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CHAPTER 12


Few people are afraid of death, but many of us fear the process.


The first thing I learned was that once you have talked about dying with someone, you don’t really need to worry about it anymore and, if you got it right, neither do they. Few people are afraid of death, but many of us fear the process. We all need reassurance that it will be a gentle and peaceful event. I always tried to dispel their fears quickly.


End of life care is mostly about paying careful attention to a few quite simple problems. Comfort, both physical and mental, and dignity are top of the list. This means precise attention to things like constipation (highly likely when the patient is taking strong painkillers), the height of the bed, and things like special aids such as waterproof sheets. Good pain control means balancing the need to be as lucid as possible with acceptable comfort. The dose is what works. Frequent doses of fast-acting, usually liquid preparations will quickly achieve reasonable comfort.


Reconciling the needs of the patient and their family can sometimes be challenging. Who should be told what and who decides? Families may need to be guided and


50


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