The Hard Work of Dying

Imagine that you’re preparing for a thirty-day trip to a foreign country and you’re limited to taking only what can be carried in a backpack. Your decisions on what to take or leave behind will determine the quality of your experience. Too many items and the weight will be burdensome. Not enough of the right ones and you might be forced to neglect some basic needs. We make decisions of this type daily. Take what’s important, leave behind what isn’t. But we tend to oblivious to the importance of these decisions for possibly the most momentous journey of our lives—our death.

As a bedside hospice volunteer for the past six years, I’ve found that the ideas and emotions people carry with them through life, as was the case with Joyce, often determines the quality of their death. During one visit she leaned back in her chair and softly said, “You know, dying is such hard work.” For two months her physical condition had been steadily declining and I assumed she was referring to her pulmonary problems. She paused, then said “I’m not talking about what’s happening to my body.” Pointing to her head she continued. “The hard work is what’s happening up here.” Although specific end-of-life issues were as numerous as the number of people I served, the type of “hard work” expressed by Joyce and others mostly fell into four categories: the difficulty of simplifying the present, forgiving the thoughtlessness of others, wanting desperately to be forgiven, and letting go of the dreams that would never be fulfilled.


Many of my patients experienced a stimulus overload as they got closer to dying. For example, the CEO of a multi-national company had difficulty each morning deciding what he would have for breakfast. A professor who spent his life analyzing language had problems following simple conversations. A carpenter who built houses couldn’t complete easy manual tasks. For patients with dementia or other neurological problems, the…

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