Select Page

Image by Bruna Araujo on Unsplash

I’ve been a fan of the BBC/PBS program Call the Midwife since the very first episode aired. Based on a book by a real nurse-midwife from years ago, the series takes place in the 1950s and moves into the 1960s.

The midwives were based in a clinic/residence run by an order of Anglican nuns. The lay women joined the sisters for meals and religious participation seemed optional. One nurse joined the order and one nun left to marry the doctor. Amazingly, and thankfully, religion does not play a role in the show. The nuns do their thing and leave us alone.

One of the ongoing characters is a nun in her nineties, Sister Monica Joan. The series introduced her with a suggestion of dementia. She has an odd style of speaking – somewhat old-fashioned and flowery, perhaps because her character supposedly came from a noble family.  Sometimes she seems confused, sometimes wise, and occasionally mischievous. She’s had a health crisis or two (I’ve lost track) but she has her own role as confidante and advisor to nuns and nurses. They love her.

In real life, I suspect that Sister Monica Joan would have deteriorated mentally over the years and most likely died. But this is television. She’s a popular character. The actor who plays her doesn’t want to leave. So she keeps going. She’s more eccentric than mentally or physically disabled.

In the 2023 Christmas special, Sister Monica Joan announces, “I’m going to die this year.” She’s quite cheerful about it. She seems to have an intuition: she senses she’s coming to the end.

The nurses and nuns respond with horror.  They seek advice from Dr. Turner, who’s a made-for-TV character in his own right. A doctor who doesn’t just deliver babies, but nails complicated diagnoses without the help of modern tests and screens. A doctor who has endless time to talk and know all his patients, yet still has time for his family. An empathetic doctor filled with wisdom and humility.

The indefatigable Dr. Turner diagnoses Sister Monica Joan as “depressed.” He suggests helping Sister Monica Joan return to her childhood memories, which involves finding a pony cart and some live animals for an exhibit. Sister Monica Joan loves the scene and her eyes light up. Presumably, her depression is gone…but I’d say it never existed.

This episode takes place in 1968.  yet I don’t think we’d be more enlightened in 2023. In fact, Sister Monica Joan would probably have trouble escaping sympathy and anti-depressants.

This mini-plot has been criticized as a mistake in scriptwriting. Everybody knows the Christmas special is always one step away from a sugary meltdown. It’s an exercise in feel-good fuzzies with a happy ending. The subplot seems misplaced.

What concerns me is the lack of understanding of the role of death among people if a certain age (and, I suspect, among the terminally ill).

Unless they’re completely out of touch with reality, older people know their remaining time on earth will be short.

As a nurse, Sister Monica Joan would know the odds. You can be health and functioning at a high level one day and lose all quality of life with no warning. A fall, a stroke, a surprising cancer diagnosis, an unexpected heart attack…anything can happen with no warning. The odds increasingly work against you, especially after you turn 80.

For many people, it’s not a tragedy. They know it’s time.

And from what I can tell, people sometimes do get a sense of when they’re going to die.

In the classic book I Heard the Owl Call My Name, a young newly ordained priest has been diagnosed with an unnamed terminal disease.  Back then people weren’t always told the truth about their health.

Not knowing his condition, he accepts an assignment to a small Native American village after he was diagnosed with an unnamed terminal disease. In this culture, he learns that people know they will die when they hear the owl…and they don’t dismiss him when he tells an elder, “I heard the owl call my name.” She simply replies, “Yes, my son.”

About 15 years ago, a mainstream respected physician wrote a NY Times op-ed about people anticipating their imminent death. He gives examples of patients who seemed healthy but accurately predicted they would die that day. He references the famous nursing home cat, Oscar, who seems to know who’s going to die next in the facility.

It’s probably a mistake to introduce this idea during the cheery holiday special.

But it would be nice for the community to treat the topic seriously and respectfully. Instead, there is a rush to denial and a wish to cheer up any “older” person who brings up the subject.

It”s even more important to avoid assumptions about death and depression.  I often refer to an episode in Susan Jacoby’s book, Never Say Die. A man loses his independence. He’s used to living alone. He is miserable. One day he steals the caretaker’s keys, goes to a bridge, and jumps.

Was he depressed? The author says no. His life had become unbearable.

In her book Incidental Findings, Danielle Ofri writes about a patient with dialysis, in constant pain, with little hope of recovery. The patient wants to end dialysis, knowing she’d also end her life. Ofri notes that sometimes there’s a fine line between realism and depression. She drops this idea almost as an afterthought, but it’s worth repeating, although Ofri’s report of the subsequent conversation comes across more like a sales pitch than science-based advice.

Call the Midwife is a popular program. If the topic is brought up at all, I’d have hoped there’d be a more nuanced approach. It may be too much to expect from a program that’s getting broader appeal each year…so that may be a good reason for the program to use extra care when promoting a value system along with mistaken beliefs about death and depression.