The online series A Good Death is a CBC News co-production with students from the Graduate Program in Journalism at Western . | MORE

Jay Graham sits up in bed at St. Joseph's Parkwood Hospital in London, Ont. Scattered around him are chocolate bar wrappers, empty pop cans, DVDs and an instruction manual for the video camera he got a few months ago. Graham had been in the palliative care unit for the past eight months, waiting to die.

It had taken the 43 year-old six years to accept that he was dying; mostly, he said, because his doctors didn't say the words.

When Graham's doctor first told him that he had non-Hodgkin’s lymphoma, he wasn’t concerned. Jay Graham and Nicole Case. Graham was a palliative care patient at St. Joseph's Parkwood Hospital in London, Ont. He died on April 25, 2011. Nicole Case, a student in the graduate journalism school at the University of Western Ontario. Courtesy of Nicole Case/Western

“When I was diagnosed, I took the nonchalant perspective,” he said. “I was laughing and having a good time. I was like, I can get rid of it. I can get rid of anything.

“But evidently, it turned out that I can’t get rid of it.”

Last year, one of his doctors told him that he was in a “bad position.” No one said the word “dying” so Graham assumed he would still recover.

“I was fighting it in my own way,” he said.

Graham’s experience is all too common. According to Dr. David Kuhl, a former palliative care physician in British Columbia and author of What Dying People Want, doctors tend to avoid discussions of dying with their terminal patients.

They unintentionally obscure the message, or push for treatments that they know won't be effective, instead of acknowledging to the patient that recovery is no longer an option. As a result, the patient can be harmed more than helped. In researching his book, Kuhl found that most patients’ pain and suffering came from interactions with doctors, not the disease itself.

“There’s a lot of insensitivity in the way doctors communicate,” he says. “It comes from our own discomfort, but it has a devastating effect on patients."

Dr. Joshua Shadd, a palliative care specialist and professor at Western’s Schulich School of Medicine and Dentistry in London, Ont., says doctors do such a poor job of coping with dying patients because they view death as a professional failure, a concept that “is now deeply ingrained in medical culture." Dr. Joshua Shadd, palliative care specialist, says doctors see death as a failure.

But Kuhl is trying to change how doctors communicate with terminally ill patients.

He says that patients who have direct and straightforward conversations with their doctors tend to come to terms with their deaths sooner.

“Patients would say ‘once I was told that I was dying, that I had six-to-12 months to live, that’s when I could start living’,” he explains. “’That’s when I started asking spiritual questions, when I determined which relationships were important, and when I determined what I still needed to do.’”

Still, there is a role for indirect language and metaphor when it comes to talking about death, says Dawn Dyer a chaplain at Parkwood Hospital, and that is to help the terminal patient communicate to others.

“Death is an experience that we can only observe from the outside, not the inside. There may not be a common language that exists to describe the experience,” she says. Dyer remembers one palliative care patient who always spoke about flying. As he approached his death, he began to talk of “catching a flight” or “being late for a flight.”

“Turned out he was an air force vet,” she says. “And he was talking about taking the last flight — the one that would take him away from the confines of his illness.”

But patients' metaphors can sometimes create misunderstanding and upset, too. One of the more common metaphors that Dyer has seen used is that of “home." She says dying patients often say they want to return home — causing confusion for family and staff.

“What’s home for them? If they’re saying they want to go to a place of comfort, where they’ll feel at peace — where is that? Are they speaking metaphorically or are they speaking literally?” she explains.

Dr. Sharon Baker, a palliative care specialist at London’s University Hospital, emphasizes the importance of clarity and honesty but she prefers using the term “end-of-life journey” in place of “dying” when speaking with terminal patients. She believes it is a more accurate description.

“The word ‘dying’ takes away our recognition of how much is happening,” she says. “Death can be one of the most life-affirming times and so to just use a term like ‘dying’ seems like you’re turning out a light.”

“When you use language that’s comforting, it changes the room.”

Back in Graham’s room at Parkwood, he made changes that helped him come to terms with dying. He was able to speak openly with the doctors and nurses, and appreciate what time he had left.

“I feel unlucky that I’m in my shoes. But it’s a good way to go. Here at Parkwood, it's like going out on a cloud.”

Editor's Note: Jay Graham died on April 25, 2011 at Parkwood Hospital.