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In the 90s, my friend and fellow journalist Dom Phillips was at the centre of the UK's dance music explosion. By 2022, he had mysteriously disappeared in one of the remotest parts of the Amazon jungle. with his friend Bruno Pereira. In 2025, so many questions remain. I'm Tom Phillips, The Guardian's Latin America correspondent. Listen to Missing in the Amazon wherever you get your podcasts.
Welcome to The Guardian Long Read, showcasing the best long-form journalism covering culture, politics and new thinking. For the text version of this and all our long reads, go to theguardian.com forward slash long read. You can let go now. Inside the hospital where staff treat fear of death as well as physical pain by Liene Wobben. Read by Freya Miller.
René Damgaud, 67, lies in a hospital bed in the palliative care unit at Vidovre Hospital outside Copenhagen. It's the first evening of May, and the window is open. letting mild air and the sound of a blackbird singing into the room. This is the kind of weather you love the most. When you usually stand and fish at the sandbank, says his niece, 53-year-old Mede Damgo.
She's leaning over the bed, her face very close to his. She's been sitting like this for a long time. René has his eyes closed and his mouth is slightly open. The evening light falls across his gaunt face, and he looks as though he's sleeping. He's not. He's dying. I will take care of you, Mida whispers. He nods. She strokes his hand and squeezes it. You can let go now, René. There is a moment of silence, then he whispers. Remember to say goodbye to everyone from me.
I will, René. I promise. The way we die is a topic of a heated debate in Denmark, as in many other countries, including the UK. The government wants to introduce medical aid in dying and in 2023 set up a committee which presented its various opinions in January this year. Palliative care is often highlighted as a counterweight to the offer of assisted dying. To witness the treatment of terminally ill patients,
I was given access to the Palliative Care Unit Section 126 at Vidoa Hospital for 10 days in April and May 2024. Unlike the rest of the hospital, Section 126 isn't focused on cure, but on relief. In this unit, terminally ill patients like René receive help to deal with their pain, nausea and other symptoms from doctors and nurses.
specialising in palliative care. But the staff in this section don't just administer morphine and methadone through IVs and injections. They also assist patients and their families with the grief of saying goodbye. the pain of leaving life, and the fear of death. Many of the patients we receive are referred due to physical pain, but they can also experience breathlessness, anxiety and existential suffering.
We call this total pain, says Dr. Johan Randin. Originally from Malmo, he trained as a general practitioner in 1996 and has been working in palliative care for more than 10 years. He has encountered several patients who talk about assisted dying. Some of them think on receiving their diagnosis that they want to end their life then and there and might as well get it over with. But they can also live.
And I find that when they receive the right support, they let go of that thought. Sire Nilsen, 65, an experienced nurse, adds, It's healthy people who want to introduce a sister dying. but the patients we meet here want to live they do not want to die every morning in the palliative care unit starts with a meeting in the staff room at the end of the hallway on this monday in april
Doctors, nurses and the unit psychologist and social worker gather around a table to talk through the patients in their care. A middle-aged man is in such severe pain that he can barely be touched. Another needs to be discharged to a hospice. A third patient requires a Polish-speaking interpreter. And then there's a male patient who is in a very bad psychological state. He feels lonely.
hasn't slept all night and wants to hold hands all the time, says Nilsen. He is really in a deep crisis. The man is not psychotic or suicidal, but he needs someone who listens. We can't change his life circumstances, but I've told him, you need to stay here until you feel safe, she says. The psychologist has made an appointment with him.
and he's also been asked if he wants to talk to a priest. After half an hour, everyone gets up. An alarm flashes above the door. Nurses are needed in several rooms, and doctors are preparing for rounds. Some of them are going on home visits with the unit's palliative mobile care team. A small sign outside each room has a handwritten message, name and a drawing. Welcome René, it says outside room 14, next to a drawing of a tree.
