A palliative care nurse has revealed the surprising things she has learned about death and dying after working in end-of-life care for 23 years.
Jan Palmer, 64, a Marie Curie nurse who works at a hospice in Cardiff, will retire on Christmas Eve after 42 years in the role.
During her time in palliative care, Jan worked with patients in hospice and provided emotional and clinical support on the free helpline for those living with or caring for someone with a terminal illness.
Despite challenging times in her long career, Jan says she “never” considered leaving the role and “loved it” from day one, when she first joined the hospice in 2002.
Speaking exclusively to FEMAIL ahead of his retirement, Jan has revealed the surprising things he has learned about death and dying.
Contrary to public belief, Jan said he has seen “more good deaths than bad” and that his time in palliative care has “absolutely” given him greater peace of mind about his own death.
She said: ‘The death of an individual can look very different. But I firmly believe that with the right support, the vast majority of us can die a good death.
“The public doesn’t necessarily know what it might look like, and that’s half the battle, if you demystify it.” Since I have the information, I feel comforted.
Jan Palmer has worked in end-of-life care for 23 years. As he approaches retirement, he talks to FEMAIL about what he’s learned about death and dying.
‘It’s a very natural process, the process of dying, and there’s really no need to fear it. It’s natural to be afraid because we don’t always have the right information and we’ve never had that open conversation with anyone.
‘But the vast majority of people die peacefully. Many people believe that all deaths are painful and that is not the case at all. In my humble experience, I have actually seen more good deaths than bad.’
Jan said one of the first things that happens when a person is about to die is that they lose the ability to swallow.
This may mean they cannot keep medications down, but nurses can usually help by repositioning them to prevent saliva buildup.
If this doesn’t work, it might be time to introduce a syringe driver, a small battery-operated pump that can continuously deliver medications under the skin.
A common misunderstanding is that syringe drivers are only used at the end of life and hasten a person’s death.
But Jan emphasized that they can be used to control symptoms at any stage of the disease and that introducing one does not necessarily mean someone is dying. In fact, it is possible for someone to abandon the syringe controller and return to other medication methods.
Similarly, many people think that palliative care means imminent death, but it is actually about promoting good living and can be applied at a very early stage.
Jan, 64, says he “absolutely loves” his job and has never considered doing anything else.
Marie Curie palliative care nurses care for all types of terminal illnesses, not just cancer, but also motor neurone disease (MND), heart disease, kidney disease, and even cognitive decline, including dementia and Alzheimer’s. .
In addition to losing the ability to swallow, signs that someone may be about to die may include: sleeping more, being drowsy, being restless or agitated, changes in breathing pattern, mottled skin, and breathing less.
These are all part of the natural process of dying.
To make someone feel comfortable in their final days, nurses use music, television, and bring the person’s pets to help them.
The cancer support charity has even launched an end-of-life music playlist on Spotify, based on research into what matters most at the end of life.
Jan says that simply being close to someone and allowing them to have a voice in this moment is one of the most important things you can do.
She said: ‘I always give the person I know a chance to speak. It’s about what matters most to them: allowing them to have a voice to hear.
‘Listening is the most important part of my role and it is very powerful because that individual may never have had the opportunity to tell their story.
‘No matter what people’s beliefs are, if they give them comfort at the end of life, it is what the patient says it is. For me, the process of dying is spiritual and I am allowed to be present. It is a privilege to be with that person.
‘I’m a scientist and I like evidence, but at the end of the day that doesn’t mean it’s not there. We can all have those values and I like to consider myself a spiritual person.’
On the support line, the most common questions Jan receives are: “Am I dying?” and ‘how much time do I have left?’
Part of the role involves speaking to patients and families through the Marie Curie Support Line.
Jan tries to personalize her responses in each case but knows that she has to be prepared for anything.
Jan says their answers are “personal” to each case and will delicately address issues such as where they would like to die and how to consider an advanced care plan.
It can also recognize if you are dealing with an emergency situation, such as sepsis, and can direct you to someone who can help you.
He added: “Often callers will know the answers, but they feel more comfortable repeating them to someone.”
‘You have to be prepared for everything. Most people die peacefully, especially with good symptom control. “Everyone has the right to good end-of-life care and I have seen what it should be like.”
Jan can help demystify the process, especially when it comes to symptom management.
Speaking about his upcoming retirement, Jan confessed that he has “mixed emotions.”
She said: “I don’t know if I ever saw myself retiring, if I’m honest, I’ve worked as a nurse for almost 42 years and I love my job.” It has been the most enriching and powerful experience. I loved every moment.
‘I wanted to aspire to be the nurse someone would want at their bedside when they were dying. “To me that was absolutely what it was about.”
Jan said the “best feeling” about work is “the feeling at the end of the day that you’ve done your best and hopefully made a difference, however small, in someone’s life.”