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Well you know from a very practical prospective, people ought to expect, to be reasonable comfortable. I mean dying is hard, but it need not be horrible. People ought to expect that their doctors, nurses, and others are helping them to be comfortable, to have reasonable well controlled pain and breathlessness and other nausea, bowel problems; that I want to be part of the full attention to the medical aspects.
They want to know numbers to call, who to call after hours if something new happens, a new pain that you cannot understand or have not been known to expect and know what to do about, a new fever or something to that nature.
They want have to have a sense of continuity between visits and among different providers. But beyond that, being able to talk to people about the fact that time maybe short that, many people will say to me Dr. Byock, I have never died. I do not know what I am supposed to do now.
Well, it feels to me to be an abdication of our responsibility, of my responsibility, if I do not at least offer people some of the guides that I believe from others I have cared for over the years.
I do not know what is going to be most important to them. But you know I know that there is some commonality in what people feel is important as they approach the end of life. And I can sort of share with them things that have in value to other people that I have come to know over and over the years.
Again, the sense of not living things undone is often people say is important to them that they want to know that they are not critically important things left unsaid with people in their lives.
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I think a major common mistake people make is that they do not want to talk about it. Mom may bring up the fact that she is worried about not getting better and maybe dying and her loving daughter maybe of 45-year old daughter says oh, mom do not talk like that. You know, there is something more that can be done. Mom, we are going to get you and to see the specialist that is long catering or whatever.
We are going to-- don’t you talk like that which really just telegraphs that you cannot handle it yourself. You know the daughter cannot deal with the emotional pain and so it is stifles mom for having the conversation.
As much as we love one another, again, to really affirmed our love, it needs to be durable through the very end of life and I think that what we try to do through the best of intentions is to protect the other person from the pain that is associated with the thought that they may die, but we are also protecting ourselves.
It is a mistake. People already own this pain together and the notion we can avoid it or pretend it is not there, really just makes it worst. It adds a separation and a motional isolation at the very time when the most healthy thing I know of to do is to go through this together, to feel the pain together, to grief together, the grieving evenly impending loss of life and relationship.
And although it does not make it easy, it really makes it a little less hard. The honesty, the authenticity and sharing the bad news allows people to walk shoulder to shoulder together hand and hand on a journey neither of them would choose. I think that is the healthiest way I know to go through this.
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