René was admitted on Monday morning. He came from the hospital's pulmonary unit, where he'd been for almost a month. René's eyes looked large in his hollow face, and his hair is a bit dishevelled. his bones are prominent at his shoulders and wrists and his muscles have shrunk he started having back pain before christmas and the doctor thought it might be a herniated disc
He also got tired a lot and felt cold. He was sent to a physiotherapist who couldn't help him, and one day in late March, an ambulance brought him to the hospital with severe pain. The paramedics thought it was intestinal obstruction. But then they found cancer everywhere, he says. The disease had started in his lungs, but had spread to his liver and bones.
Nilsen enters the room and reminds him to drink more, he promises. As long as it's only water, he says. He quit drinking in 1996, he tells Dr Randin. Well done, says Randin. he sits on the bed and asks how they can help him he's short of breath lacks appetite he says and then there's the pain a burning sensation it sits under his shoulder blade
I know what's going to happen, says René. What's going to happen, asks Randine. My life is coming to an end. What do you think about that, asks Randine. It's too early. but it's not up to me to decide. He was offered chemotherapy but declined. He doesn't know if he has a week or a month left to live. And chemo makes you really sick.
I'd rather spend my time feeling good. Randine understands. He says, that's not how you should spend your energy. He explains that it's important to speak up as soon as he feels the pain. Pain is like fire. You can easily blow out a candle. But if the fire spreads and the whole kitchen goes up, it's hard to extinguish. It takes time for the medicine to work, so you need to tell us as soon as you feel the first flame.
René notes. I've never been good at asking for help, he says. As soon as the pain is under control, he wants to move back to his flat where he lives alone. His niece has rearranged his flat, and everything is ready for him to spend his final days there. Do you have any children? asks Randine. I have a son, says René. Do you have a good relationship with him? No. Does he know you're sick? No. Out in the hallway, Randine stops and talks to Nilsen.
Maybe we should ask René if he wants to write a letter to his son, he suggests. Randine says one of his most important tasks is to listen to the patients. You can run all kinds of blood tests and scans, but if you don't talk to the patients about what they want, it's pointless. You must talk to them and touch them, he says.
It's the experience of Randine and his colleagues in the palliative care unit that no one else in the healthcare system has talked to the patients about the fact that treatment could extend life yet diminish its quality. especially towards the end. Many doctors shy away from talking about death. They keep treating the patients until the very last moment before they finally say, now there's nothing more we can do.
But then there is no time left for the patient to prepare themselves for death, says Randine. There are three things that are important for someone dying to get the opportunity to say to the right people, Randin says. Forgive me, I forgive you, and I love you. you Life is too short for bad coffee, says Nils Abrahamsen, who is 63. He pours freshly ground coffee into a glass pot from a small bag his wife Regge has brought.
He smells the freshly ground beans and says, Ah! On his bedside table is a box of luxury chocolates. Life is also too short for bad chocolate. Abrahamson often uses that phrase, he's a bon vivant. He was diagnosed with stomach cancer in January 2020, but even with a death sentence hanging over him for four years.
He's not lost hope, he says. In February, he had a stomach bleed, and after radiation therapy to stop it, he experienced severe pain. In recent weeks, there has been a build-up of fluid in his abdomen. and a few days ago he was admitted to the palliative care unit to relieve his discomfort. Erbar Hampson's approach to illness is holistic, he explains.
On his bedside table are various exquisite dietary supplements, as he calls them. He does not like medication, especially not chemotherapy, of which he has had about 30 treatments. He likes the palliative unit compared with the gastro unit in the hospital where he was initially admitted and where everything was complete chaos. They are more professional here, more experienced.
And they have time to sit down and hold your hand, he says. He has settled into his room with a yoga mat and a stack of magazines. He also unpacks a Bluetooth speaker his wife has brought. so he can listen to good music, because life is also too short for bad sound. The doctor enters to check on him. His abdomen is swollen with fluid.
and during the night he paces the hallway restlessly. Randine wheels in an ultrasound machine, sits on the edge of the bed, scans and gently feels Abrahamson's stomach. They discuss whether to try to drain some of the fluid or wait a while. We'll take it step by step and see what we can do for you, says Randine. He sits for a moment, quietly.
