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Loneliness.

In an ideal world no one should be left to die alone (unless they have expressed a preference for that). A comforting hand can make a huge difference. Even in hospital, that cannot be taken for granted. Here are two contrasting vignettes from my own experience. A male cancer patient clearly nearing death, is hugged by a trainee nurse, who gently calls his name and assures him he is “Alright, my duck.” My sister dies of cancer; the nurse allocated to her could not attend “Because I had to be at Hand-over.” (Luckily, I arrived on the ward just in time to be with her in her last moments.)

Obviously, a close friend or family member is likely to be more helpful at this point than even a skilled professional. Ideally it should be possible to arrange a rota so that the dying patient is never alone (nor feels intruded upon.) Sometimes a friendly presence is enough - without words or touch. It is important to remember, however, that hearing is the last faculty to shut down, so even if the patient is unresponsive, s/he may be able to hear what you say. So words of encouragement and appreciation can be very helpful. (So can reassurance about the future of immediate family or pets. Eg “Mum will be well looked after, Dad. We will take it in turns to see her each day, I promise”. “Fido will come to us. The children love him so I am sure he will settle in very soon.”)

Death is notoriously fickle - which is why doctors are very unwilling to tell you “how long she’s got”. This can make ensuring there is always some family member on hand almost impossible. It may be sustainable for a day or three, but most of us have other commitments that cannot be neglected for long. If it becomes more prolonged than you had expected, try to communicate to the patient when someone will be coming. The basic fear is that they will be left alone. If they know that Fanny will come at tea time and Bill tomorrow morning, that is often reassurance enough. If it happens - as inevitably it sometimes does - that the patient does in fact die alone, try to avoid feeling guilty about it. “If only I had gone….” That does not help the deceased - and it certainly does not help you.