{"id":29,"date":"2019-12-03T14:43:17","date_gmt":"2019-12-03T14:43:17","guid":{"rendered":"https:\/\/blogs.ncl.ac.uk\/medlit\/?p=29"},"modified":"2020-01-20T11:01:05","modified_gmt":"2020-01-20T11:01:05","slug":"an-interview-with-dr-kathryn-mannix-author-of-with-the-end-in-mind","status":"publish","type":"post","link":"https:\/\/blogs.ncl.ac.uk\/medlit\/2019\/12\/03\/an-interview-with-dr-kathryn-mannix-author-of-with-the-end-in-mind\/","title":{"rendered":"An interview with Dr Kathryn Mannix, author of ‘With the End in Mind’"},"content":{"rendered":"
Dr Kathryn Mannix (MBBS Newcastle 1982) spent her medical career working with people who have incurable, advanced illnesses. She found their ability to deal with illness and death both fascinating and inspirational, and she believes that a better public awareness about what happens as we die would reduce fear and enable people to discuss their hopes and plans with the people who matter to them.
\nHer account of how people live while they are dying, With the End in Mind: Death, Dying and Wisdom in an Age of Denial<\/em>, was published to universal acclaim and was shortlisted for the 2018 Wellcome Prize.  You can read the first two chapters here<\/a>.
\n<\/strong>Kathryn visited the Walton Library on 3rd<\/sup> May 2018 to donate a copy of her book and join as an alumni member, and she sat down to discuss life, death and Eastenders with Elizabeth and Rosie from the Walton\u2019s social media team.<\/strong><\/h6>\n
What has the experience of being nominated for the Wellcome Book Prize been like?<\/h6>\n

I didn\u2019t know my publisher had entered it for the prize, so the first I knew about it was when the longlist was announced on Twitter – and as I wasn\u2019t on Twitter at that point, it was only when I started getting excited messages from people that I realised I\u2019d been nominated. I\u2019d already had lots of really nice messages from people who had been helped by the book \u2013 which was the only reason for writing it, really \u2013 but I felt that being nominated justified writing the book in an academic way, and it was something that said \u2018and the writing\u2019s alright as well\u2019. I thought \u2018that\u2019s my prize, I\u2019m on the Wellcome longlist\u2019. So I really was astonished when it made it onto the shortlist as well, and as it now had a one in six chance of winning I became a person who was worrying about what it would be like if it did win!<\/p>\n

The whole experience has been really lovely because it\u2019s boosted sales and interest, and that means that it\u2019s got the message out to more people. The publicity company who work with Wellcome organised a few interviews, so I\u2019ve done a couple of podcasts \u2013 Little Atoms and BBC Science Focus Magazine<\/a> \u2013 and an article<\/a> for the Daily Telegraph recently as well. So all of those are opportunities to reach out to the public with the book\u2019s message, which is: \u2018Dying isn\u2019t as bad as you\u2019re probably expecting, but as long as you don\u2019t talk about it or find out about it, you\u2019ll continue to be frightened and not want to talk to people about it\u2019.<\/p>\n

Do you think social media has been useful in having this conversation?<\/strong><\/h6>\n

One of the invitations that I had simply as a result of having written the book, rather than to do with the Wellcome Prize, was that I was invited to speak at the Free Thinking Festival for Radio 3 at the Sage, and while I was there I was asked by BBC Ideas if I\u2019d make a little video for their \u2018In My Humble Opinion\u2019 series \u2013 titled \u2018In my humble opinion, dying isn\u2019t as bad as you\u2019re expecting\u2019<\/a>. So they made this three and a half minute film, posted it on social media, and over the next two weeks it went on to have two and half million views on Facebook. It had lots of views on the BBC website and Twitter too, but it was really on Facebook where it generated the most interest. I think increasingly it\u2019s older people who are now using Facebook, and I think the video\u2019s popularity on Facebook is important because they\u2019re the generation who most need to have those conversations.<\/p>\n

One of the things I talk about in that little video is the noises that people make when they\u2019re very deeply unconscious, when they\u2019re approaching death, that tell those of us working in palliative care that the person is very deeply relaxed. They\u2019re not distress noises or pain noises, they\u2019re actually \u2018everything\u2019s going a bit floppy at the back of the throat\u2019 noises. I had a tweet from an end of life nurse somewhere else in the country yesterday, that said \u2018I\u2019ve been keeping vigil with a family and heard a granddaughter say to her cousin, \u2018the reason grandma\u2019s making those funny noises is because she\u2019s really deeply relaxed\u2019 \u2013 just thought you\u2019d like to know\u2019. And I just thought \u2018wow, isn\u2019t that beautiful?\u2019<\/p>\n

Is there a particular book, film or TV programme that gets death or dying right?<\/strong><\/h6>\n