patting his patient's hand. Ebrahimsen begins to cry. What's happening? Randin asks. It's you, Johan. You are the most attentive doctor I've ever met, says Ebrahimsen. He covers his face with his hands as tears stream down. It's not easy, I know, says Randin. The nurses move quickly down the corridors, keeping an eye on the clock and the flashing alarms. However, when they enter the patient's rooms, the pace is often different. They speak softly.
and take their time. Patients and relatives talk about a unique calm atmosphere in the unit, a stark contrast to the hospital's other departments. a middle-aged man enters the corridor in his hands he holds two large boxes of cream puffs which he places in the nurse's office his wife died in the unit a month ago They were admitted together up until her death. We had talked about coming home to die, but she felt most secure here, he says. Now he wants to say thank you.
I promised my wife that I would come back and properly say goodbye to the staff. But it was difficult to walk through the door to the unit. This is where I saw my wife for the last time, he says. The man gets a cup of coffee and talks at length with two of the nurses. One of them places a hand on his shoulder. His eyes fill with tears. We don't just take care of the patients, we also take care of the relatives, their emotions and their grief, says Nilsen later.
She has saved some of the many thank you cards and letters she has received over the years. There are also several memorial cards from patients funerals she has attended. You don't just distribute food. Make the beds and give medication. You also embrace them and care for them, she says. Liu Simonsen is being visited by one of her three daughters and two grandchildren. The youngest crawls into her bed and cuddles up to her. The girl doesn't say much, but shows with her hand how old she is.
Five fingers. On the wall of the room hangs a child's drawing of a princess in a castle. Simonsen is 70 and had just retired from her job as a speech therapist. when she was diagnosed with breast cancer in 2020. She was declared cancer-free in 2021, but in January she experienced back pain.
The doctor thought it was muscle pain and just wanted to give me pills, she says. But when she was admitted to casualty with severe pain, they sent her for a further examination. It turned out that the cancer was back. and had spread to her spinal cord and bones now it's incurable when simonsen was admitted to the palliative unit last week the pain was so intense she couldn't get out of bed
She has never been able to sit still. Three months ago she was swimming and playing volleyball and paddle. And now here I am, she states quietly. She lives in a townhouse in Elbortslund with her husband Jens. Together they have five children and ten grandchildren. He is also admitted in the room. His bed is placed close to hers. The oncologist's plan is to keep the disease at bay with oral chemotherapy. But only if Simonsen recovers strength enough to move around.
otherwise they will have to stick to life-prolonging treatment she explains and first the pain must be under control A nurse brings a small brown pill that Simonsen needs to take to muster the strength for later when his sister comes to visit. Randine prescribed the morphine-based drug oxycodone. Initially, she wouldn't take it.
I freaked out when he mentioned it, because I've heard on TV how people can become addicted to opioids. Randine explained to her that it was for the pain, not for fun. And now I'm glad. It's really nice not to be in so much pain. But when the pain is under control, you start to think, she says. And then you get sad. I told Cyril earlier that if I start crying, it feels as if I can't stop, she says. But when my grandchildren are here, I don't cry.
Thanks for listening to The Guardian Long Read. We'll be back after this. ServiceNow puts AI to work for people across your business, removing friction and frustration for your employees, supercharging productivity for your developers, providing intelligent tools for your service agents to make customers happier. All built into a single platform you can use right now. That's why the world works with ServiceNow. Visit servicenow.com slash UK slash AI for people.
My friend and fellow journalist Dom Phillips was at the centre of the UK's dance music explosion. By 2022, he had mysteriously disappeared in one of the remotest parts of the Amazon jungle with his friend. Bruno Pereira. In 2025, so many questions remain. I'm Tom Phillips, The Guardian's Latin America correspondent. Listen to Missing in the Amazon wherever you get your podcasts.
Welcome back to The Guardian Long Read. Randine looks at the CT scans of René Damgault on a computer. It looks like a map. His bones, lungs and other internal organs depicted like islands in a sea of white and grey. Randine Scrolls zooms in. and points to numerous small and large black spots and shadows. Cancer. There, there and there. It's everywhere and it's causing him pain, Randine says. Even though they can't cure or treat the cancer, there is plenty they can do to give him relief, he says.
