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Conversations on Dying: A Palliative-Care Pioneer Faces His Own Death
The story of the end-of-life experience of a palliative care physician who helped thousands of patients to die well.
We all die. Most of us spend the majority of our lives ignoring this uncomfortable truth, but Dr. Larry Librach dedicated his life and his career to helping his patients navigate their final journey. Then, in April 2013, Larry was diagnosed with terminal pancreatic cancer.
Unlike the majority of us, Larry knew the death he wanted. He wanted to die at home, surrounded by his family: his wife of forty years, his children, and his grandchildren. He did. He was peaceful and calm at the end. Larry proved that the “good death” isn’t a myth. It can be done, and he showed us how.
Ever the teacher, Larry made his last journey a teachable moment on how to die the best death possible, even with a pernicious disease. As hard as it is to guide patients toward dying well, it is far harder to live those precepts day by day as the clock ticks down to one’s own death, but Larry, together with author Phil Dwyer, chronicled his final journey with courage and humour.
We all die. Most of us spend the majority of our lives ignoring this uncomfortable truth, but Dr. Larry Librach dedicated his life and his career to helping his patients navigate their final journey. Then, in April 2013, Larry was diagnosed with terminal pancreatic cancer.
Unlike the majority of us, Larry knew the death he wanted. He wanted to die at home, surrounded by his family: his wife of forty years, his children, and his grandchildren. He did. He was peaceful and calm at the end. Larry proved that the “good death” isn’t a myth. It can be done, and he showed us how.
Ever the teacher, Larry made his last journey a teachable moment on how to die the best death possible, even with a pernicious disease. As hard as it is to guide patients toward dying well, it is far harder to live those precepts day by day as the clock ticks down to one’s own death, but Larry, together with author Phil Dwyer, chronicled his final journey with courage and humour.
242 pages, Paperback
First published April 16, 2016
11 people are currently reading
211 people want to read
About the author
Phil Dwyer
5 books19 followersPhil Dwyer’s asthmatic childhood contributed to a deep love of reading, an encyclopaedic knowledge of sixties British pop, and a healthy distrust for the curvature of normal lives. He was a journalist for 20 years in the UK. He moved to Canada in 2002 to work on a research project with Don Tapscott and Anthony D. Williams that spawned Tapscott’s The Naked Corporation. Dwyer is an alumni of the Humber School for Writers and has also studied writing at the Banff Centre for the Arts and the University of Toronto’s School of Continuing Studies. He has workshopped his writing with Alissa York and Charlotte Gill. His creative writing and journalism have been published in a number of publications, including The Financial Times and the Times of London, and Canada’s Globe and Mail. Conversations On Dying, his first full-length book, was published in April 2016 by Dundurn Press. His website is www.phildwyer.ca.
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Displaying 1 - 15 of 15 reviews
April 25, 2016
Conversations on Dying is a compelling read, and not just for those who knew of Larry Librach. I didn’t know of him before the book. I bought the book because I know Phil Dwyer; I read the book because I have a particular interest in what the book is about, being a community-care registered nurse who works with chronically ill and disabled members of the population.
I’m in a unique position because of the nature of my job, being able to see how some of our healthcare dollars are distributed to care for people who are not in hospitals. A lot of it doesn’t make much sense—cutting here to save a couple dollars, only to have to spend several times that amount later on. The disconnect between acute and chronic becomes pretty apparent when you’re there, working with families out in the community. There’s been a move to deinstitutionalize patients because it costs less than having them in hospitals, and because it’s better for the patients. But at the same time, the supports aren’t necessarily there—for certain members of our population, they’re not really there at all. When impending death is added to the mix, it brings along whole new layers of issues. It takes strong, educated, and fearless people to advocate for those who are sick and dying. The issues have to be examined through many lenses: personal, physiological, psychosocial, political, historical, social, just to name a few. Larry (unfortunately) ended up in the perfect position to articulate the troubles with healthcare in terms of chronic and palliative care, adding impact to his ideas and observations by not only having the professional experience behind him, but also now possessing the personal insight of a patient. If you want to see the bigger picture, then read the book. It’s so clear when it’s coming out of Larry’s mouth. Everyone deserves to die with dignity, and to die on their own terms, but most don’t get that.
