A perfect death

BMJ 2004; 328 doi: (Published 22 January 2004) Cite this as: BMJ 2004;328:202
  1. Cornelius Katona, dean
  1. Kent Institute of Medicine and Health Science, University of Kent, Canterbury

    My mother was 85 years old. She had just returned from her biennial “long trip” adventure. This time she had travelled alone across the United States visiting friends. She was proud of having boarded 24 planes and of having seen the “grassy knoll” in Dallas from which John Kennedy had been shot. She had lost weight though, and she looked very pale. “Sit down,” she said when I next telephoned. I sat down. “I am dying. I have cancer of the pancreas. It has gone to the liver. They say it will be three to six months, but I know it won't be that long.”

    She told me that she wanted to say goodbye to her many friends. Refusing all help, she set herself a schedule of inviting them to her house—cooking meals for them, telling them her diagnosis, comforting them, and returning any gifts they had ever given her. She said that she saw such gifts as lifelong loans and that the time had now come to repay them.

    Her strength was ebbing, but she seemed ever more focused and determined. She was referred to her local palliative care team and was delighted at their positive and unpatronising attitude. She rather reluctantly accepted a blood transfusion but said she was sure it would not relieve her exhaustion. She was right.

    Within a month of her diagnosis, she was too tired and breathless to walk across her living room. She was admitted to the local hospice, where she seemed to rally. Friends poured in and she “held court” as she had always loved to do. “It's so unfair,” she said in mock complaint. “All my life I've entertained my friends. Now you should be entertaining me, but I am still the one telling the stories.”

    The next day, a Sunday, she was much weaker. “I've had enough,” she said. “No more transfusions. No more drugs. I want it to be over. They say it's a matter of weeks, but I don't think so.”

    On Monday I had to work all morning and did not get to the hospice until mid-afternoon. I was told that she was no longer taking telephone calls or seeing visitors but that she wanted to see me. As I walked in she looked at me, her gaze as piercing as if I was still her naughty child. “Sit down,” she said. I sat down. She died.

    I am grateful that she had waited for me. I have also learnt that the “good death” that is the aim of modern palliative care is about much more than symptom control. It is, or should be, about enabling people to retain their dignity, to exercise choice, and above all to stay in control until (as in my mother's case) their last moment.

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