Each year, many of us will face death, whether of a friend, a relative or ourselves. This is a painful time when fear and distress can be overwhelming for patient and carers alike. However well-informed we are about the illness and its treatment, the uncertainties surrounding death can be very frightening. Yet open discussion of death remains taboo in our society.
For most of us, knowledge of death is gleaned from detective novels and Hollywood films. It is hardly surprising that we are confused. Compare our knowledge of birth and death. Everyone knows that a home birth requires ‘plenty of towels and hot water’ although most of us will never witness a home birth, and are uncertain how these items will be used. What advice should be given to those preparing for a home death?
A 25-year-old woman with advanced cancer recently told me, ‘I have read all the books about cancer but none of them tells you what happens when you die.’ She wanted to discuss the choice of where to die (home, hospital or hospital) and to know what would actually happen to her body at the time of death and after.
Cancer can attack many different body organs and cause a wide range of different symptoms. Many patients and their carers find it helpful to know that the final events are usually similar and occur gradually, not suddenly. When an organ finally fails (whether brain, lungs, liver or kidneys, for example) the result will usually be drowsiness leading to coma, then death. Although patients may be sleepily confused in their last days, agitation and dementia are rare.
Pain is a much- feared complication of cancer. It is important to know that more than a third of patients experience no pain at all during their illness. In the vast majority of those who do pain, it can be very effectively controlled. Specialists in hospitals and pain clinics have many techniques available to treat pain. More importantly, GPs and Macmillan nurses are increasingly aware of these resources and how to exploit them.
Patients and their carers need information about all aspects of death and dying. Discussing questions such as those listed above and dealing with the practical issues can reduce anxiety and help patients and their carers prepare for death. This may make it easier to express sadness and talk about the past and the future.