I really appreciated the structure of the book. Phil is an amazing writer, and every moment chronicled—from the final days of his cancer-stricken brother, to the recounting of his heart attack, to Larry’s declining health that never seemed to affect the strength of his message—is rich with detail and reads effortlessly. It's such an accessible read, especially because of the way conversations unfold between Larry and Phil during interviews, that no one should be hesitant to pick this up for fear of not being well-versed in technical medical things to understand. I think it’s an important read for everyone—if only for the reason that dying is the one experience we all share—but in particular, I think it’s vital for us in healthcare to be reminded of our roles as patient-advocates.
I’m in a unique position because of the nature of my job, being able to see how some of our healthcare dollars are distributed to care for people who are not in hospitals. A lot of it doesn’t make much sense—cutting here to save a couple dollars, only to have to spend several times that amount later on. The disconnect between acute and chronic becomes pretty apparent when you’re there, working with families out in the community. There’s been a move to deinstitutionalize patients because it costs less than having them in hospitals, and because it’s better for the patients. But at the same time, the supports aren’t necessarily there—for certain members of our population, they’re not really there at all. When impending death is added to the mix, it brings along whole new layers of issues. It takes strong, educated, and fearless people to advocate for those who are sick and dying. The issues have to be examined through many lenses: personal, physiological, psychosocial, political, historical, social, just to name a few. Larry (unfortunately) ended up in the perfect position to articulate the troubles with healthcare in terms of chronic and palliative care, adding impact to his ideas and observations by not only having the professional experience behind him, but also now possessing the personal insight of a patient. If you want to see the bigger picture, then read the book. It’s so clear when it’s coming out of Larry’s mouth. Everyone deserves to die with dignity, and to die on their own terms, but most don’t get that.
I really appreciated the structure of the book. Phil is an amazing writer, and every moment chronicled—from the final days of his cancer-stricken brother, to the recounting of his heart attack, to Larry’s declining health that never seemed to affect the strength of his message—is rich with detail and reads effortlessly. It's such an accessible read, especially because of the way conversations unfold between Larry and Phil during interviews, that no one should be hesitant to pick this up for fear of not being well-versed in technical medical things to understand. I think it’s an important read for everyone—if only for the reason that dying is the one experience we all share—but in particular, I think it’s vital for us in healthcare to be reminded of our roles as patient-advocates.
June 11, 2016
It is more efficient to list those who would not benefit from reading this book. Here is the list: no one. No one at all, that I can think of.
Conversations on Dying bristles with actionable insights for designers and managers of Canada’s health care system, for general and palliative care practitioners, for nurses and chemo ward coordinators, for patients navigating a terminal illness and their anxious families and friends, and for people who are afraid of death and dying and want only for the topic to go away. (News flash: it will never go away. Get your grounding here.)
Author Phil Dwyer battles his British reticence to mine extraordinary wisdom from Canada’s well-loved palliative care pioneer Dr. Larry Librach, wisdom honed during Larry’s thirty-five years of providing care and comfort to thousands of Canadians seeking dignity and purpose in dying, wisdom tempered by the fire of his final four months as he observes with an analytical eye how he is deteriorating from pancreatic cancer.
Despite the unparalleled scope of his experience, Larry encounters surprises when it is his turn to face the final frontier. In this book, his voice so predominant, true, and powerful that he is in effect co-author with Phil Dwyer, Larry shines light on those surprises, dismantles myths, and exposes inefficiencies and callousness in Canada’s patchwork palliative care system. What Phil has done is sculpt Larry’s insights and his own into a manual for all those moved to make dying better for those doing it (pretty much everyone).
Diagnosed with cancer and want to avoid being a “burden” to your family? Read this book. Larry is dogged about the need for patients to communicate widely and truthfully, and shares tips on how and when to do it. Withdrawal and stoicism, he says, don’t work. Communicating actually reduces suffering for families, including children, and gives those who care about you the priceless, sustaining gift of knowing they helped.
Caring for someone who is dying and not sure what to expect? Read this book. Larry replaces fear with facts about the various stages the body goes through when it is shutting down: debilitating weakness (far more encompassing than people realize), confusion, agitation, changes in taste, disinterest in food and fluids, withdrawal, and more. He addresses the value of blood tests and CT scans, clarifies what chemo can and can’t do (at best extends life but cannot cure), and shares his rich and comforting definition of miracles and hope.
