A Few Months to Live: Different Paths to Life's End by Jan Staton, Roger Shuy, Ira Byock. Georgetown University Press, £19.50, pp 384. ISBN 0 87840 841 X
Physician's Guide to End-of-Life Care. Eds Lois Snyder, Timothy E Quill. American College of Physicians, £27, pp 267. ISBN 1 930513 28 3. Rating: ★★★; ★★★
Five years ago, one of my dearest friends was diagnosed with leukaemia. Three years later she died. The close involvement with her and her outgoing, fun loving family during that time taught me more about palliative care than any number of years of specialist training could. Hospital appointments governed their lives. They were swamped by seemingly dozens of professionals—all no doubt by now identified in the cancer pathway—but they still managed to share laughter until the end.
It is difficult to imagine what it must be like to have a terminal illness and to be dependent on others for your every need. What is it like to experience the change in relationships that illness and dependency often cause? How frustrating is the loss of normal chat and gossip—to be replaced by a stilted conversation in which everybody makes sure that they do not mention the illness or, horror of horrors, the D word. 
A Few Months to Live offers a unique perspective of what it is like to be dying and to be a carer. The last few months of life of nine people living in Missoula, United States, are carefully documented by semistructured interviews. This, however, is much more than a qualitative study and it is written in such a way that I felt that I knew Kitty, Dennis, Roberta, and the others. As illness progresses, horizons are narrowed and relationships change, but the overwhelming sentiment of the participants is one of joy and of trying to live each day to the full. Some had a family that provided all of the care, supplemented by the primary care team and palliative care service. Kitty had no surviving family but was lovingly and ably supported during the last five months of her life by long term friends and members of her church.
This is not a cosy, “dying is OK” book. The feelings of anger, doubt, pain, anguish, and futility are not hidden. They are recognised by the researcher, explored with both patient and carer, and sensitively shared with the reader.
Those of us working in palliative care believe that allowing life to be lived to the full should not be just for those dying from cancer—it is in the remit of all doctors and nurses to ensure that symptoms are adequately controlled and that communication needs are addressed for patients with all terminal illnesses. Palliative care means recognising that sometimes the best treatment is no treatment and that just because something can be done does not always mean that it should be done. A relatively neglected group of patients are those who die in intensive care, for example, where it may be difficult to switch from highly aggressive curative treatment to a palliative approach.
Physician's Guide to End-of-Life Care includes these other patients, which is where its strength lies. Case histories illustrate difficult psychosocial or ethical issues or situations where symptom control is difficult—the reader is taken through such situations and allowed to see what can be done.
One of the main frustrations for those of us working in palliative care is that we are often considered as “end of life doctors.” In a now well established specialty, we still see patients referred within days of death who have had uncontrolled pain or other symptoms for many months. I am disappointed, therefore, that a book containing good and new thoughts on symptom control and palliative care has a misleading and what many would consider “old fashioned” title.