René has dozed off with a crossword and quiz magazine in front of him on the duvet. His niece, Mid, drops by straight from her job as a department head at a school nearby. She has brought a popsicle for him. called champagne. This is the only type of champagne we used to celebrate, she says. They both laugh. She has big curly hair and smiles a lot.
she is the daughter of rene's older brother and there are only fourteen years between uncle and niece her father died of cancer when rene is no longer here There won't be anyone around anymore who's known me my entire life, says Mide. René worked in shipping as a hospital porter and in IT. While he's been in the hospital, he turned 67.
and is now officially retired. He was supposed to be spending all his time on his hobby, fishing. Instead, he's scheduled to be discharged on Monday to die at home.
and his niece has applied for care-leave so she can be with him as much as possible you can sit by the window and see the new leaves on the beech hedge and we'll eat good food i've stocked up on frozen meals she says she has arranged home care from the municipality up to twelve times a day still she worries about her uncle being in pain for the doctors and nurses in the unit
It's important to prepare the family and the patients for death, so it doesn't end in helplessness and chaos. But it's not always possible, says Randin. The patients hardest to handle... are those who don't want to talk about death and do everything they can to avoid facing it especially young people and mothers with small children they fight with everything they have
Understandably, he says. Even though most dying people want to be at home, patients and relatives can become uncertain or overwhelmed in the final days and hours. And then the dying person gets admitted to hospital, stabilised and perhaps sent home again, only to end up in the hospital again a few days later. Sometimes it ends up in what I call...
blue light deaths, where a patient is rushed in by ambulance, dies on the way, is resuscitated, and maybe doesn't regain consciousness and never gets a chance to say goodbye. That's not a dignified death. says randine during the night just before the weekend rene gets a fever he wakes up with chattering teeth the next morning his skin is still sweaty
Randine examines him, first thing. I think you have pneumonia, so take it easy. No dancing today, the doctor says, prescribing antibiotics. We need to get you back on your feet. You still want to go home on Monday, right? René struggles through a handful of pills with the help of a protein drink. Nilsen arrives. I'll open the curtain so we can get some sunlight in.
It'll make the day a bit better, she says. She starts preparing everything for his discharge, so he will get all the help and care he needs for his final days. Wound care for his bed sores. a form to say his condition is terminal so all medication is free of charge. She also notes down the phone number for the emergency nurse so he and his niece have someone to call.
But Nielsen doubts he will make it until Monday morning. Pneumonia is serious in his condition. He might die over the weekend, she says, adding, I'm just being realistic. The most important thing is that he's not in pain. We're chasing the good days. For Liv Simonsen in room 11, it's a bad day after several good ones. She feels nauseous and sits up in bed with a small plastic pill cup of medicine in front of her and a smoothie beside her bed.
She can't get either of them down because she has an upset stomach. It started last night. I threw up and got really tired, like I was hit with a hammer, she says. Three small pills remain. Randine enters and sits down on the edge of the bed. He listens to her stomach with a stethoscope. Nausea can have many causes. Sometimes it's an imbalance in the body.
sometimes it's the medication sometimes it's anxiety it all feels the same he says nilsen has joined them she wants simonsen to get out of bed You need to get up and brush your teeth, and then we'll get you in the wheelchair and wrapped up so you can sit on the terrace in the sunshine. It's better for your appetite and your mood, she says firmly.
Simonsen is grateful for the way she's treated, that Nilsen constantly reminds her to make the most of the time she has left. Nils Ebrahimsen has had trouble sleeping. He usually stays active by doing exercises, but hasn't had the energy in recent days. He is increasingly worried that the fluid in his abdomen is due to the cancer spreading.
he's asked for a ct scan he keeps up with music both big stars and new names and he has tickets for a bruce springsteen concert in july and a local music festival in august He also bought tickets for the Euros in Germany which he hopes to attend with his 19-year-old son who graduates from high school in a couple of months. It's going to be huge. I must be there, he says.
