Dr Kathryn Mannix is a soft-spoken powerhouse whose recent visit to Canada, including a public lecture for the 看片视频 Council on Palliative Care at Montreal鈥檚 Jewish General Hospital and a plenary presentation at the Canadian Hospice Palliative Care Association (CHPCA) conference, demonstrates how to talk openly about a tough subject and how we as a society can do a much better when it comes to death and dying. As a junior doctor in 1988, Kathryn came to Montreal from Britain on a scholarship to visit the Royal Victoria Hospital, the first site of palliative care, and to meet Dr Balfour Mount, considered the 鈥渇ather鈥� of palliative care. This visit was pivotal and helped establish Kathryn鈥檚 lifelong commitment to palliative care. Fast forward after 30 years of work in palliative care, Kathryn decided to retire from her clinical work and blend her experience in palliative care with her love of storytelling. This allowed her to turn her full attention to public education around death and dying.
The result has been astonishing and has including the bestselling books, 鈥淲ith the End in Mind鈥� which recounts how people live as they are dying, and, 鈥淟isten: How to Find the Words for Tender Conversations鈥� which was written during the COVID-19 pandemic and addresses the art of having conversations that may be daunting or emotionally charged. Kathryn regularly gives live lectures, and produces podcasts and webcasts on BBC , TedTalks, etc [link: h]. Where does her drive come from? Kathyrn鈥檚 foray into the media comes from a desperate need to have people understand what happens as we die.
As part of her commitment to community outreach, about 20 members of the palliative care community took part in an impromptu conversation with Kathryn. The event was hosted by Suzanne O鈥橞rien, Co-Chair, 看片视频 Council on Palliative Care, and Rick Simoneau, Executive Director, Hope & Cope, at the Hope & Cope Cancer Wellness Centre in Montreal [link: ]
Kathryn told the story of what made her go public with her outreach. She had been called to care for a 97-year-old-man who had arrived in an ambulance, lights and sirens blaring. This gentleman was close to death. His wife was talking to him but their three sons, in their 60s or 70s, appeared dazed. When Kathryn asked the sons,鈥� What did your dad say he would like to have happen if he was so sick that he could die?, they replied, 鈥淲e did not talk about that kind of stuff鈥�. Eventually their mother said, 鈥淵ou have to let him go boys. Dad and I have talked about this for years. I know you will take care of me, but we have to let him go鈥�. Kathryn was not surprised that that this elderly couple had been talking about the possibility of dying for decades but their sons were completely unable to have the conversation.
鈥淭hat was the family that finally cracked me. We cannot keep having these conversations about dying, only one family at a time. We cannot wait for the GP to come and have this conversation. This is bigger than palliative care. This issue is way bigger than medicine. This is about society and how society is stupid. We have to make this conversation happen. So I took early retirement to make a public conversation about dying happen. Now I get to spread the word about dying, death and loss. We have to give ourselves permission to talk about death.鈥�
Kathryn explained that our experience with death as a natural part of life has radically changed in the last few generations. Kathryn鈥檚 鈥淣ana鈥� (her grandmother, born around 1900) looked after several dying people at home when she was an adolescent and young woman. But by the time her Nana was dying, her children and grandchildren knew nothing of dying and had never sat with a dying person. In two generations, the understanding of dying has been lost and our society (and media) are in denial, as illustrated by the death of Queen Elizabeth in 2022. Kathryn鈥檚 posts on Facebook and Twitter went viral because she posted that the Queen was 鈥渄ying in plain sight鈥� despite the press鈥� denial of all the evidence, such the Queen no longer attending events she enjoyed. Her posts resulted in over 3 million responses, with many people acknowledging a profound disconnect.
Kathryn has been happily surprised to find that that social media has played a positive role in supporting grieving people and that in fact, compassionate communities exist on social media.
鈥淪ometimes people are describing difficult dying and we cannot pretend that doesn鈥檛 happen. I find that other people try to help and engage with those people. They say, 鈥� I am so sorry that happened to you. Would you like a telephone or Zoom call? They get love bombed! We have about 10,000 people on Facebook and Instagram and another 40,000 on twitter. Extraordinary.鈥�
When asked what resonates well when talking to someone who is dying especially given time pressures, Kathryn emphasizes that open and honest conversations are essential, including the need for healthcare professionals to state clearly what is happening and to ask people, given their situation, what matters most to them. She notes that effective conversations can ultimately save time.
鈥淭here are less resources, less time. Conversations are so important for patients and healthcare professionals. No one goes into healthcare just to administer medication. We cannot make more time, but if we do the conversation well, it can be time saving, if not at the moment, then down the line in another part of the patient鈥檚 journey. Find the courage to sit with your convictions, might be 5 or 8 minutes. We got good at this during COVID, delivering difficult news, but we allocated 鈥渞ecovery time鈥� to de-stress as part of self-care.鈥�
Her final message focused on the advantages of providing both healthcare professionals and patients with a framework, such as cognitive behavior therapy, to help them identify the link between their distress and their behavior so they are able to manage difficult situations more effectively.
鈥淭here is a need to integrate palliative care into the treatment plan. Next, teach people, patients and healthcare professionals, how to self-manage their crisis. Help people map the dimensions of what is causing distress. Behaviors are triggered by thoughts. There are different physical sensations- pain, breathlessness, lack of energy. Cognitive behavior therapy training helps show us how to draw a map of what you are thinking and feeling and what your behavior is. Give people a framework so we are not always making it up as we go along.鈥�
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