There\u2019s a lot that doesn\u2019t \u2013 and I think public understanding of dying is very distorted by the silence being filled by things like Eastenders, where you\u2019ll have several very dramatic deaths per year, which isn\u2019t a realistic figure for somewhere the size of Albert Square. But I think that\u2019s because normal dying isn\u2019t terribly interesting, and it\u2019s not going to make good drama. I did do a project a couple of years ago trying to find good Hollywood depictions of dying and couldn\u2019t find any really to recommend. The terminal illness of Andy, Tom Hanks\u2019 character in Philadelphia<\/em>, is really well done, but they don\u2019t show him dying \u2013 there\u2019s a reconciliation scene with Denzel Washington\u2019s character and then they cut to the cemetery, which is the sort of thing that happens a lot with those kinds of deaths in films.<\/p>\n

Call the Midwife<\/em> really gets dying right, and it was the visual picture that I had in my head as I was writing my case stories – it introduces people, it makes them real, and it treats them with dignity, and it doesn\u2019t try and smooth out the difficult bits \u2013 it recognises that some things just aren\u2019t great, and that\u2019s the way they actually are. What\u2019s interesting is that Jennifer Worth, who wrote the book that the TV series was based on, was interested in palliative care from the very beginning, and she went on to become a palliative care nurse.<\/p>\n

In terms of books, I think Atul Gawande\u2019s Being Mortal<\/em> really turned a page in how we as doctors think about dying. The thing that\u2019s beautiful about the arc of his story is that he is perfectly prepared to talk about how as a surgeon he didn\u2019t understand managing dying as a process, rather than just trying to resist it. He talks about how he then invited his hospital\u2019s palliative care consultant to go on rounds with him, and was astonished to find that she didn\u2019t tell patients anything, she just asked them questions, and in asking them questions elicited from them all this information that must have just been inside them waiting for somebody to find it out. It wasn\u2019t that it was new information, it\u2019s just that she used a different tool – she talks about questions as being surgical instruments, and choosing a question like you would choose a scalpel. At the very end of his book he talks about applying that way of questioning, of eliciting what\u2019s really important to somebody, to his own dad. That\u2019s a wonderful humility on his part, and he\u2019s saying to the medical profession \u2018there\u2019s a different way of doing this, it\u2019s hidden in plain sight amongst us and we\u2019re not doing it, and we need to learn more\u2019. I think it\u2019s a book that all medical students should read.<\/p>\n

Another book that I\u2019ve read recently that I\u2019ve really enjoyed is Richard Holloway\u2019s Waiting for the Last Bus.<\/em> It\u2019s a much more existential, spiritual contemplation of the end of life when you\u2019re in your eighties, and I think it\u2019s a book that would speak to us in a very different ways at different stages in our lives \u2013 as students or in our twenties, it would be about our grandparents, but if we were to re-read it in our forties and fifties when we\u2019ve got aging parents, we would take something completely different away from it. I think Gawande\u2019s writing is probably very similar in that respect.<\/p>\n

How have you seen attitudes to death and dying change over the course of your career?<\/strong><\/h6>\n

I think medical attitudes have changed quite a lot, but I think public attitudes have changed depressingly little. When I first qualified it would be normal for the doctor to do the worrying and not bother the patient with bad news – you might not tell somebody that they had multiple sclerosis during their first or even their second demyelination, for example. Cancers would be referred to as \u2018little spots\u2019 and nobody really used the proper words for anything. I think the idea that we are in a position of having information that the patient has a right to know, unless they declare a wish not to know, has been a huge transformation over my practice lifetime of 40 years or so. But depressingly, the ability to actually talk at home in families about what to expect and how to prepare for it has drifted away, and it was that I wanted to address through the book and the campaign.<\/p>\n

Do you think that\u2019s perhaps because the generations that witnessed death more regularly have themselves died, and current generations are not as accustomed to this?<\/strong><\/h6>\n

I think it\u2019s a public health issue in two ways \u2013 I think improvements in public health are responsible for people becoming less accustomed to death, and addressing this is a public health issue too. In 1900, life expectancy at birth was somewhere in the mid-50s – now it\u2019s the mid-80s. Which means that in the space of a generation from my grandmother through my parents to me, we\u2019ve had a whole generation of people who have not seen normal human dying during their teens, twenties and thirties. I\u2019ve still got both my parents and they\u2019re in their eighties, and I haven\u2019t lost a sibling. Both my parents had lost siblings and parents themselves by the time they were in their early twenties. So they saw enough dying in family members around them that they would know there was a kind of sequence to things. It\u2019s my generation, the current parents and new grandparents, who are the first generation to get to retirement without being familiar with dying, because of good nutrition, good sanitation, antibiotics and all the clever technical advances we\u2019ve made.<\/p>\n