In the health care system (a GP, the person behind the desk in the chemo ward, a nurse in Emerg, a systems engineer), possibly inured through over-exposure to the patient’s perspective on how things work, yet open to ideas that would make a difference and save tax dollars? Please, read this book.
Here’s a quick dip into the quality of Phil’s prose and a window into Larry’s humanity, just after Larry’s doctor has delivered the bad news.
No matter what side of the conversation on dying you’re on, you can’t do better than to read this book.
Conversations on Dying bristles with actionable insights for designers and managers of Canada’s health care system, for general and palliative care practitioners, for nurses and chemo ward coordinators, for patients navigating a terminal illness and their anxious families and friends, and for people who are afraid of death and dying and want only for the topic to go away. (News flash: it will never go away. Get your grounding here.)
Author Phil Dwyer battles his British reticence to mine extraordinary wisdom from Canada’s well-loved palliative care pioneer Dr. Larry Librach, wisdom honed during Larry’s thirty-five years of providing care and comfort to thousands of Canadians seeking dignity and purpose in dying, wisdom tempered by the fire of his final four months as he observes with an analytical eye how he is deteriorating from pancreatic cancer.
Despite the unparalleled scope of his experience, Larry encounters surprises when it is his turn to face the final frontier. In this book, his voice so predominant, true, and powerful that he is in effect co-author with Phil Dwyer, Larry shines light on those surprises, dismantles myths, and exposes inefficiencies and callousness in Canada’s patchwork palliative care system. What Phil has done is sculpt Larry’s insights and his own into a manual for all those moved to make dying better for those doing it (pretty much everyone).
Diagnosed with cancer and want to avoid being a “burden” to your family? Read this book. Larry is dogged about the need for patients to communicate widely and truthfully, and shares tips on how and when to do it. Withdrawal and stoicism, he says, don’t work. Communicating actually reduces suffering for families, including children, and gives those who care about you the priceless, sustaining gift of knowing they helped.
Caring for someone who is dying and not sure what to expect? Read this book. Larry replaces fear with facts about the various stages the body goes through when it is shutting down: debilitating weakness (far more encompassing than people realize), confusion, agitation, changes in taste, disinterest in food and fluids, withdrawal, and more. He addresses the value of blood tests and CT scans, clarifies what chemo can and can’t do (at best extends life but cannot cure), and shares his rich and comforting definition of miracles and hope.
In the health care system (a GP, the person behind the desk in the chemo ward, a nurse in Emerg, a systems engineer), possibly inured through over-exposure to the patient’s perspective on how things work, yet open to ideas that would make a difference and save tax dollars? Please, read this book.
Here’s a quick dip into the quality of Phil’s prose and a window into Larry’s humanity, just after Larry’s doctor has delivered the bad news.
“Larry had been on the safe side of this conversation hundreds of times before. It didn’t inoculate him from the impact of the news. Time, that elastic, malleable but ultimately stable measurer of our days, broke open, ceased to obey its customary rules. It was as if it were still running along, outside of him; as if everyone else was still pounding down its path, but whatever mechanism had attached him to that same treadmill had broken, disconnecting him. And into that silence, that sudden darkness, that crack that opened up in his world, poured all his grief and fear. The chaos of unknowing. As Larry described it, it felt like an implosion of all certainties.”
No matter what side of the conversation on dying you’re on, you can’t do better than to read this book.
May 2, 2016
An important contribution to the literature on end of life decision making and the issues involved in care, from primarily a Canadian perspective, I appreciate this book's willingness to explore vulnerability, failures, and struggles we have in providing comforting end of life care. Lots of things to discuss, so good choice for book clubs, adult study groups.
August 25, 2025
it was a life changing book. I didn’t want to review it for a long time because of how much it resonated with me and how i didn’t want to put an arbitrary rating on something so powerful. But it really helped me shape my thoughts on a lot of things and I think about this book often. I think everyone should read this as it gives you so much knowledge about the healthcare system ans palliative care, as well as lots of touching and emotional personal stories. I can’t think of any downsides. Highly recommend :”D
September 5, 2016
Informative and deeply moving, Dwyer weaves stories of his brother’s harrowing end of life with lessons and insights from a pioneer in palliative care who faces his own untimely death. In asking what constitutes a good death, Dwyer provides an engaging and elegant examination of the challenges we face, both as individuals and as a society, while deftly illustrating how palliative care possesses the tools and skills to relieve suffering for a humane, respectful passing.
