Living with Uncertainty – by Catherine Proot and Michael Yorke

Categories: Education and Featured.

The full title for this meaty book is: “Challenges and Choices for Patient, Carer and Professional at the End of Life – Living with Uncertainty” and I for one can’t imagine a shorter title which would do justice.

To begin with I wondered whether the authors were trying to take on too much yet, given the pastoral tone and embedding of many personal stories – from patients, carers and professionals – something would have been missing if any of these groups had been ignored. And it is this interweaving which makes the book both compelling and perhaps unique.

Patients, carers and professionals (and volunteers as well) are each part of a complex web of relationships, and to focus on anything less than this holistic reality requires a pretence which Proot and Yorke are not prepared to allow – and this book is all the richer for it.

There are two parts to the book. Part I looks at the dying person and their loved ones and Part II focuses on Medicine and care at the end of life. These in turn break down into chapters exploring attitudes to death and dying, people’s experience at the end of life, medical intervention, euthanasia & assisted dying and person centred care – plus a post script on lessons from Covid 19 – any one of which could easily be expanded into a book of its own.

The reader will find this a thought provoking read which will require time to absorb and reflect on. It is not a one-sitting book by a long way – yet each section can comfortably be read in one go and together they weave a quilt reflecting the complexities of care in our twilight years.

Catherine Proot is a psychotherapist by training and Michael Yorke an Anglican priest who was also the chair of the Samaritans for a while. Sadly Michael died in 2019 – before this was published. Their professional backgrounds come through in the language used, their embracing of others voices and the gentle manner in which they reflect on tough issues.

The intensity of topics covered is assisted by a great use of language and numerous phrases the reader will want to write down and reflect on. To take but a few examples:

  • Dying is the normal final part of our life, and it is crucially important.
  • Death arouses strong feelings ….and sensitivity must be the watchword for all who care for the dying and the dead.
  • …professional boundaries may become blurred into a shared humanity where being there for each other is healing for the professional as well as the patient…all share the reality of our mortality.
  • We have more questions than answers…
  • “I have pain” does not mean ‘Where are the painkillers?”
  • Knowing the story behind the patient, we may be in a better position to appreciate how they think or why they decide something.
  • …beyond the provision of drugs and symptom control, there is the vital ‘presence’…
  • There are no rights and wrongs at the twilight of life.
  • Quality of life is a subjective response to personal circumstances…

I could continue at length – and perhaps I should because these ditties, or perhaps we might call them end of life ‘wisdom sayings’, though withdrawn from their context, present, together, something of the essence of the journey we are all on. The reader will find plenty to reflect on.

On a personal note I was pleased to see that the fact that palliative medicine is getting more medicalised is noted, the dominance of the scientific method challenged and the reader reminded of Dame Cicely Saunders’s idea of ‘total pain,’ – physical, mental, social and spiritual.

There is so much more to be said but this is not the place. This is a book which cries out to be read by groups of people, a chapter at a time, who can then discuss and debate the thoughts it provokes. It deserves to be essential reading for everyone working in hospice, palliative, bereavement care – and indeed anyone engaged in anyway with their own or another’s twilight years. It could be described as a textbook – there is a great deal of learning to be had – but it so much more; a book of knowledge, of experience, of reflection, which, in the words used by Philip Larkin in his Foreword, “remind us of the fragility of our human existence.”

“Challenges and Choices for Patient, Carer and Professional at the End of Life – Living with Uncertainty”

by Catherine Proot and Michael Yorke is published by Routledge, 2021

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Review by David Praill – d.praill@ehospice.com

 

 

 

 

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