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Does it hurt when you die?

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About Us - Dr Colin Dicks

Dr. Colin Dicks

MBChB, FRANZCR, MBA, MSc Palliative Medicine.
April 22, 2022

Yes! 

There is no way around this but before we get too excited it is important to understand pain and what it means to hurt.

We have all experienced pain in life, whether it was the severe pain of childbirth or a kidney stone or perhaps a broken bone or simply the pain of a bee sting. We know that pain is unpleasant, and we try and avoid it as much as possible.

Pain is a good thing; it is a survival thing. We stay away from things that hurt and in that way we live longer. Pain stops us doing stupid things like jumping in a fire or jumping off a roof. This benefit of pain generally works unless you are a young adult male or drunk or both.

Pain is also protective. It is how our bodies warns us that things are not going well. If you twist your ankle for example, the pain will let you know where the problem is, and it will also protect you from putting too much weight on to the ankle until it has healed up and all is well again.

No one likes pain and the good news is that for most of us, most of the time, there is the hope that pain will get better. But this is not always true and when the body is failing due to illness there is not always the hope that things will improve. In the world of cancer, where I work, pain is a common problem. Cancer for example causes injury to bones and resulting fractures and they are painful. It may cause swelling in organs and tissues, and this will be painful. It can cause nerve irritation, and this will be painful. As cancer progresses the pain will get worse and if untreated most people with cancer will have a painful death. There will be suffering.

But there is no need to have suffering. When it comes to pain, it can be treated. The palliative care doctors have access to amazing pain drugs, if you are prepared to take them. Cancer responds well to radiation, and this improves pain for many people, if you accept having radiation. At the end of life when there are few treatment options left, the invention of the syringe driver has revolutionised the way we manage pain. With a syringe driver there is a constant delivery of morphine and pain relief can happen even if you are unconscious and cannot swallow. But it only works if you accept to use it.

What I am saying is that while it may seem chivalrous and brave to put up with pain, it is not necessary. Only a fool will endure pain if there is an alternative. It is true that pain cannot always be totally, but small gains are beneficial. It is better to endure a 4/10 pain than to suffer a 9/10 pain. While it is true that dying hurts, it does not have to hurt a lot. If doctors can lessen the pain of childbirth, there is hope for all of us in dying!

The good news is that not everyone suffers physical pain in dying. Some peel feel no pain at all, but physical pain is not the only consideration.

The more difficult thing about dying is the emotional pain and distress people experience when life is ending. Having to say goodbye to all things is a painful journey and this makes the process of dying so much more difficult. Understanding what is at stake emotionally is important because something can be done to diminish this distress. In ‘Death, Dying and Donuts” I discuss the emotions around dying. These emotions are often overlooked, and they can sometimes cause more pain than physical pain. In the book I give the example of a patient with uncontrolled pain, who had to either be knocked unconscious or she was crying out in pain. Her pain was not physical but related to her emotional distress in dying.

Sometimes those saying goodbye and left to mourn also suffer this emotional pain in death. Being aware that emotions can cause untold suffering is important because once there is an awareness of this, there is the hope to get help.

Pain can be managed and dying does not have to be unbearable. When it comes to dying it is important to anticipate pain and to have a game plan about how to manage pain. Fear makes pain much worse and once we can diminish our fear of dying, the pain will be better as well. Fear comes from ignorance, and it is important to be aware of the factors involved in pain. It is important to know what triggers the pain and how to remove the trigger. It is important to accept medication for pain. It is important to consider supplementary treatments such as heat packs and splints, or TENS machines and massage where required.

From an emotional perspective it is important to not have baggage and be ready when death visits. Having emotional pain is not necessary when you understand that death is not necessarily the end of everything, it is merely a doorway to the next adventure.

If you want to know more about dying and the issues involved please read, “Death,  Dying and Donuts” by Colin Dicks. If you are unsure why not get in touch at admin@dyingtounderstand.com.

Regardless, in all circumstances, the storm of dying will pass, and death will have visited and may there then be peace.

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