bed as they die – but we once managed to bring a woman’s beloved horse into our courtyard. Fortunately it behaved fabulously well.
Fruit lollies and soups are popular as people lose their appetite, as, I’ve found, are holiday programmes on television such as A Place in the Sun – pure escapism.
I’m not at all religious but my spiritual belief in an afterlife has been strengthened by my work. Patients talk to me not so much about God, but the deceased relatives they see coming to them. When they tell me they’ve seen their mum, or a lost child, or even a pet – whether as spirits or images in their mind depends on their belief system, but they always find it reassuring – I know they only have hours or days left.
Spending most of my days talking to people about dying means I don’t get caught up in small things. Traffic jams and tax returns don’t phase me. At 52, I exercise and eat well to remain as healthy as possible, but I don’t worry about getting ill. I appreciate family and friends more and focus on the now, rather than what could happen in the future.
My career also enabled me to give my father Bill, a retired flooring company owner, the best possible end when he died last October, aged 75.
After suffering lung disease for a couple of years, he deteriorated rapidly, and it felt that my whole career had built up to making sure his final four days were as good as possible, with nothing left unsaid.
Aware how limited his time was, I said we needed to bring his grandchildren in to hospital, where his condition had to be managed, while he had the energy to ask them to be pallbearers at his funeral. It was a hard and upsetting conversation but meant such a lot to all of us to be able to talk through.
Lucid and pragmatic until the end, Dad had been proud of my work, still showed moments of humour as he advised me his golf buggy at his golf club was unused, making us eligible for money back, and warned me his wine subscription needed cancelling.
We sang his favourite John Denver playlist – badly – and he spent his last hours cuddling his seven-year-old grandson. As deaths go, his final days were beautiful. He lived until he died, and in my job, that’s the aim.
Now too many of us die in hospitals, rather than at home; we’ve grown squeamish about dead bodies, but I see them as a continuum of dying. We talk to the deceased as we would when they were alive. Nurses perform the last offices and we wash and dress the deceased with the support of their family. It’s a dignified, beautiful ritual; my sadness is accompanied by a sense of pride that we were able to play a tiny part in their lives.
I’m not scared of dying myself. I understand what’s going to happen and will make sure I am surrounded by the people I love, because above all else, this job has taught me that our connections with others are what truly matter.
As told to Antonia Hoyle
Marie Curie is one of four charities supported by this year’s Telegraph Christmas Charity Appeal. The others are Go Beyond, Race Against Dementia and the RAF Benevolent Fund. To make a donation, please visit telegraph.co.uk/2023appeal or call 0151 284 1927