It is not death , it is dying that alarms us (Montaigne). To the believers “Death is the golden key that opens the palace of eternity (Milton)”. Death means complete cessation of functions of all vital organs of the body e.g. heart, lungs, brain etc. There are two types of death:
a) Somatic i.e. cessation of function of vital organs, and
b) Molecular i.e. death of individuals cells which occurs after cessation of life.
In the holly Quran Allah says “ Kullu nafseen jaekatul mout” , which means every living soul shall have to taste the death. Death can’t be denied but we can demand it’s dignity . Everybody’s wish should be a dignified death if not glorious . Men can’t die like cats and dogs especially if he/she is a patient in a hospital. Due to advancement of science now a days death can be delayed but can’t be stopped forever.

Prof. Dr. Hafizuddin Ahmed Principal Monowara Sikder Medical College & Hospital Cell: 01716097701 E-mail: [email protected]

Most of the people die in the hospital especially in urban area. Despite the efforts of the doctors the patient may die just few days after getting into the hospital. Some chronically ill patients painfully understand there gradual deterioration and the advancement of the Death Angel. And he/she realizes this advancement is inevitable.
There occurs an unexpressed tension and untold inter-action between the mind and the body of the patient. The doctors, nurses and ancillary staffs shall have to recognise this situation and give a positive support to the patient make his/her life comfortable during the final days of life. Not only the patient but sometimes their relatives are anxious and can’t face death themselves usually because of lack of faith in religion and God.
Now a days the medical treatment has made tremendous development which has greatly improved our life span. Death is regarded as failure in medical community.
In a general hospital a dying patient is moved to a corner of a ward or in a isolated cabin and nurses only attend him/her when call bell is rung. In a sophisticated hospital the patient is shifted to ICU, a sense of despair develops --- and ‘there is nothing we can do more’ atmosphere prevails.
If the patient is concious he/she bitterly feels now it is his /her time to go and develops sevre depresion affecting his/her cardiovascular and mental condition. Once he/she was a vibrant personality and but now he/she at the mercy of everybody --- this feeling loads to resentment to everything leading to exacerbation of symptoms and the condition worsens. The clinician is fooled. For a dying patient the attention should be directed to the symptomatic relief and not to the actual disease.
Death seems to be the loneliest experience, any of us will ever have to face so patient should not be isolated.
They need our support, companionship and should be told about his/her condition as far as possible instead of telling lie because soon the patient realizes doctor does not consider him/her capable of hearing the truth. He/she then turns to  his/her dearest spouse or daughter who only give him/her false assurance ---‘everything is coming along nicely, don’t worry’. But this put the patient in more worries and he/she feels totally alone. The patient understands no one is going to tell him/her the truth and gets frustrated.
A forced kiss by a visitor should be avoided. This makes the patient more suspicious, rather one should hold his/her hand while talking or put an arm around shoulder. This is a non-verbal communication which means ‘No matter what happens I shall stand by you’. Sitting beside the bed by doctor means ‘The physician will not keep distance with the patient’.
Sometimes the patient may ask
 : Doctor, Am I going to die ?  
This does not mean the patient wants a direct answer. It means he /she wants more information about him/her and the disease. At times the patient does not want to know the real truth as he/she does not believe the illness is fatal. So the doctors should be cautious about telling him/her about his/her condition. The aim should be to make the dying a little easier, less painful and removal of fear of death from the mind.
Even at the death bed the patient may be anxious about:
a) Seperation from family
b) Losing of job
c) Responsibility of unfinished task
d) Fate of dependent and spouse
e) Death itself and life after world (in case of believer)
The patient may not communicate the feelings to his/her treating physicians but the doctor should remain aware about it and provide an unspoken confidence and try his/her best to relieve depression, anxiety, fear, pain and other symptomatic conditions.
In a recent survey it was found  that the state of palliative care in Bangladesh is diplorable. In a list of 80 countries in this ragard Bangladesh lies at the bottom i.e 79th  position .
The “Economist” of USA published a list of countries under title “Quality of Death Index” on 6th Oct, 2015. In this list first place was given to USA. It received 93.9 out of 100 points. Australia became second by getting 91.6 points and New Zealand became third by secuing 87.6 points . Bangladesh received 14.1 points only. The position Phillipine is just above Bangladesh. It received 15.3 points.
During terminal illness the patients’ relations also suffer from mental trauma and variety of emotions which should be taken into care with respect and tolerance by the physicians.
The doctor, nurse, social workers, hospital chaplain (Moulobi) and patients’ relations can be of help during the final hours by staying around and giving comfort so that moment of death becomes peaceful, painless and not frightening , rather a dignified cessation of functional life occurs.
 At the bed we must be kind , care-taking and respectful to the dying patient and should not lose our heart, give up our hope and turn every stone to bring him/her back to normal.
We shall also have to pass through this stages one day. We should keep in our mind:
Life is real, life is earnest Death is not its goal Dust thou art, dust returnest Was not spoken of the soul.