However, he knows he can't travel in his current condition. He takes more morphine than he'd like. And then my stomach gets constipated and I get sluggish and forgetful, he says. he takes a walk on the grass outside the hospital and performs an exercise routine in his socks among daisies and bushes he does this every day all year round at home in his own garden he says
Now I feel almost reborn, he says afterwards. René is scheduled to be discharged on Monday morning, but that doesn't happen. Over the weekend, he gets delirium. a condition with hallucinations that often affects the dying and very sick he has seen visions of his mother and father and when nilsen arrives he is crying
Nilsen doesn't think he's well enough to go home. What are you afraid of? Are you afraid to die? The way she says it sounds like a mix between a question and a statement. Damgo doesn't respond.
i will make the decision for you now i can't send you home when you're in this state she says rene cries so hard the bed shakes he raises his hands to his face he finally says it's good for you to cry it's okay to let it out says nilsen stroking his short grey hair a little later she gives him a shot of sedative and makes a call to cancel the transport home she also gets hold of his niece mede ren was supposed to get a visit at home from his son whom he hasn't seen in years
Mede arranged it. She promises to make sure the son pays a visit to his father at the unit instead. Randine has just arrived. He hasn't even taken off his backpack when he goes in to see Renée. He is still crying and upset about having to cancel the transport home. The doctor explains the hallucinations. About 80% of dying patients experience them.
It feels like dreaming while you're awake. Sometimes the patients see people from their past. It can be frightening. The room is quiet. Randin holds his patient's hand. and just sits there for a long time eventually renne calms down the medicine is working Nielsen walks down to the nurse's office with a bag of medication Renée was supposed to take home. I had packed everything, but things never go as planned here, she says.
She talks about a young female patient who was severely troubled by hallucinations before she died. It was very scary. She saw shadows that wanted to take her. They surrounded her in the room. Nilsen moved her patient's bed into the hallway and lay down with her, holding her. It was the only thing that helped. She was terrified.
Every Monday, a musical duo visits the unit to play for the patients. It consists of a guitarist and a singer who knock on each door and ask if they can come in to sing a song. They are welcomed into three rooms. They play Somewhere Over the Rainbow to an 80-year-old woman who has been in the ward for a few days. She appears to be asleep. And 20 minutes after the musicians leave...
She takes her last breath. Later that day, René's niece Mede arrives. He feels better after the decision has been taken about staying in the ward. He has eaten two cups of yogurt, and in a few hours his 39-year-old son, whom he hasn't seen in four years, is coming to visit. Now that the meeting is approaching, he's worried that his son might be angry with him. But he wouldn't come if he was very mad, I guess, he says.
Although he's been sober since 1996, many things remain unsaid between them. And I know I was a jerk at some point, he says. But a lot of good things have happened since, Meda reminds him. René's son arrives precisely at the agreed time. Randine and Nurse Nilsen greet him at his father's bed. When they leave, Nilsen shows that she has goosebumps on her arm.
Randine takes off his glasses and wipes away a tear. He and Nilsen hug. They get to say goodbye and it's good for the sun and good for René. He can leave at peace with himself, Randine says. He often finds himself crying. René's son stays for a long time. When darkness falls, he's still there. has felt better over the weekend. The pills are working, reducing her nausea. She's been out on the hospital's roof terrace in a wheelchair several times. She's eaten ice cream and had many visitors.
When the pills work, I become weightless, she says. Handeen and Nilsen want to persuade Simonsen to accept a temporary stay at a hospice facility. where she can regain more strength before possibly going home. They sit down in her room. Last week we talked about apathy. You were very sad, but it seems like you're in a different place now.
says randine yes it was a low point but i feel better i can talk about the future she says her home is not set up to provide the necessary help yet so she accepts the suggestion of receiving care at a hospice facility randine walks towards his office to write the referral as he makes his way down the hallway he performs small Joyful dance steps. The next day, René's condition has worsened. His hallucinations have intensified during the night. And now he's crying again, feeling frightened.
