WITH THE END IN MIND
I’ve thought a lot about death before, through a combination of childhood curiosity, being a lifelong fan of history (where everyone is already dead), being in medicine and having almost weekly existential crises since I can remember. This book is a great insightful look into the life of doctors from the perspective of end of life care.
It reaffirms my belief that we normally hold onto our ego and control so tightly, but rarely think of the days when we will lose our dignity; when we can’t control our bowels, when we can’t walk on our own, and none of this will matter. Those days may come sooner than we think and certainly will come if we’re lucky to live long enough.
I wish the knowledge that was common to us all when people would die at home should be shared with us all again, so we have more knowledge and less anxiety and pain around death.
When people are dying, their focus shifts from themselves to their loved ones and people around them. They also tend to find that world is more likely loving and kind than they have previously felt. This is probably because of their behaviour change too. If you’re kinder, the world will seem and be kinder.
By thinking that everything is temporary: harder things are easier to bear and good things are more precious.
We interpret what happens to our body consciously rather than this being objective: for example, the panic and fear of sudden death in a palliative care patient is physically exactly the same as a the nerves of a bride on her wedding day.
Why do we have a system of steps for childbirth and children coming into the world, but we don’t have the same for death, when it’s just as structured of a happening
It’s helpful to tell a patient exactly what will happen when they are dying from something known: how tired they are, how much more tired they will become, how they might go into a coma, what we will do to help them.
Bravery is about tolerating fear, not absence of fear.
People always think they have a limit beyond which they cannot endure, but they will always find this isn’t true, especially when it comes to health, you’re probably much stronger than you think.
CBT is massively helpful for palliative care patients (the basis of CBT = we are made unhappy by the way that we interpret events, so we can examine and challenge this).
Helplessness has a good side - it allows others to step in and help.
When we see people in conditions that seem unbearable to us, we are too harsh and wonder why they would want to live, but we forget that they have gotten there in multiple small straps (like ageing) and that’s why life definitely feels worth living for them.
People are not as limited as much by their condition as their attitude to it .
How we deal with the most vulnerable is the true measure of virtue in our society.