Jean Kittson National Palliative Care Week Interview

The Humour Of Death

The topic of dying isn't often met with laughter, but for comedian Jean Kittson, comedy is often the best way to talk about taboo subjects.

"As a dinner conversation, dying is not what anyone wants to talk about. They're happy to talk about holidays, yes. Reality tv, oh yeah. You know, food allergies. Menopause, even. But not dying. La la la la la la la."

"I hate to break it to you, but we're all gonna die. We might as well talk about dying. Anyway, isn't the conversation easier when we all have something in common?

Ahead of National Palliative Care Week (20-26 May), Jean joins other prominent Australians, including chef Kylie Kwong, former rugby union player Mark Ella, Intensive Care Specialist Professor Ken Hillman, and Commonwealth Games Lawn Bowls Gold Medalist and geriatric nurse Carla Krizanic, to encourage all Australians to talk about their end-of-life care.

Each has recorded an intimate video, sharing their honest and candid thoughts on the importance of having a conversation about death and palliative care with their loves ones. The video will go live just prior to National Palliative Care Week at www.health.gov.au/palliativecare

"I think humour can be used as a great tool to talk about taboo subjects. I don't mean you use it to make light of death and dying, but I think comedy and humour is important in opening the conversation," says Jean.

82% of Australians feel that talking about their own death and dying is important, but when it comes down to it, most people don't actually have the conversation.

National Palliative Care Week is supported by the Australian Government Department of Health and aims to raise awareness and understanding about palliative care in the Australian community.

In 2016, there were 3.7 million Australians aged 65, and that number is expected to grow. By 2056, it is projected there will be 8.7 million older Australians, and by 2096, 12.8 million people will be aged 65 years and over. With Australia's ageing population, it's essential that people talk to their friends and loved ones about their end-of-life care wishes.

"As you get older, you realise that conversations about death and dying are more important. It's a hard conversation to have because it's a downer, but it needn't be. You can have fun and it's a good way to open up these conversations," says Jean.

"Talking about death and dying with your loved ones means you won't have any regrets and that awful guilt that can come when you think you could have done more or you could have done something differently. So, it's just out there in the open and everyone's honest and it's such a relief."

And for Jean, there are several items on her checklist when it comes to planning for her end-of-life care:

- I'd love a concierge by my bed just getting my every wish, doing whatever I want, making sure I'm happy.
- I want music from the 60s and 70s, probably a bit of classical. I don't want any rainforest or meditation music. No music that I get while I'm having a facial or being waxed.
- I want a huge bed with lots of pillow so when I'm dying, I want everyone to lie down with me.
National Palliative Care Week runs from 20-26 May 2018.

Interview with Jean Kittson

Question: Tell us a little about yourself in relation to your family and Palliative Care?

Jean Kittson: My name is Jean Kittson and I am the Patron of Palliative Care Nurses Australia.
Until fairly recently I had no idea about death and dying and grieving and would never talk about them. For me, death and dying and grief were frightening and fraught with difficult emotions and often overwhelming.
Like most people, I was simply never taught how to handle or confront death and dying or even grief and I had no idea what to do when death and dying struck my friends and family.

My family was masterful at turning a potential occasion for grief into a non-threatening, humorous display of denial as quickly as possible. "Children, don't bother telling your grandfather dinner's ready," is one example.
And so I grew up thinking that changing the subject was the way to behave. That it was best to help distract people from their sorrow.
Your uncle's dead? Look! A puppy!

People don't even use the words death and dying any more.
Death is often called "passing." Or perhaps: "moving forward." Or some other euphemism. "How's your dad?" "He's a euphemism." "Oh, I am sorry to hear it."

Because I was ignorant about everything to do with death, I still regret the things I could have done and should have done and could have said and should have said when friends have died.

Then I was introduced to the wonderful nurses and experts who are part of the palliative care world, at one of their conferences.

I was suddenly immersed in the world of people who deal daily with death and dying and I had to think about it and to talk about it. Especially to talk about it. it was liberating. It was wonderful to experience death and dying coming out from behind the screens, out from the specialised confines of the funeral parlour, out from around the roses, and recognised as an integral element of life, as a fundamental part of the human condition, a universal clause in the human contract, and by talking about it to learn what to do with this difficult and unwanted companion.


Question: What message do you hope to spread this National Palliative Care Week?

Jean Kittson: My main message is to encourage everyone to talk about death and dying because by talking about it we are not only sharing with our loved ones what matters most to us, but we are also helping each other not to be frightened of death and not to fear grief. To accept them and make provision for them. Talking about it will give us courage to accept the inevitability of our own deaths, whenever they might be and, more importantly, the courage to contend with the deaths of our loved ones.

