I was driven to palliative care by wanting to give peace to the dying. I particularly wanted to give comfort around a process which was so deeply frightening and painful. Sudden death, the heart attack, the massive pulmonary embolus, the traumatic brain injury, SIDS, robs us of the ability to give a peaceful death. The death which we expect, which we want and know how to give, the managed course of transitioning is seized from our hands. Instead we are left with a rapid, wild-card descent.
At the end of the day, my desire to palliate death has everything to do with control. Although I'd like to believe that I as a palliative care physician truly understand we have no control over anything, I still in trying to manage dying towards comfort, am trying to control it. Just like every human, I can't seem to turn off my irrational need to change reality.
But sudden death is a frank reminder that no matter how successful you've been with hundreds of deaths, there will be one which eludes you, one which is out of your influence, which dies before you can reach it. For this reason alone, sudden death needs to be mentioned, needs to be talked about, because as infrequent as it is, it is still a real possibility.
I have come to understand that sudden death should be included in the gamut of possibilities of dying discussed in end-of-life talks. It may not be easy, as just talking about death alone is tough. To mention dying suddenly and rapidly seems brutal. But having witnessed enough cases of rapid decline in my career, and having seen that preparation and expectation made all the difference in acceptance, I've come to believe that it must be mentioned. Otherwise, even in hospice, sudden death is a shock.