Palliative care physician Dr. Sunita Puri wrote recently in “The New York Times” that “death is never neat.” Dr Puri suggests that our most authentic caring for those who are dying comes at the point we are prepared to “sacrifice neatness” and to “stumble through the thicket with them.” Those who work around advanced illness and dying are all too familiar with the messiness that such illness can bring.

And yet, the most oft-used image of dying is of an old, wrinkled hand laying gently in the hand of the one giving accompaniment. This is a picture of death’s serenity and peace: its neatness. These hands are commonly used as emblematic of palliative care, a symbol of the good work we have done to provide this neatness at the end of life. For those of us working in palliative care, these hands represent the full spectrum of things we do to support people to live life with quality long before death comes to pass. These hands also do not honestly convey our most important role, not in serving tidy resolutions, but in stumbling through that thorny thicket together.