What a lovely welcome. Thank you. I feel such an imposter on this red dot after those fantastic talks. Thank you so much. So I’ve come to cheer us all up by talking about dying. (Laughter) I want us to think about whether knowing more about dying might actually help us to live better. And I’ve got a reason for thinking that it might. Because over 30 years of working in palliative care, where a little bit of doctor gets spread a long way by working with lots of different other professions in the team, the teams that I’ve worked in, between them, have looked after somewhere between 10 and 15,000 people at the very end of their lives. So that means that when I'm talking to you about the process of dying, I’m not talking about how my relative died, how my friend died, what my neighbor told me about the way their friend died. I’m talking to you about the process of dying. So the first thing that I would like us to know is that it’s not like on the movies. It’s disappointingly not like on the movies because it’s always very exciting on the movies. And it’s not really like what we read in the newspapers and see on the news. We see tragedies and difficult things that have happened to individuals. But they are the exception. So just think for a moment: If the only thing that you knew about air travel was what you read in the papers or saw on the news, would you ever get on a plane? Because I wouldn’t. You know, all those free snakes, for a start. The zombie pilots, that’s troubling. The stag parties, the, you know, the things that can go wrong with the plane, technically. Now, there are unusual, tragic accidents. The reports of plane crashes are true. But every day, 100,000 flights take off from the right airport and land, eventually, in the other right airport with the same number of people on at the end as got on in the beginning. And about 6 million people worldwide are moved by planes every 24 hours. But we don't hear about the ordinary. We don't hear about ordinary air travel because it's not newsworthy. And we don't talk about what my team calls ordinary dying either. Ordinary dying is a process like ordinary giving birth is a process that our bodies know how to do. And towards the very end of our lives, it doesn’t really matter what the illness is; the pattern is very similar. It’s a pattern of being more tired. It's a pattern of having less energy. Some of you have seen this amongst your own family and friends. People whose energy is running out and what becomes important to them now isn't so much eating and drinking as sleeping. Sleeping is like putting your phone back on its charger. It recharges our energy for a little while, but like a failing battery, the charge lasts less and less time. So people sleep more; they’re awake less. And gradually, they move from being just asleep to being unconscious. When we’re un-conscious, and the clue is in the name, we're not conscious of almost anything. And one of the things we're not conscious of is the back of our throat. Now, there are parts of our body that have lots and lots of sensory endings, and some of those are for pleasure, and some of those are for protection. And the back of our throat has lots of sensory endings so that we won’t choke. We've evolved to protect our airway. So you know that if you get a crumb or a drop of tea or vodka at the back of your throat, you’ll cough, you’ll retch, you’ll splutter, you’ll swallow, and eventually you will get it up or you’ll get it down in the right direction. But when people are deeply unconscious, that doesn’t happen. They’re not aware of their throat. They breathe through their voice box, so they make a peculiar noise, a kind of “hmmm” noise. I’m just going to do that again. Hmmm. When’s Halloween? Soon. The difficulty about this noise is that if you just heard that noise, you might think the person was trying to speak or the person was uncomfortable or they were groaning. And in fact, they’re just breathing out through their voice box. When we’re completely unconscious, we don’t swallow little bits of saliva that our mouth makes or the fluid that we’re using to clean somebody’s mouth. But the breathing goes on, the airway isn't blocked, so the air is moving in and out, in and out through a little pool of liquid, and it bubbles, it clicks, it rattles. We call it the death rattle. And actually people feel very anxious about that noise. But what it says to me is that this dear person now is so deeply unconscious, they no longer feel the back of their throat. And if they’re not feeling the really sensitive bits, they won’t be feeling the other bits either. They are completely safe, deeply unconscious. And science has recently shown us that despite that level of un-consciousness, the thing that we’ve observed for many years about people looking more settled when the right voices are in the room or the news that the baby’s been born in Australia is announced is borne out by science that shows that even as people are dying, and we can measure their brainwaves and watch them becoming more and more deeply unconscious, the brain still flickers into action, not with sensation or light, but with sound, that hearing is preserved. So keep talking to our dying people. And eventually the only part of the