7/21/2019 A Thank You Letter to David Bowie From a Palliative Care Doctor

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A Thank Y ou Letter to David Bowie

From a Palliative Care DoctorPosted: 18/01/2016 11:56 GMT Updated: 18/01/2016 11:59 GMT

o

Oh no, don't say it's true - whilst realisation of your death wassinking in during those grey, cold January days of 2016, many of uswent on with our day jobs. At the beginning of that week had adiscussion with a hos!ital !atient, facing the end of her life. "ediscussed your death and your music, and it got us talking about

numerous weighty subjects, that are not always straightforward todiscuss with someone facing their own demise. n fact, your storybecame a way for us to communicate #ery o!enly about death,something many doctors and nurses struggle to introduce as a to!icof con#ersation . $ut before del#e further into the aforementionede%change, &d like to get a few other things o' my chest, and ho!eyou don&t (nd them a saddening bore.

Thank you for the Eighties when your )hanges*ne$owie album!ro#ided us with hours of joyful listening, in !articular on a tri! from+armstadt to )ologne and back. y friends and will !robably alwaysassociate +iamond +ogs, ebel ebel, )hina irl and olden /earswith that !articular time in our li#es. eedless to say, we had a greattime in ln.

Thank you for Berlin , es!ecially early on, when your songs !ro#idedsome of the musical backdro! to what was ha!!ening in 3ast and"est ermany. still ha#e &4elden& on #inyl and !layed it again when heard you had died 5you&ll be !leased to hear that 4elden will alsofeature in our ne%t Analogue usic )lub in the ilot !ub in enarthlater this month7. 8ome may associate +a#id 4asselho' with the fall

of the wall and reuni(cation9 but many ermans !robably wish thattime had taken a cigarette and !ut it in r 4asselho'&s mouth aroundthat time, rather than hear : &#e been looking for freedom: endlesslyon the radio. ;or me that time in our history is sound tracked by&4eroes&.

Thanks also on behalf of my friend Ifan , who went to one of yourgigs in )ardi'. 4is sister 4af was on the doors that night and heard arumour that fan managed to sneak in for free 5he says sorry<7. /ouga#e him and his mate a wa#e from the stage which will remain in hismemory fore#er.

7/21/2019 A Thank You Letter to David Bowie From a Palliative Care Doctor

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Thank you for Lazarus and Blackstar . am a !alliati#e caredoctor, and what you ha#e done in the time surrounding your deathhas had a !rofound e'ect on me and many !eo!le work with. /ouralbum is strewn with references, hints and allusions. As always, youdon&t make inter!retation all that easy, but !erha!s that isn&t the

!oint. ha#e often heard how meticulous you were in your life. ;orme, the fact that your gentle death at home coincided so closely withthe release of your album, with its good-bye message, in my mind isunlikely to be coincidence. All of this was carefully !lanned, tobecome a work of death art. =he #ideo of >a?arus is #ery dee! andmany of the scenes will mean di'erent things to us all9 for me it isabout dealing with the !ast when you are faced with ine#itable death.

Your death at home . any !eo!le talk to as !art of my job thinkthat death !redominantly ha!!ens in hos!itals, in #ery clinicalsettings, but !resume you chose home and !lanned this in somedetail. =his is one of our aims in !alliati#e care, and your ability toachie#e this may mean that others will see it as an o!tion they wouldlike ful(lled. =he !hotos that emerged of you some days after yourdeath, were said to be from the last weeks of your life. do not knowwhether this is correct, but am certain that many of us would like tocarry o' a shar! suit in the same way that you did in those !hotos.

/ou looked great, as always, and it seemed in direct de(ance of all thescary monsters that the last weeks of life can be associated with.

For your symptom control needs , you will !resumably ha#e had

!alliati#e care !rofessionals ad#ise on !ain, nausea, #omiting,breathlessness, and can imagine they did this well. en#isage thatthey also discussed any emotional anguish you may ha#e had.

For your advance care planning 5ie !lanning heath and caredecisions !rior to things getting worse and before becoming unable toe%!ress them7, am certain you will ha#e had a lot of ideas,e%!ectations, !rior decisions and sti!ulations. =hese may ha#e beenset out clearly in writing, near your bed at home, so that e#eryonewho met you was clear on what you wanted, regardless of your abilityto communicate. t is an area not just !alliati#e care !rofessionals, butin fact all healthcare workers want to !ro#ide and im!ro#e, so that itis less likely that any sudden health incidents will automatically resultin a blue-light ambulance emergency room admission. 3s!eciallywhen !eo!le become unable to s!eak for themsel#es.

nd I doubt that anyone !ill have given you "ardiopulmonary#esuscitation $"%#& in the last hours@days of your life, or e#enconsidered it. egrettably, some !atients who ha#e not acti#ely o!tedout of this treatment still recei#e it, by default. t in#ol#es !hysical,sometimes bone-breaking chest com!ressions, electric shocks,

injections and insertion of airways and is only successful in 1-2 of!atients whose cancer has s!read to other organs in their body. t is

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#ery likely that you asked your medical team to issue you with a +oot Attem!t )ardio!ulmonary esuscitation order . can only imagine

what it must ha#e been like to discuss this, but you were once again ahero, or a &4eld&, e#en at this most challenging time of your life. Andthe !rofessionals who saw you will ha#e had good knowledge and skill

in the !ro#ision of !alliati#e and end-of-life care. 8adly, this essential!art of training is not always a#ailable for junior healthcare!rofessionals, including doctors and nurses, and is sometimeso#erlooked or under-!rioriti?ed by those who !lan their education. think if you were e#er to return 5as >a?arus did7, you would be a (rmad#ocate for good !alliati#e care training being a#ailable e#erywhere.

o back to the conversation had with the lady who had recentlyrecei#ed the news that she had ad#anced cancer that had s!read,and that she would !robably not li#e much longer than a year or so.8he talked about you and lo#ed your music, but for some reason wasnot im!ressed by your Biggy 8tardust out(t 5she was not surewhether you were a boy or a girl7. 8he too, had memories of !lacesand e#ents for which you !ro#ided an idiosyncratic soundtrack. Andthen we talked about a good death, the dying moments and whatthese ty!ically look like. And we talked about !alliati#e care and howit can hel!. 8he told me about her mother&s and her father&s death,and that she wanted to be at home when things !rogressed, not in ahos!ital or emergency room, but that she&d ha!!ily transfer to thelocal hos!ice should her sym!toms be too challenging to treat athome.

"e both wondered who may ha#e been around you when you tookyour last breath and whether anyone was holding your hand. belie#ethis was an as!ect of the #ision she had of her own dying momentsthat was of utmost im!ortance to her, and you ga#e her a way ofe%!ressing this most !ersonal longing to me, a relati#e stranger.

=hank you.

$y +r ark =aubert, alliati#e )are )onsultant at Celindre 48 =rust,)ardi', D

=his blog !ost (rst a!!eared on the $ritish edical Journal blogs !agehere .