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Palliative Care Perspectives : Chapter 11: The Final 48 Hours : Clinician Checklist for Actively Dying Patients

All of us need such reminders. (On more than one occasion, I have been politely approached by a nurse who was "just wondering" if I still really wanted a certain medication, such as a psychostimulant, given to an actively dying patient - a polite manner of suggesting that I should review medications.) However, the actively dying must not be approached mechanistically. Active dying is not a disease but a natural process that may benefit from support and facilitation. I recall a talk I heard by Tibetan Buddhist master Sogyal Rinpoche (author of The Tibetan Book of Living and Dying), who was discussing dying from a Buddhist perspective. He told us with a chuckle not to worry - we would all "die successfully." He was not suggesting that dying is necessarily easy or free of suffering, but he was warning us not to treat dying like some difficult final exam for which we have to cram in order to pass. It is my impression that while some suffering is engendered in dying for most people, this tends to fade in the active dying phase. Sometimes dying reminds me of a bad case of insomnia. People struggle with being sleepy while still being unable to sleep. Being caught between the conscious world and the world of sleep can be very unpleasant. However, when, finally, people do fall asleep, they usually do so totally. It is no longer a question of mind vs. body. Sleep, when it comes, is so obviously the right thing to do that no question or even consciousness of a question arises. The total person, body and mind, knows what to do; so, too, with dying. When people do die, they die totally and quite successfully. I find this very reassuring.

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Palliative Care Perspectives

James L. Hallenbeck, M.D.

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Copyright 2003 by Oxford University Press, Inc.

The online version of this book is used with permission of the publisher and author on web sites affiliated with the Inter-Institutional Collaborating Network on End-of-life Care (IICN), sponsored by Growth House, Inc.