You are dying.
This is something no-one wants to hear, but it is true for you as much as it is for the critically ill patients I treat each day in hospital. Many of them are much closer to the end than you are, but life is unpredictable, chaotic and sometimes cruel, and few of us will die at the time of our choosing. I work in healthcare where miracles occur on a daily basis, but where we are also surrounded by death. Death was not always a medicalised experience – for centuries people died at home, within families and communities, meaning we were all exposed to it as a process and an event from an early age, and people died surrounded by the things and people they loved. But these days a large proportion of the population are brought to hospital for their final weeks, days and hours.
People’s wishes at the end of life vary and not everyone wants to die at home: some are comforted by the hospital environment; some want to live in denial until their last breath; some will suffer pain, nausea or indignity; we cannot all expect a spiritual and transformative experience. But too often investigation and attempts at treatment take priority over care despite people’s wishes for peace and dignity. And so people spend their last days surrounded by unfamiliar equipment and professionals, and are cut off from the things and people they love. We can do better.
For those not working in healthcare it can be difficult to engage with these emotion-laden subjects, meaning many wait until the last moment to even acknowledge that death is a possibility. But this can be damaging, with wishes unknown, plans never actualised, questions never answered and things left unsaid. Death is inevitable but a bad death is not. We need a common language to articulate our questions, our fears, our wishes, but the words are not always easy to find. Art, in all its forms, can help to make sense of death and grief. It can help us find space for our emotions and existential concerns, and bring this most hidden of human experiences back into the land of the living.
Artists and death
Over the years art has helped me to reflect on and process my emotions caring for the dying. My experience has primarily been with visual artists, many of whom have used their practice to explore their own mortality or grief. One of my personal favourites is Skull of a skeleton with burning cigarette by Van Gogh. It is unclear what the artist intended with this piece, thought to be a comedic dig at the seriousness of morbid art. But I like to think it is a cautionary tale, an early public health message on the dangers of smoking, still a major cause of death and disability today.
Frida Kahlo used self-portraits to explore many very personal experiences including illness, miscarriage, and death. Thinking about Death [above] is a self-portrait from a time when she was ill and predominantly bed-bound. In this painting, death, symbolized as a skull and crossbones, is on her mind, literally in this case, appearing on her forehead. She is also surrounded by lush green plants, which may symbolise new life, since rebirth after death was a concept central to Mexican culture.
Damian Hirst is well known for his self-stated “obsession with death”, although he saw his works such as The physical impossibility of death in the mind of someone living as “a celebration of life rather than something morbid.” His work is not to everyone’s taste, but I find many of his pieces evocative, in particular Let’s Eat Outdoors Today, a huge glass box containing a barbecue and set of table and chairs, setup for a meal. Maggots hatch into flies which feed on the remnants of the meal, and there is a blue electric light, in which many of the flies meet their demise. Being confronted with decay in action forces the reality of our mortality into our consciousness which can be uncomfortable. But I come away not frightened or defeated, but instead invigorated and in awe of my living, breathing body.
Emma Kisiel, a contemporary photographer, elevates roadkill to high art, in her series At Rest. Dead animals are photographed where they were found, surrounded by flowers to create beautiful memorials. She states that At Rest “expresses the sacredness to the bodies of animals hit by vehicles while crossing the road” and addresses “our human fear of confronting death and viewing the dead”.
A Creative Death
There are many examples of people using personal creativity to facilitate a more enlightening and meaningful end of life period. Arts therapy has been central to the hospice movement for years. But there are also a growing number of people exploring and extending their creative outlets, without a clear therapeutic aim. People nearing the end are in a liminal space between life and death, where there is the potential for transformative experiences as well as intense grief. Engagement with artistic practice can create space to make sense of loss and mortality, can empower those losing their ability to make an impression on the world to make connections, and can enhance autonomy at a time when this is fading.
For those left behind, art can facilitate the grieving process. Grief is a complex, personal and unpredictable emotion which lasts far longer than many of us expect, and can last a lifetime. There are too few opportunities for people to revisit their loss, expose themselves to pain, and engage with their emotions on a profound level. A recent residency at Sutton House National Trust property in East London brought together a number of artists to explore LifeDeathWhatever. This brought death and grief into a public space and encouraged passers by to look, to listen and to share. One of the projects All That is Left Unsaid, continues to grow online, as people contribute the words they wish they could say to loved ones who have died. It is beautiful and heartbreaking in equal measure.
Art can be many things: imagination, beauty, reflection, provocation, emotion, therapy, inspiration, experimentation, agency, connection and communication. We need all these things when facing death, dying and grief.
I hope you can join us during our Creativity and Wellbeing Festival to explore some of these themes together, in particular at our The End of Death (as we know it) event on 16th June.
Dr Laura-Jane Smith is a Respiratory and General hospital doctor in NorthEast London. She is interested in supporting patients to self-care, palliative care for people with conditions other than cancer, the value of the arts for health and wellbeing, and medical education and training. She blogs at www.drlj.me and you can find her on twitter @drlaurajane.
A version of this post was first published as an article in the Huffington Post on 26 May 2017. It was originally commissioned for the LAHF blog.
The author is writing in a personal capacity. The views contained in this article do not necessarily reflect those of LAHF or the organisations described therein. Copyright is retained by the author.