So it\u2019s certainly not a bad thing that people are less accustomed to witnessing normal dying, but there\u2019s a societal adjustment to be made for that and we\u2019re not making it. Because we haven\u2019t seen the normal dying process, and because the reason people aren\u2019t dying in their prime is because we\u2019ve developed things that save their lives, now people who are no longer in their prime are rushed into hospital with the same set of expectations and then we feel that medicine\u2019s failed when those people don\u2019t get better. So I think it\u2019s a really interesting conundrum.<\/p>\n

What was your student experience like at Newcastle medical school?<\/strong><\/h6>\n

I had the most fantastic time at Newcastle! I came in 1977 and graduated in 1982; I thought about doing a BMedSci, and then decided I\u2019d rather just get qualified. I got my highest grades in psychiatry – I think it was the only thing I ever got a distinction for. I did my house jobs in haematology, which I really liked, and afterwards I did the medical rotation at the RVI.<\/p>\n

I then did a year as a radiotherapy oncology SHO when the cancer centre was at the General. It was a really exciting time in cancer research, there were lots of big developments in molecular biology on the horizon and I was very excited by it all, but the people who I was most interested in weren\u2019t the ones who were going to be cured, it was the ones who weren\u2019t. We were going to have to send these people home and they needed to be able to function, to do everyday things like wash the dishes, but they had breast cancer that had spread to their humerus and it was hard to move their arm. That just seemed to me to be so much more interesting.<\/p>\n

So by then Sunderland had established a hospice, simply by virtue of a doctor putting all his lung cancer patients into one ward and then telling the hospital \u2018look, we\u2019ve got a hospice here, we should have carpets and nicer curtains\u2019. I went to see that and thought it was really interesting, and just at the time I was thinking that I might like to go into that area they built St Oswald\u2019s just down the road from me, and I was very lucky and got a job as a registrar there.<\/p>\n

But in terms of medical school, I\u2019ve still got very dear friends who I met there – I married a boy who I met on the first morning when we couldn\u2019t find the lecture theatre. I really enjoyed neurology \u2013 I worked for the RVI team, and the team at the General was Lord Walton\u2019s; we would have meetings on Friday mornings alternating between the two hospitals. They were terrifying<\/em>, particularly terrifying if he was there! But he was an absolutely fantastic teacher and trainer.<\/p>\n

You used to get three-month elective periods – I went and worked in a children\u2019s hospital in Florida, which included a stint in a summer camp for deaf children and their siblings, so I had to learn American sign language while I was away.<\/p>\n

I had an absolutely fabulous time in medical school, and I\u2019m very, very glad that this is the medical school I chose.<\/p>\n

If you had one piece of advice for today\u2019s medical students, what would it be?<\/strong><\/h6>\n

I\u2019d give two pieces of advice \u2013 one about end of life care, and one about being.<\/p>\n

Firstly, in terms of palliative care, I think I would like to ask medical schools across the country to re-examine their practice of asking students to have witnessed a certain number of births before they can graduate, but not a certain number of deaths -because most doctors are never going to need to deliver a baby, but they\u2019re all going to have to work with dying people, and they\u2019re not required to work alongside any at the moment. So I would like students to have to accompany people through that last part of life, in the same ways they have to accompany a birth \u2013 they don\u2019t just whip in and deliver the baby, they have to accompany a woman all the way through her labour to have the privilege of being there when the baby is born \u2013 and they should have to do this enough times that they can see the individual variations in the dying process, but also the basic background and pattern.<\/p>\n

My second piece of advice is just to relax, enjoy your time at medical school, and notice everything<\/em>. Just enjoy everything and take a moment at the end of the day to just think about the things you\u2019ve been grateful for that day, because gratitude has been shown to reduce depression, increase resilience and lengthen life. Gratitude is a really useful thing.<\/p>\n

Kathryn\u2019s book With the End in Mind<\/em> is available to borrow now from the Walton Library\u2019s Medicine in Literature collection (near the silent study room).<\/strong><\/h6>\n","protected":false},"excerpt":{"rendered":"

Dr Kathryn Mannix (MBBS Newcastle 1982) spent her medical career working with people who have incurable, advanced illnesses. She found their ability to deal with illness and death both fascinating and inspirational, and she believes that a better public awareness about what happens as we die would reduce fear and enable people to discuss their […]<\/p>\n","protected":false},"author":7567,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12],"tags":[],"class_list":["post-29","post","type-post","status-publish","format-standard","hentry","category-wellcome-book-prize"],"_links":{"self":[{"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/posts\/29","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/users\/7567"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/comments?post=29"}],"version-history":[{"count":11,"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/posts\/29\/revisions"}],"predecessor-version":[{"id":110,"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/posts\/29\/revisions\/110"}],"wp:attachment":[{"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/media?parent=29"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/categories?post=29"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/medlit\/wp-json\/wp\/v2\/tags?post=29"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}