With hospice being all about death and dying you’d think that it be all panic all the time. After all if everyone is dying then everyone is in crisis.

The truth is that “dying” is much more of a continuum in hospice care. Everyone is dying to some degree, but not everyone is on the brink of death. Hence the Monty Python and the Holy Grail bit.

Dying can take place over months, with gradual withdrawal and decline followed by more acute symptoms within the last few days. Of course it can also happen very suddenly, with almost no warning at all. I still remember seeing a new patient at the hospital who had just come on. She was complaining bitterly about pain in her back. The nurse had already given her some medication, so we thought re-positioning her would help the pain. We rolled her on her side and put a pillow under her shoulders. As she was no longer upset we thought we had helped. It turned out that she had just died.

Most of my visits are relatively routine, with side tracks for new admissions and schedule changes here and there. There are occasional emergencies of course. But even these emergencies are unique each time. A person dying isn’t necessarily an emergency on its own for example. If the family is struggling or the patient is having problems those are emergencies. But a patient dying comfortably under the care of trained staff isn’t an emergency. I get some strange looks whenever I tell a family that a patient is “doing pretty well” as they’re dying. “Pretty well” in this case refers to their dying in comfort without distress rather than being healthy. Sharing that often helps families with their own acceptance and that dying itself can be “ok”.