When a Client Dies

I am part of a team that supports vulnerable people in the community. Some have chaotic lives, mental health problems, or drug and alcohol problems.

One client, James was typical in many ways — a former drug user who, though clean for many years, suffered from mental health problems and the effects of poverty. For all his frailties, James had made an impressive effort of will and stayed clean for over 10 years. He was trying to make a success of his life, but depression could get the better of him. He would tend to retreat into his flat for weeks on end and hide from the world. It was my job to coax him out of it. He had suffered from poor physical health for a long time, and just a few weeks ago had been diagnosed with liver cancer. Despite his best efforts, his past had caught up with him.

What really shocked me about James’ death was not the death itself, but how little it affected me. I got the news when I checked my emails between meetings and found the message from the hospital social worker. I felt a pang of sadness. I sent the appropriate reply to the social worker, who had gone way beyond her obligatory duties and had tracked down his estranged family so that they could visit him before he died. I thought about him for a few moments, and felt regret that I hadn’t managed to see him for a week or so. I had planned to visit him the following week, when he was due to return home to receive end-of-life care there.

I phoned my boss to let him know, then the next appointment came along, and thoughts of James were pushed to the back of my mind.

I still remember my first experience of death in this work, just a few weeks after I started my first job at the night shelter. I can’t tell you his name, but he was a skinny, long haired “acid casualty” from the 70’s. I remember his deeply lined face as he recalled to me his experiences of LSD. He was talking about the Void — the chasm of emptiness, the fear of nonexistence, that he sometimes encountered on his many trips.

“One time” he said, his eyes alight, “I looked into the Void, and the Void looked back”.

The Void never really left him. A couple of weeks later, I heard he had died. I never knew how.

That was twelve years ago. I promised myself I wouldn’t forget him, and I have just about managed to keep that promise, although the details are hazy. Unfortunately, I can’t say that for everyone. At first I used to remember their names. Then, after a while, I realised I would need to write them down; but after about 20 names, I stopped. I guess I got used to death.

It’s not that deaths are that regular really — I’ve just been doing this for a long time. The older ones don’t shock you much. For some, seasoned drinkers or former addicts, an early death seems almost inevitable. But many make it to their fifties, even beyond. Sometimes they amaze me with their staying power, keeping on going in spite of everything, apparently getting by on sheer determination and the will to live. The younger ones get to you though. Drug overdoses — so sudden and so avoidable, the danger exacerbated by the need to hide and fear of the law.

But now, it seems, the death of a client barely affects me at all. I tell my adult daughter that I think it’s time I packed it in. If a death doesn’t affect me, what have I become?

“Nurses have people die all the time. It can’t affect them much every time someone dies, or they wouldn’t be able to do their job”, she tells me.

I ponder this. She’s right. We are lucky, in this line of work. Most of our clients survive, deaths are relatively rare. But for me the end of the road in this work is always just around the corner. You know that although you’re getting by now, the next death, the next injustice, the next trauma, the next client who loses custody of their child, or just the sheer day to day weight of it all, could suddenly just break you, and it will be over.

But even so, at your funeral James, I bet I cry despite myself. You were a good guy, and you didn’t deserve this. You’d quit the drugs years ago — you didn’t even smoke anymore. You’d been to college, you’d done a diploma. They said you were a good student, that you should go back and study more, and you were so proud of that. I was proud of you too. And when you knew that death was coming you weren’t bitter, despite the unfairness of it all.

You said “ah well, no point dwelling on it”, and you were delighted and grateful when the social worker found your family for you.

So here’s to you James

Postscript

I blubbed all the way through your funeral James. Sorry about that. I stayed near the back and tried to be inconspicuous. It seems most of your family had come from far and wide; not just parents, brothers and sisters but nephews, nieces and old friends, too. Looks like you really will be missed.

Tracy is a support worker who participated in the Lankelly Chase Systems Changers programme in 2016. The programme aimed to take frontline workers on a 6 month journey to gain a much broader and deeper understanding of the systems in which they work and to explore how they can contribute to systemic change.