Into the wilds of Ireland I went .................

People die everywhere and Ireland is no exception, in fact they've been dying there for a very long time, so they should know how to do it well! I spent quite some time with the palliative care teams at Drogheda and Cavan. I must say I didn't see Rachael Ward or Richard Chamberlain frolicking in the hay in Drogheda, nor did I see John Wayne and Maureen O'Hara canoodling on a stone bridge, though I did see the VERY bridge on which said canoodling occurred.

Firstly to Drogheda I went, where the team made me feel most welcome. I sat in on their weekly meeting and was interested to hear that the problems their patients are confronting are very similar to those problems faced by patients at home. Of course there's the usual physical symptom management stuff, but as always it seemed to be the psycho-social and spiritual issues that the patients were struggling with the most. The more I've travelled, the more I've understood that as death approaches, for most patients the fears around how, when and where they will die and with whom are the issues that prey on their minds. In Ireland as in all the countries I have visited, the problems associated with trying to keep patients in their homes (when that is where they want to be) are similar. Who can care for them at home if they don't have family or friends capable or willing to do so? What happens if they are on their own and the nearest clinical support is over an hour away? Who makes sure they have what they need when the palliative care service and/or public health nurse can only visit once or twice a week? Who is there to listen to their stories, fears and concerns when they are ready to talk about them (not when it suits us, but when it suits the person)?

I always thought that the Irish had a far healthier view of death and grief then we in "the colonies", after all people have died from war, famine and poverty in Ireland since the dawn of time. I listened to the stories of my parents and grandparents as a child and as I grew I read widely about Celtic and Gaelic culture and traditions. I felt that I had a relatively good understanding of Irish superstition, the "wail of the Banshee" that can be heard as the dying person breathes their last, "the Coshta-Bower" or Death Coach, drawn by the six black horses and driven by the head-less Dullahan (or death herald) that cannot be turned back once it sets out to "collect" a person for transporting to the "other world", the stopping of all clocks at the moment the person dies, the covering of mirrors with black velvet and so on. I always felt that the tradition of the person remaining in their home after their death, to enable friends and neighbors to visit and pay their respects a far healthier practice for all concerned, than our modern habit of shipping them off to the funeral director as soon as possible. I remember my Dad telling me that when he was a kid in the Mallee district of Victoria, it was common for people to be "laid out" in the front room and all of the local families would come to express their support to the grieving family and say goodbye to the deceased person. This also involved toasting the person who had died with a few "sherbets", telling stories about them and singing the "sad" songs that went along with grief............ Laughter and tears. This also meant that the kids would be able to see the dead person, touch their skin and understand how death looks and feels.

I was interested to see if my preconceived notions about the influence of Christianity on the way Irish people deal with death, discuss death and mourn and comfort each other after death were accurate. I wanted to know if wailing and keening helped people to express their grief in a healthy way and if strong community networks made bereavement less isolating for grieving people. I wanted to know if those traditions we had "let go of" (in our rush to leave behind the "old ways" and embrace the new) were still practiced and if so, what impact did that have on how kids understand death. Of course I knew I wouldn't find definitive answers to these big questions in a couple of days, but I was optimistic that I could get a "feel" for how Irish people deal with death and whether their approach differs very much from how we in "modern" Australia do it.

And so I ventured out on some visits with the lovely Maureen. I must say she was a font of information. We discussed everything from Gaelic Football to religion to politics. I gained a real insight into how difficult community palliative care is in rural Ireland. I didn't understand until I spent the day with Maureen how very far they have to travel to visit patients. There was no stop and have "a cuppa", because it took over an hour to get to the first patient. An hour on skinny roads with confusing signage (if any) and even she wasn't sure how to find one patient, so had to ring the office for directions, which, with her permission I reproduce here, "Go down the Church road to the corner, turn right at the rock and go along past the big tree for about ten minutes, then turn left and you're there" Thank God I wasn't driving that's all I can say, because there's no way I would have found the place!

I am so grateful for the opportunity I had to visit patients and of course, confidentiality prohibits me from telling you anything about the people I visited, but I can tell you, they were all so grateful for the visit they received from the palliative care service. They all "passed the time of day" and exchanged pleasantries with me and I felt somewhat helpless to contribute anything other than polite "chit chat" as I was an outsider. Not only did I come from a distant land, but despite my years as a clinician I realised very quickly that my understanding of the cultural influences on their dying excluded me from contributing anything meaningful to their care. Not only this, but with some of the patients, I had no way of understanding what it was they were saying, their accents were so broad (and I guess they felt the same way about me). I did however, as I shook hands with each of them feel that wonderful human connection that unites us all and held that moment of empathy and understanding that needs no words, no action, just that space of hearts and eyes connecting and becoming one..............and in that space all of our differences were irrelevant. Maybe this is something we all need to remember.?

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