The article is based on interviews with an 81-year old man with advanced pulmonary fibrosis, his son, and his primary care physician. As noted by Quill, patients, their families, and their clinicians frequently collude to avoid mentioning death or dying, even when suffering is severe and prognosis is poor. The article illustrates how conducting such discussions earlier and more systematically can allow patients to make more informed choices, achieve better palliation of symptoms, and have more opportunity to work on issues of life closure. We hope this new column will engage readers in the process of improving care for patients at the end of life. Individuals interested in contributing cases or who have suggestions regarding topics or the section overall should contact the series editors.
Death is inevitable, and while there is no way out, there is a way through.
Caring for patients at the close of life is one of the greatest challenges most clinicians ever face, yet it can be one of the most appreciated and personally rewarding experiences. Listening to the rich and varied perspectives of these dying patients, their families, and their clinicians, and learning from these authors and from one another, will help meet this challenge, and help find a way through. At the close of life, clinicians can learn to attend to patients' hopes to have their symptoms controlled, their emotions understood, their relationships supported, and their spiritual concerns addressed. One of the greatest gifts in confronting death is the perspective it offers about living life. Perhaps we too can achieve some perspective and understanding of how to share fully in the lives of those we love, all of whom will inevitably die, and how to live our own lives well in the time we have.