do not go gentle into that good night

"and you, my father, there on the sad height,
curse, bless me now with your fierce tears, i pray.
do not go gentle into that good night.
rage, rage against the dying of the light."
- dylan thomas

the dying process is often associated with physical and psychological suffering, and in palliative care, we try to alleviate this and achieve a peaceful, dignified death for our patients. we often console our patients and their families with this promise and sometimes this helps them to move on from the shock and hopelessness of a terminal diagnosis.

however, despite our best efforts, sometimes we fail. although total failure in the form of a screaming patient surrounded by crying family is thankfully a rare occurrence, often the medications we use to treat symptoms compromises our patients' mental faculties. they spend more and more time sleeping. and when they are awake, they find themselves in the grey zone: unable to concentrate, their thoughts wander as their minds slip back into the haze, their senses dulled, their humour muted. they become the hollow men, a shell of the people they once were. it's a horrible state of being.

i don't know how i would like to go. i certainly don't have the right to tell my patients how they should go. but what i do know is that, even though we might like our dying to be peaceful and dignified, sometimes it's noisy and messy, filled with gasps and groans. and despite all that we are trying to achieve in palliative care, sometimes, a person's struggle against death can feel so overwhelmingly noble, human and right.

"this is the way the world ends

this is the way the world ends

this is the way the world ends

not with a bang but a whimper."

- t. s. eliot