“Dying is an art, like everything else. I do it exceptionally well.” — Sylvia Plath, American Poet (1932-62) Lady Lazarus
How do you tell a friend or a loved one that she is dying? Do you tell her that she is? In this time of “transparency” and of “full disclosure,” people are tempted to do the same to dying patients. In a 1961 survey of British doctors, 90 percent thought that patients ought not to be told that they were terminal. By 1979, only three percent thought this was right. One wonders what medical professionals and the public think about telling the truth to dying patients, in 2009. End-of-life issues continue to confuse even doctors because the subject of death is taboo. After all, death like life only comes once and very few want it to discuss openly, except perhaps insurance agents and undertakers. It is possible to prepare for a loved one’s death in a way that is responsible and caring. It should not mean that you want her to die sooner. There are four questions that guide a doctor or a designated relative or friend to what “level of truth” the patient can be most comfortable with. Some cancer patients don’t want to know that they are dying – truly, ignorance can be bliss. That is why it is wise to first ask, “How much have you been told?” The second question is “Are you the sort of person who wants to know exactly what’s going on?” The third is “Would you like me to tell you the full details of your diagnosis?” And finally, “Do you want me to go on?” Doctors and nurses are notorious for cloaking bad news in medical jargon. The simplest explanation is usually the best. Once the bad news has been broken, a patient may want a second opinion. It is her absolute right to get one. Roger Bone, a doctor who was dying of cancer, wrote, “A second opinion will relieve your mind and resolve doubts one way or another that a major mistake has not been made.”
Dying people have voiced out that the most distressing and painful experiences involve silence and avoidance about their final weeks or days. Especially for those wanting to make peace with themselves. These questions are most helpful:
- What have you enjoyed most in this life? Ask them snapshot memories that have made it all worthwhile. Surely this is the time to reminisce.
- What would you like someone to hear that you have never said? Perhaps he has never said “I love you,” to a son or daughter. Maybe it’s not too late. Maybe he would like to forgive someone or ask forgiveness, too.
- What are you most frightened of? This is the time to assure the patient of pain control and the avoidance of suffering even in his last moments.
- What do you need to do? It is very difficult to do things from a hospital bed. In practical terms, this could mean anything from writing a will, seeing the priest or minister to feeding the aquarium fish at home. Reasonable requests should be written down and carried out.
When do we know that the patient is ready for death? This is probably not a precise moment but a slow surrender to the inevitable. One clue is how the dying person begins to direct her attention to loved ones. Sometimes the hardest part about dying is the effect it has on your family and friends. Helping them deal with your death helps you find peace and comfort. Now whether death is transition or extinction is a matter of philosophy, or religion. What we do know is that we can help the dying patient to truly rest in peace.