Dealing with death

How, as a patient, do you react to a devastating diagnosis?

“The Good Man, Death and the Doctor” by Thomas Rowlandson, 1815-16

Death and taxes were said by Benjamin Franklin to be the two inevitabilities of life. There are more eminent contributors to this journal who write eloquently on the latter so I shall confine myself to the former.

As a practising GP, it is my unfortunate responsibility occasionally to inform a patient of that most awful news — a fatal diagnosis with a poor prognosis. How, as a patient, do you react to this devastating revelation?

There is a spectrum of responses. On the one hand there is acceptance with quiet dignity. For such patients, the end of life is the full stop at the end of a long, pleasing and all-encompassing sentence. They will have enjoyed an enduring marriage and raised children of whom they are proud. They will, within their capabilities, have reached the pinnacle of their careers and made adequate financial provision for their loved ones. They are content to depart without pain and with dignity, quite within the ability of modern palliative medicine.

For others, however, there is denial, anger and even rage. There are demands for second and third opinions. They “do not go gentle into that good night”.

They search frantically for clinics in Mexico or Java that offer miraculous non-conventional “cures”. They are overcome by their sense of self-importance and impotence. “My name is Ozymandias, king of kings: Look on my works . . . ”

They have devoted an entire life to the worship of the false gods of money, fame, fashion and popularity. All their expected tomorrows have now been distilled into today. Their indomitable egos have alienated them from their offspring.

Life is a unique and precious gift for each of us. It should not be squandered. We should exploit it to the maximum of our potential but not at the expense of our happiness. I remind my patients that in my experience retirement is the shortest route to the graveyard. There is always a little more to do and the in-tray is never emptied.

One of my favourite definitions, the wry medical one, is that life is a sexually transmitted disorder for which the ultimate prognosis is death. When your time comes, as indeed it must, which sort of person will you have become?

Fear no more the heat o’ the sun,
Nor the furious winter’s rages;
Thou thy worldly task is done,
Home art gone and ta’en thy wages:
Golden lads and girls all must,
As chimney sweepers, come to dust.

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