The more we talk about death and dying, the more we learn about it. What to do, what to say and how to behave. We all think we will know what to do when the time comes, but I don't think that is true. It is always difficult and sudden, and love is not enough to prepare us. We need to be able to talk about it.
Most of us will need help, and learning about palliative care and the indispensable guidance and support and help the wonderful palliative care nurses can give us, and the fact that no-one need die alone or unaided, is an enormous consolation. It dispels so much fear.


Question: Why do you think it is so important that we talk about end-of-life care with our family?

Jean Kittson: Simply, it will help our family to get our deaths right, when they come. It will help them to know what to do when we are dying. Where to get help if we need, it or our families need it. What their choices are in terms of looking after us.

Most importantly if we go through the Advanced Care Plan together, our loved ones will have no doubt about what is important to us. What matters to us.


Question: How can we begin conversations about death?

Jean Kittson: I have introduced the death and dying conversation many times with my family, always around the dinner table and at first it was disconcerting, but after the third or fourth conversation my kids just said OK, mum we get it.
I think bringing it up when you are a relative spring chicken, like me, is easier than bringing it up with my mother and father who are both in their nineties.

Should I start with, "So, Mum, how are you feeling? Good? That's great. Well you know your time is going to be up in the future, don't you? The near future judging by the fact you've been getting those chest pains, so let's have a bit of talk about you dying. Just in case it's slow or painful. We don't leave it to the last minute when you may be delirious or think I am the postman."

Mum is frank about death: "Jean, in case I don't die but I just lie there like a vegetable and I really feel I will, I want you to turn off the machine. Promise me you will just turn off the machine." Firstly, this would have more force except that she's been saying it since she was forty. I now realise it was probably menopause.

And secondly, I am not even really sure which machine she had in mind. Possibly the iron. The best way to start the conversation is to have a copy of an Advanced Care Plan and go through the questions. Also Palliative Care Australia has a useful conversation starter brochure. Just casually insert it between their nose and their iPhone screen.


Question: How can we make these subjects less taboo?

Jean Kittson: Talking about it. Have I mentioned this?
It is not easy but it is so important. There is no one-size-fits-all conversation.

We consider death differently, we approach the death of others differently, and the best conversations involve different points of view, different emotions, and different styles. In the very best conversations, everyone contributes a little, everyone learns a little, everyone reveals themselves a little, all without fear of judgment or censure. Like exchanging recipes, only more comforting.

Talking about death and dying helps us all.
There was an inspiring speaker at a palliative care event recently who has terminal cancer, and she said that one of the hardest things was when friends say to her "You'll win this battle, you won't die, you will fight it," when she knows she won't. So, often, she has to agree, to make THEM feel more comfortable.


Question: What types of conversations have you had about end-of-life care with your family?

Jean Kittson: I have had conversations in hospitals in public wards where the GP has gone through my an Advanced Care Directive with my mother, at her request, after a stroke, and it has taken about 45 minutes of shouting because my mother is quite deaf and when the GP drew back the curtains everyone else in the ward was weeping. Better to try to do it quietly and privately.

I have gone through it with my father in rehab after he fell and broke a femur. That was not so good either, because recovery is a lot about psychologically wanting to get home and willing yourself home. So, on the one hand I am saying "You will get through this, Dad, and be home in no time!" And on the other hand I am saying "Just in case you can't go home, can you tell us when you want to wind down the treatment? Take your time."

You don't want to be doing these things at the hospital bedside unless absolutely necessary. I find the death conversation is not as fraught as the dying conversation. Funerals seem easier to discuss and they are important. They are not only revealing and express what matters but you can work your way back from there.

My father, who was raised a Catholic, but who was excommunicated when he married my non-believing mother, 60 years ago, has recently let his wishes be known. He wants a full Catholic Mass and to be buried in consecrated grounds. I am hoping that the Catholic Church has become more compassionate and less exclusive in the years since their marriage.
With these wishes in mind, when my father was in hospital recently my mother asked him if he wanted to see a priest.

Which reminded me of the author Voltaire when a priest came to his deathbed and said, do you renounce the devil and all his works? Voltaire replied, this is no time for making new enemies.

Then there was W.C Fields, whose friends were said to be surprised to see him on his deathbed, reading a Bible. "What are you doing?" "Looking for loopholes."

My non-believing mother wants to be cremated and her ashes scattered out to sea, accompanied by a lone piper, who presumably then has to swim back to shore. Interestingly, she isn't the slightest bit Scottish. She just likes a piper. Luckily, she doesn't have a thing for brass bands.

In terms of funerals maybe we should all follow the lead of Bob Hope. When the late great comedian, Bob Hope turned 100 and his wife asked where he wanted to be buried? He said: "Surprise me."


Question: Where do you suggest Australians have these types of conversations with their family?

Jean Kittson: These conversations will probably take time and there will be more than one of them. They may happen out of the blue and you may be in a car or in front of TV or in bed or at the footy. Best to be somewhere private and comfortable with snacks and drinks so people will not have an excuse to duck off.


Interview by Brooke Hunter