After a conversation with Randine and Nilsen, he agrees to a combination of sedatives and painkillers that might cause him to fall asleep and not wake up. We talked to him about the possibility that he might not see Mede and his son again, but he was completely at peace. He wants to go to sleep now, says Nilsen afterwards. This process is known as palliative sedation when terminally ill patients are given medication to relieve pain and reduce anxiety and distress with a possible side effect.
of shortening life and causing loss of consciousness. He shouldn't have to experience what he went through last night again. It's too cruel, says Nilsen, as she prepares the mixture in the medication room. She sets up a pump by René's bed that will provide him with a continuous doze. She inserts a drip into his upper arm, just above a tattoo of the logo from F.C. Copenhagen.
the silhouette of a blue lion's head the muscle and the lion have shrunk ren opens his eyes she strokes his hair are you in pain He shakes his head and points to his mouth. But your lips are dry. Nilsen fetches small sticks with firm tips, which she dips in water and uses to moisten his lips and tongue. He says something. It's hard to hear. He repeats it in a barely audible whisper. I'm sorry. No need to apologise. Now sleep, she says.
Nilsen calls his niece and explains what's happening. On his way home, Randine passes by René's room. The frown line on his forehead is gone, he says. After a few frustrating days of waiting, Nils Ebrahimsen finally gets the CT scan he requested. It takes place in the hospital basement. He performs stretching exercises against the machine.
before lying down on the bed and being rolled into the scanner tube. Soon I'll find out if it's the worst case scenario, if the cancer has gone wild, or if it's just fluid accumulation, he says. when he gets back to his room. The next day, Abrahamson is informed that the cancer has spread. He is offered a place at a hospice facility, which he accepts.
Just before midnight, the night nurse assesses that Renée doesn't have much time left. She calls Mede, who along with her husband, arrives at the hospital and sits by her uncle's bed. René's breathing rattles slightly, but otherwise the room is quiet, with only a single lamp lit. There's not much left of you, says Mide, stroking his bony hand.
a few days ago they had talked about the funeral maida suggested that her uncle's ashes be scattered over the sea at the sand-bank where he used to fish so you'll be out there when we swim and sail she said. He liked the idea. She reminds him again. She tells him to imagine fishing at sunrise, the water shimmering like gold. And you're in your boat. sailing towards the sun she says time passes in silence rene's breathing is bubbling and rasping but behind his chest
His heart is still pounding hard. He has trouble letting go, Maeda thinks. Yesterday, he said he would miss all of us. René dies just after sunrise at 5.57am. Afterwards, he lies peacefully in bed with a slight crooked smile. The morning light shines into the room. Randin stops by to say goodbye before he's taken away. He stands for a long time, looking at René with his head bowed.
He was a wonderful man, he says. Meda cries as she hugs the doctor. You've been so fantastic, she says. Meda's sister. has also arrived, and they stand side by side as the porter takes their uncle to the chapel. He's been dressed in his FC Copenhagen jersey. Between his hands... they've placed roses and gebras Thanks again for listening to The Guardian Long Read. That was You Can Let Go Now. Inside the hospital where staff treat fear of death as well as physical pain by Lina Vauban. Read.
This article is nominated for the 2025 edition of the European Press Prize. in the distinguished reporting category, originally published in Danish by Politiken. René Damgaard was buried on the 15th of May. Nils Abrahamsen died at the hospice. on the 31st of May. Lou Simonsen returned home after a stay at the hospice. For more Guardian Long Reads in text and a selection in audio, go to theguardian.com forward slash long read.
Here's the truth about AI. AI is only as powerful as the platform it's built into. ServiceNow puts AI to work for people across your business, removing friction and frustration for your employees Supercharging productivity for your developers, providing intelligent tools for your service agents to make customers happier. All built into a single platform you can use right now. That's why the world works with ServiceNow.
Visit servicenow.com slash UK slash AI for people. In the 90s, my friend and fellow journalist Dom Phillips was at the centre of the UK's dance music explosion. By 2022, he had mysteriously disappeared in one of the remotest parts of the Amazon jungle with his friend Bruno Pereira. In 2025, so many questions remain. I'm Tom Phillips, The Guardian's Latin America correspondent. Listen to Missing in the Amazon wherever you get your podcasts.