One Last Stone
Spoiler alert, stop reading this now if you follow Eastenders and aren’t up to speed……
This blog explores the use of media as a powerful way to trigger conversations and plans about subjects that are important, but potentially challenging. Reflecting on fictitious storylines, what we see, how it made us felt and the what if that was me or our family can be springboards for introducing topics normally shied away from.
I have been following & reflecting on the Nigel storyline in Eastenders for some time. Using storylines that people will be familiar with to support Advance Care Planning can be incredibly valuable and I have highlighted some of the key themes below.
Nigel’s diagnosis of early on set dementia
· What was the impact on Nigel?
· What did it tell us about the perceived stigma of a dementia diagnosis?
What plans could have been made at this stage?
· Would Nigel have considered a Lasting Power of Attorney or an Advance Decision to Refuse Treatment?
· And when would it have been too late to create these?
Mental Capacity
· Declining capacity and fluctuating capacity were explored through Nigel’s behaviours and decision making
· Best Interests decision making could be considered, making plans in line with Nigel’s wishes, values and beliefs – how do we know what was important to Nigel?
Children, grief and death
· In a touching scene, the impact on Lexi is seen, expressed in a fear of going to school and being told by a teacher that Nigel has died. How do we navigate death and dying with children?
Anticipatory Grief
· Was shown brilliantly by Steve McFadden playing resident hardman Phil Mitchell. Using Phil as an example is a great way of introducing what anticipatory grief can look like and to reflect on men’s mental health.
The challenges of care giving
· Watching the decision to admit Nigel to a care home explored the reality of caring alongside the challenges, guilt and impact of being a carer.
Nigel’s diagnosis of pneumonia
· Followed by an admission to an acute hospital, for IV antibiotics. This can lead to discussion on reversibility and management of an acute event in a long-term condition.
· IVs discontinuation with a decision to return to the Care Home for Nigel to die. What End of Life Advance Care Planning would have been in place to support this? A ReSPECT plan? I am guessing a Universal Care for London would be the plan of choice. Were crisis medications and a chart in place? Did the Care Home have a clear plan of how to manage Nigel’s symptoms?
Ordinary Dying
· The changes we see as someone dies – changing in breathing pattern and acknowledgement of “rattly” breathing by Nigel’s wife Julie. How super if the BBC had linked to the Dr Kathryn Mannix video as support after the show.
· The pauses, slow and longer breaths as dying approaches
The importance of oral care
· 360 degreed toothbrush next time Eastenders, rather than a pink sponge – these were banned some time ago!
The sense of hearing while dying
· Something we have intuitively know in palliative and end of life care and recognised more recently in research
I’d also like to acknowledge the Eastenders scriptwriters & cast. Yes, Nigel’s illness and last hours had to be condensed for television, but there was clearly huge effort, sensitivity and research into the production.
Thank you to everyone involved….to whom do I send a bill for the boxes of tissues used during last night’s episode for rather damp eyes…..
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