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