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Ira  Byock, MD was the Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and is currently Professor of Anesthesiology and Community & Family Medicine at Dartmouth[…]

Dying well.

Question: How can one die well?


Ira Byock: Well, from a very practical perspective, people ought to expect to be reasonably comfortable, dying is hard, but it needn’t be horrible. People ought to expect that their doctors, nurses and others are helping them to be comfortable to have reasonably well-controlled pain and breathlessness and other nausea, bowel problems. That ought to be part of full attention to the medical aspects.

They want to know numbers to call, who to call after hours if something new happens, a new pain that you can’t understand or having been known to expect and know what to do about, a new fever or something of that nature. They ought to have a sense of continuity between visits and among different providers, but beyond that, being able to talk to people about the fact that time maybe short, that, many people will say to me, “Dr. Byock, I have never died, I don’t know what I am supposed to do now”. Well it feels to me to be an abdication of our responsibilities of my responsibility, if I don’t at least offer people some of the guidance that I have gleaned from others I have cared for over the years. I don’t know what’s going to be most important to them, but I know that there is some commonality in what people feel is important as they approach the end of life.

And I can share with them, things that had been of value to other people that I have come to know over the years. Again the sense of not leaving things undone is often, people say is important to them, that they want to know that there are not critically important things left unsaid with people in their lives, those sorts of things.


Question: What are some common mistakes?


Ira Byock: Well, before the final hours, I think a major common mistake people make is that they don’t want to talk about it. Mom may bring up the fact that she is worried about not getting better and maybe dying, and her loving daughter maybe 45 year-old daughter says, “Oh mom don’t talk like that”. There is always something more can be done, “Mom, we are going to get you in to see this specialist that’s slow in catering or whatever, we are going to – don’t you talk like that”, which really just telegraphs that you can’t handle it yourself, the daughter can't deal with the emotional pain.

And so it stifles mom from having the conversation. I think there are – as much as we love one another, again to really affirm model of, it needs to be durable through the very end of life. And I think that what we try to do through the best of intentions is to protect the other person from the pain that is associated with the thought that they may die, but we’re also protecting ourselves. It’s a mistake. People already own this pain together, and the notion that we can avoid it or pretend it, it’s not there, really just makes it works. It adds a separation and emotional isolation at the very time when the most healthy thing I know of to do is to go through this together, to feel the pain together, to grieve together, the grieving even the impending loss of life and relationship.

And although it doesn’t make it easy, it really makes it a little less hard, the honesty, the authenticity in sharing the bad news, allows people to walk shoulder-to-shoulder together hand-in-hand on a journey neither of them would choose. I think that’s the healthiest way I know to go, to go through this.


Recorded on: March 21, 2008