As 0nce again I glance through the main points of this correspondence, I am aware of its tendency throughout to focus on and seek to encourage an up-beat approach (in the very best sense the use of that phrase). My blogs have – perhaps you might agree – sought both to inform and to encourage a realistic and hopeful attitude and outlook, as you naturally and rightly seek in every way to optimize the life now unfolding before you. Yet it is also quite true to assert that a significant part of my professional life has been spent with people and patients – young and old, male and female – who have been increasingly required to acknowledge a growing awareness; namely that life, (in this world at any rate and whatever that may mean for them personally and individually) is now drawing to its close. If I have learned one thing from such experiences, it is simply this: to hold the hand of a dying person is to be changed forever. Yet seldom have I dwelt to date in these writings upon such sensitive feelings and issues to anything like the commensurate degree (if you see what I mean).   Nor do I find this an easy blog to compose; maybe that is, in part at least, the reason why I have left it until now.

Now I hope it goes almost without saying, that my wish for you as you are reading though what has here been declared to paper, is that you are by now coping much more readily and satisfactorily, not only in the emotional and psychological sense but that physically too, things are improving. Yet notwithstanding that entirely sincere wish, we do – all of us – have to face the realities and the truth about how we have been and now are. This in turn may mean that in spite of everything, your illness has in fact been steadily progressing. Maybe you are now increasingly aware of the need for an inner strength, peace and tranquillity of mind, which will take you on through these most testing of times, to the threshold of what may lie beyond our present existence.

There are, of course, manifold inputs to such a desired state of being. Perhaps what is being writtennn here might help by drawing into sharper focus some of the more salient of these. And the first must surely be the overriding importance of adequate and appropriate pain control. Nothing – in my experience of terminally ill patients – causes them to want to just ‘throw in the towel’ altogether, more quickly and assuredly than uncontrolled and unremitting pain. Often, when we talk about quality of life for cancer patients, we place pain well down the list of relevant variables for consideration and this, in my opinion, is a grave mistake. Quality of life is almost bound to just ‘go out of the window’ altogether where pain is left uncontrolled and unabated If Dame Cicely Saunders has taught us anything about caring for the dying, it is this cardinal truth: that the presence of pain will almost invariably exacerbate all other troublesome symptoms being experienced. Yet this really needn’t, indeed it must not be.

Fortunately, such messages are being received loud and clear by hospital and hospice wards and in General Practice. Nevertheless, all cancer patient-carers must continue to be diligent in this regard. Accordingly, it is important for patients and their family members to know this and where required, to seek help promptly. ‘State of the art’ analgesia in a wide variety of forms and applications is available to all through the NHS. Properly supervised and managed, adequate pain control can make a world of difference to the physical, mental and spiritual well-being of everyone concerned. And what about the variety of thoughts and experiences frequently encountered, as the awareness of impending death becomes increasingly more of a reality? (I would be so sorry if these words in any way appear to convey an interpretation, which appears stark and unfeeling. That is certainly not intended. Rather has experience taught me that people are more comfortable with and more ready and willing to accept one’s utterances about whatever topic, where issues are simply, sensitively but plainly put).(C)SB.