brain that is still doing anything at all is the bit that works our breathing. It’s right down at the bottom of the back of the brain near where it joins onto the spinal cord. So people have a particular way of breathing in deep unconsciousness. It’s cycles of automatic breathing from deep, gradually becoming more shallow, and then going back to deep again. And fast breathing that gradually slows down, and there are pauses and longer pauses, and suddenly, we go back to the beginning again. And then at some point during one of those slow phases, usually, there is a breath out. And there isn't another breath after it. There is absolutely nothing special about the last breath. There is no sudden feeling of fading away. There’s no crescendo of pain or terror. There’s no sitting up and telling you that you were adopted or where the treasure is buried. That doesn’t happen. It’s incredibly ... not dramatic, and that’s why it doesn’t make it onto TV dramas and into Hollywood. But if you mind about the person it’s happening to, it’s incredibly reassuring to see it happening. A few minutes after that last breath, the heart will run out of its oxygen supply, and it will stop. Everything else has already stopped, and the heart stops last. So the second important thing about ordinary dying is that it isn’t the same thing as a situation where somebody is relatively well, their body is filled with oxygenated blood, and suddenly, (Snaps) their heart stops, and they drop. Christian Eriksen did it during a football match in the Euro 2020 finals during 2021. He had CPR on the pitch. He was resuscitated. He was defibrillated. He was taken to hospital. He was one of the one in 10 people who survive cardiac arrest and are well afterwards, so well that he is still playing for his nation. So the next thing about dying is that it isn’t the same as a cardiac arrest, where the right thing to do is CPR. Who in here is trained to do CPR? Wave. Wave your hands because it’s so dim. Right. We’ve got a couple of people. Thank you. Thank you for being trained. Because actually, the people that I love and the people that you love will not stand a chance if they are one of those people whose heart stops unless somebody starts CPR within two minutes. So we need bystanders who are trained. And every nation requires all of its citizens to be able to begin that first aid that will keep somebody’s brain alive by pressing hard enough on the chest, so hard that sometimes we break people’s ribs to circulate that blood from the chest where it’s got oxygen in it, up to the brain and around the body’s organs until we can get them to the hospital where they can have a treatment that might be able to restore their heart to beating on its own and save their life. So think about who in your family, in your school, in your community is trained for CPR, and think about why you might be the next person. And then the last thing that I’ve learnt that I want to share with you about being at so many deathbeds is the importance of the things that are said around deathbeds. There are conversations that we who work in end-of-life care hear over and over again. People are grateful. People want to say thank you to the people who’ve been important to them through their lives. And when a person tries to thank you, you get embarrassed. You say, “Oh, no, no, no, it doesn’t matter. It was nothing.” Actually, we must let them speak. This is their heart speaking, and they need to feel heard. They need us to say, “It was okay. It was my pleasure. It was my delight. God, it was hard. But I’m glad I did it.” Whatever it is. Hear their gratitude. They want to repair rifts in relationships. They may want to say “I’m sorry” and ask for our forgiveness. Or they may want to say to us, “That thing that we felt out over, it’s nothing now; it doesn’t matter. Don’t live with the regret of it.” When they apologize, don’t say “It’s nothing.” This is their soul putting things right. We need to hear them. We need to say “Thank you for saying that. And I accept your apology.” But the thing that we hear over and over that is the most important is “I love you.” Over and over again, in nursing homes, in hospitals, at roadsides next to traffic accidents, paramedics report the same thing. The messages from the Twin Towers after the atrocities of 9/11, nobody had mobile phones. They were phoning house phones and leaving messages on tapes, and they were all the same thing: I love you. I love you. The four last messages: Thank you. I’m sorry. I forgive you. And I love you. And always there’s a sense of: “If only we’d said this sooner.” So can we live our lives better for understanding dying? I think that we can. We can know that we can prepare ourselves and be somebody's companion while they're dying and insist that they could get good symptom management so that they're comfortable during their dying. But we can start today to think about those messages because actually they don’t have to be the last messages. They are the last messages because they are the most important messages in life. And there is no time-wasting at deathbeds. Who do you want to thank? Who do you want to make peace with? Who do you love who needs to know? Make that your homework today. Thank you. (Applause)