The urgency of this issue is undeniable. Despite forty-two years of formalized, quality palliative care in Canada, only 15% of Canadians who need it are lucky enough to receive it. This is a stark reality, where ignorance, lack of political will, and outdated health-care models deprive the dying of what should be a fundamental and guaranteed human right: the right to a humane, dignified, and gentle end of life.
Conversations on Dying provides a compelling, insightful, and timely contribution to this crucial issue that all of us will face.
The urgency of this issue is undeniable. Despite forty-two years of formalized, quality palliative care in Canada, only 15% of Canadians who need it are lucky enough to receive it. This is a stark reality, where ignorance, lack of political will, and outdated health-care models deprive the dying of what should be a fundamental and guaranteed human right: the right to a humane, dignified, and gentle end of life.
Conversations on Dying provides a compelling, insightful, and timely contribution to this crucial issue that all of us will face.
June 12, 2016
Conversations on Dying is about one of my favourite topics - hospice palliative care and death and dying - so perhaps that makes me an ideal reader (or an idiosyncratic one!). In addition, I knew Larry Librach, the subject of the book, and, in Dwyer's words, the "godfather" of palliative care - not personally - but I had heard him speak eloquently and passionately at palliative care venues, and I had followed his career. The book chronicles Librach's life as he approaches its end. Diagnosed with pancreatic cancer, he was given two months to live and stretched that out by a couple of months. During that time, he met weekly with the author to talk about what it was like to die, from someone who had cared for dying people for much of his life. Larry had a curiosity about life and he brings that to bear on the process of his own dying, as he yearns to help people better understand what dying is like for the dying person. I was particularly struck by his discussion of fatigue and weakness near the end of the life and his wish that more oncologists would understand this better. Though I've worked with hundreds of people who are dying in my hospice volunteer role, I learned a great deal from Larry's story, and from the parallel story of the death of Dwyer's brother. Highly recommended.
May 14, 2016
An important and very interesting book. Gave me more insight into how a person feels as they are dying and the difficulties encountered. I found the book confusing when Dwyer would suddenly throw in his brother's death and his own encounter with a heart attack to add more interest and more information. Larry Librach's story is more than enough.
December 11, 2017
I had the privilege of meeting Larry (Dr Librach) at a number of different Canadian palliative care conferences and meetings. He was a leader in the field and served as a mentor to many. This book captures him as an educator and student of life up until his death and allows readers to continue learning from his life. Thank you Phil Dwyer for capturing Larry's legacy and honouring his life in this way. This book provides insight into living until you die and is an important read for us all.
July 1, 2019
A perfect mix of personal experience, engaging interviews and critical research. Why is it so easy to avoid talking about dying? Why are the tough questions so hard to face? Conversations on Dying dispels some of the unnecessary mystery that we cloak death in and helps readers come to terms with the real issues palliative care patients and their families face.
August 14, 2019
excellent and approachable read of Canadian Palliative Care doctor's journey towards death as well as critique of Canadian health care system. Has much to relate to US health care as well as understanding what dying people experience emotionally, physically, and spiritually.
March 25, 2024
A good book to not only read about the journey of death of a friend, but also to learn facts throughout the day, such as the impact of caregivers, palliative care, social support, and what can happen to one with pancreatic cancer.
This entire review has been hidden because of spoilers.
October 8, 2018
Informative, honest and direct. The courage it took to document this journey is commendable.
May 30, 2021
A well written book on a topic that is not discussed as openly as it could be. I learned a lot that I will be able to use both in my work & personal life. Absolutely would recommend.
March 11, 2023
Very good book. We think about end of life and what we can do to have a good end.
September 20, 2016
There's something about reading a story about a man who's dying that makes you reflect on your own life. This is a story about the state of palliative care in Canada... all told via the personal story of a palliative care physician who has terminal pancreatic cancer. It's not morose, it's eye-opening. An important book.
Displaying 1 - 15 of 15 reviews