Juha Hänninen, palliative care specialist, has a deep-rooted habit: when he goes to confirm a death he talks to the deceased.
So, you went and died then, he might say when testing the pulse. Is this how it turned out, he may ask.
Hänninen is not really talking to the deceased but himself. He has seen thousands of dying patients and dead people over the years, yet death is always new. It is not something he will ever get used to. Goodbyes are easier if you say at least a few words.
The first time death touched Hänninen was when he was a medical student some 25 years ago. He was spending an evening out with his friend Pekka, planning trips they would take and talking about the future.
The following night, his friend died.
"He suffered from kidney failure but death was not on the cards," says Hänninen, turning his gaze to the floor of his office at Terhokoti Hospice in Helsinki.
One of the walls of his office is decorated with birthday cards and greetings as Hänninen recently turned 60. A framed Konrad Reijo Waara reward, awarded to Hänninen for his achievements in hospice work, hangs on the opposite wall.
Hänninen became a hospice doctor by chance. He studied political science first but also wanted to gain another qualification. In his current work, he can combine his knowledge in both fields.
"If you believed in some higher force you could say this was divine providence," he says, smiling.
His holds an agnostic view on religion and declines to participate in religious ceremonies, finding them awkward and disagreeable. On the other hand, he is convinced that there must be something in this world that cannot be witnessed with human senses, saying that this can be seen in the way a dead person looks like. A body is but an empty shell, something has gone.
"Whether that something is a soul or something else, I don't know," says Hänninen.
Who is he?
The director of Terhokoti Hospice, chief physician and an author of non-fiction. A master of political science and licentiate of medicine by training. A specialist in palliative care.
What is he known for?
Advocacy of hospice care in Finland and active engagement in discussion on euthanasia.
What is not known about him?
When he has time, he enjoys reading comics. His favourite hero is Corte Maltese. He also likes Ville Ranta’s style.
Juha Hänninen’s top 3
Wife and children
My wife Päivi Hänninen also works at Terhokoti and we have a really good relationship. I have two daughters and grandchildren living all over the world. Fortunately my son lives in Helsinki.
The importance of publicity has not been understood in the healthcare sector. I have tried to get it across that talking about hospice care in public domain is vital.
I have a large Harley-Davidson, which I ride to work in summer. Perhaps having a hobby like this makes a doctor seem more human.
Everyday occurrence of death
Hänninen took over as the chief physician and director of Terhokoti over 20 years ago. Death has become an everyday occurrence to him with the hospice having treated nearly 10,000 dying patients.
"You come to appreciate the unpredictability of life here. I have met so many people who say that four weeks ago I climbed a mountain and now I'm dying. Or I went on a cycling trip two weeks ago and now I'm dying."
This has had a profound impact on the way the staff approach life, with no one making long-term plans without reservations. When the staff talk about their summer holiday plans they add "if I'm alive".
"This kind of attitude makes you value and cherish what you have now."
It is easy to understand that being constantly surrounded by death might make you downcast but the chief physician describes his work as nice. The work community at Terhokoti is exceptionally good and encounters with patients are rewarding.
"People are quite open when they reach this stage. They have no need to maintain a facade or stick to superficial topics. They want to talk about the meaning of life, the story of their own life and everything connected to human life and existence. I also gain so much from these conversations."
Most patients are facing the end with a calm mind. Even though deeply saddened by the imminent death, they still feel they have had a good life and derive pleasure from having their family around.
"Yesterday, a patient celebrated his birthday here. The family decided to bring the party forward a little as he might not live until his actual birthday. The family came around, they all had cake and sparkling wine."
Hänninen has come to realise that dying patients are a total departure from the values prevalent in today's society.
"The general trend is that people should work as much as possible, work longer careers and be more productive. Towards the end, these things don't matter at all."
Hänninen says that people who are close to the end of their lives hardly ever want to talk about their work.
"We have treated esteemed scientists and professors who have forged illustrious careers but they want to tell about their hobbies , families, world views and fears."
Hänninen finds it heart-wrenching if people have put off all their dreams until retirement only to find that it is too late.
"We have many cancer patients and cancer often develops around retirement age. If you have left it all until then, thinking that if I work hard now and lead the life I want then it is easy to feel bitter when the plans fall through."
At the time of death people regret things they left undone, such as never getting to know their children properly as work took up too much time.
"Apparently, for many steering a company is more important than bringing up a child."
Even though Hänninen comes face to face with death all the time, the thought of your own mortality is not easy to consider.
"This is my job. I care about these people, but it's not love. My own death and the death of my loved ones is a different thing."
Hänninen believes that on his deathbed he will think about his children.
"I have divorced once. When feeling low and uncomfortable, it's easy to start wondering if you have done something wrong, for example, neglecting the children when going through the divorce. I believe that when death is approaching, I will wonder if I should have done something differently."
If Hänninen was given the opportunity to choose, he would not like to be hit by a sudden death.
"I'd wish for some time to prepare. Say goodbye to my children and grandchildren, to tell them they are good children and to take care of themselves. I wouldn't want to suffer for long."
Most people do not fear death itself but the process of dying and the pain they might have to go through, says Hänninen.
Sometimes no medical help can alleviate the pain. Hänninen hopes that if his suffering becomes unbearable at some stage, euthanasia will be an option.
He has not always been an advocate of euthanasia. When starting as a palliative care doctor, he firmly believed that medical science could help with all the pains and problems that may be part of dying.
While he gained more experience he realised that unfortunately this was not the case.
The experience that had a dramatic effect on his views was treating a young woman who suffered from cancer of the mouth and neck. Her face had become deformed, blood and saliva trickled out and there were tubes going in and out of her. Everyone knew she would die by suffocating.
"Then I wondered what if it was me. What would be the point in having to live through those stages?"
Sometimes patients ask if Hänninen could help end their lives and he believes doctors should be allowed to do this.
"There comes a stage when a person feels that their existence as a human being has ended and it's all about surviving and the vital organs working from now on."
A couple of years ago, Hänninen had to take leave for another friend. A man in a group of friends that had got together regularly over the decades had been diagnosed with a brain tumor. He did not have long to live.
But there was still time left. Deciding to have one last get-together, they bought food and wine and went to the Puolarmetsä hospital in Espoo, where their friend was being treated.
"We celebrated the way we had always done. It was slightly different as we had to help him drink the wine because he couldn't hold the mug. It's not nice having a friend lie in the bed, dying, but it was still a pleasurable moment," says Hänninen, looking away for a moment.
In an ideal situation, death brings people closer instead separating them. Sometimes, only when facing inevitable death, people learn to let go and live in the moment.
"Caring has become somehow diluted in our society. The focus is always on achieving something. People are always in a hurry to be somewhere."
When the men ate their Indian food and drank wine in the Puolarmetsä hospital, they were not in a hurry. The wine mellowed them and full stomachs made them feel languid. They chatted just as they had always done.
Sonja Saarikoski – HS
Niina Woolley – HT
© HELSINGIN SANOMAT
Image: Liisa Takala