In Dr. Richard Kalish’s classic (1985) parable “The Horse on the Dining-Room Table” – talking about death and dying with friends and family is analogized to trying to eat dinner with a horse standing betwixt and between the dinnerware. In the story, a man goes to a friend’s dinner party, only to discover a horse standing on the table upon his arrival. The host, hostess, and guests are all horrified but hold their silence throughout. It is an ostensibly awkward affair: “it was cramped, sitting there, trying to avoid getting too close to the horse while pretending that no horse was there.” With the analogy of the horse, Kalish sums up how it feels to encounter a friend who has recently lost someone, or received a serious diagnosis. Death is as conspicuous at as “the elephant in the room” but instinct says “hold your tongue.” The story culminates with a piece of wisdom: that eventually a horse will visit everyone’s dining room table. And if one dares to speak of the horse, then others will also dare. The key is to speak kindly. Kalish says: “the horse will remain on the dining-room table, but you will not be so distraught. You will enjoy your repast, and you will enjoy the company of the host and hostess. Or, if it is your table, you will enjoy the presence of your guests.”
Sitting at a table over food and talking about death may be a human experience familiar to all generations over all time periods – for death is and will always be an event we all share. However, today it is often particularly hard to discuss illness, death, and dying, with strangers as much as with people we are close to. Death is an “awkward” topic – unpalatable, distressing, or perhaps even insulting. Much research and literature assert that in the Western world, people are more alienated from death than we have ever been – because taking care of dying patients as well as dead bodies are now the jobs of institutions rather than families, friends and neighbours. But hiding death, dying, and grief has serious consequences: it can result in magnified feelings of social isolation, depression, loneliness, and fear on the part of patients and their close family and friends. Taking up the topic, and acknowledging the presence of death, dying, and grief in life can do a lot to erode the stigma which besets patients, families, and bereaved people. One conversation can have broad ripples. That is to say, talking about the horse renders it less problematic. You may even be able to have a nice dinner party in company of the horse.
It is for this reason that Palliativt Utvecklingscentrum (Österlenprojektet and Death Ed) are actively arranging “death cafes” in and around Skåne. In Simrishamn, our partners are Stiftelsen Hospice Österlen and Svenska Kyrkan. A “death café” is open conversation environment where people can talk freely about death, dying and grief over free coffee, tea, and cake. It is not a place for support around grief and sorrow, rather a gathering for unprejudiced discussion and sharing. The café is not in a fixed setting. It is a “pop-up” event which migrates around different venues associated with different collaborators. On the 4th of April, our death café team arranged a café at Kyrkans Hus in Simrishamn. In total there were 50 attendees. Many were pensioners but not all. There was diverse representation of people affiliated with healthcare, the church, the municipality, and volunteer organisations like Väntjänst (a service to support sick and elderly people often living alone). Everyone came for similar reasons: to investigate what a “death café” was (Dag Lundberg, chairman of Stiftelsen Hospice Österlen himself expressed that the name was rather morose, but thought provoking none-the-less), engage in friendly discussion about a rather un-friendly topic, and get free cake.
Helena Stövgård, a psychologist based in Kivik, was one of the attendees. She expressed that during her time as a psychologist, she has taken interest in pursuing conversations that take up important existential questions, such as death. In her career, she had the opportunity to meet Professor Kübler-Ross, famous for her work on grief, many times at various conferences. So the death café was an attractive idea to her.
“During the café my group was able to talk about personal things as well as things like care services at home, and experiences of loneliness. I think this is very important and it was a good experience for me.”
The event summed up with a quick Q&A with members from Stiftelsen Hospice Österlen, Christel Wihlborg (chief physician at the palliative ward in Ystad and founder of Österlenprojektet), and Jamie Woodworth (Project coordinator at Palliativt Utvecklingscentrum). The sentiment after 90 minutes of discussion was clear: people had interest in finding solutions and better ways to give good care to people at the end of life. There was an active back and forth between representatives and participants on the matter of: well, what do we do now? To which Jamie answered: “we continue the conversation at our next café. We have so much experience and expertise represented here, I think next time we all meet we can find some meaningful connections that will inspire what the next step will be.”
Look forward to the next café on the 15th of May at Österlens Museum, 13:00 – 15:00. There will be a screening of a film: “What is Death?” Cake and discussion to follow. The event is free and open to everyone.