Michael Steinberg, MD
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Steinberg M. The Dying Experience. Ann Intern Med. 1997;127:242-243. doi: 10.7326/0003-4819-127-3-199708010-00016
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Published: Ann Intern Med. 1997;127(3):242-243.
TO THE EDITOR:
The conclusions drawn by Lynn and colleagues  from their study of the perceptions of family members of the deaths of seriously ill patients paint a bleak picture of death in the modern hospital. Several points seemed to me to be misleading, however, or at least incongruous with those conclusions.
First, the proportion of patients in this study who had cardiorespiratory disease, failure, or cancer was high; one would therefore expect dyspnea, even severe dyspnea, to be present in the final days. Other than sedation to the point of stupor with or without mechanical ventilation, I am unaware of any way to alleviate dyspnea (or others' perception that the patient is dyspneic) in the presence of a failing lung. Second, I would argue that “fatigue” is really not an appropriate symptom to include in this study. Certainly, I would expect patients in the end stages of terminal or major systemic illnesses to be fatigued and to appear to be fatigued to observers, especially those who knew the patients in times of health. It is certainly reasonable to expect to alleviate pain. However, by lumping such symptoms as fatigue, dysphoria, or even dyspnea together with pain, the authors create the impression that all such symptoms are truly reversible or treatable in the dying experience.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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