I’ve told my children that when I die, to release balloons in the sky to celebrate that I graduated. For me, death is a graduation. ~Elisabeth Kubler-Ross (1926-2004)
Living well and leaving well
When a terminal illness progresses a deep feeling of loss may occur in these patients and their family. Nothing can take away the feeling of loss. But having information on the dying process may help their family to know what to expect and how to respond in ways that will comfort patients. Each person’s dying process is unique, so it is not easy to say exactly what will happen, but there are some signs and symptoms indicating that death is near.
Becoming very weak
Patients will gradually become very weak and feel more tired and drowsy. They will find it difficult to move around and spend most or all of the time in bed. As time goes on they may show little interest in their surroundings. Even if the patient is unable to respond, they are still able to hear. So it is important to continue to touch and talk to them, move them regularly to keep them comfortable, sit with them and be close to them.
Confusion, Hallucination, or Akathisia
Confusion or hallucination may happen because of medications or changes in the chemical balance of the brain. Or it could be a process of detaching from this life and preparing for transition. People may see or hear things that are not there. Some people may see people who already passed away and talk to them. Do not belittle or argue what they experienced; just affirm their experience and explain it is a natural process. Some people may experience restlessness and seem to be in distress. Ensuring the patient’s safety and keeping the environment relaxing and free of noise may calm the person down and relax his/her family. If necessary, there are medications that can be used.
Changes in breathing
Changes in breathing may be experienced in the last days or hours of life. Breathing may become irregular, deeper or rapid and then there may be a pause before breathing begins again. Breathing may become worse if patients are anxious. Therefore, just sitting quietly and holding patients’ hand can make a real difference. In addition, using a couple of pillows to keep the head up at least 30 degrees and using fans to keep the air circulating would alleviate the distress.
Occasionally breathing may become a noisy rattle due to the build-up of mucus in the chest. Suction is not recommended as it would only make patients suffer more. Change of position may be help and there are medications that can be used. The noisy rattle may be upsetting to patients’ family, but it does not appear to distress the patient.
Fluid and Food Decrease
When someone is approaching death, their body no longer has the same need for food and drink as before. Not wanting to eat or drink is common during the process. If patients become not able to swallow, it is important to discuss with their doctor to arrange their medication in a different way. If their mouths look dry, using a damp sponge to moisten the mouth and applying lip salve will give comfort, but do not force patients to drink. Family can show their love through spending time and being present with patients.
Incontinence and urine decrease
Loss of control of urine or bowel movement may happen when the related muscles begin to relax. Some pads or waterproof sheets can be used to protect the bed and also keep patients clean and comfortable. Because of the decrease in circulation through the kidneys and less fluid intake patients’ urine may become less and darker. Ask for a professional assessment in this situation so as to ascertain if there is a need for inserting a catheter.
Cold hands and feet
Because the circulation of blood is decreasing, patients’ hands, arms, feet and legs may be increasingly cool and becoming pale. Extra blankets, socks and mittens could be used to keep them warm, but do not use electric blanket which might harm patients.
Bleeding
Occasionally patients may bleed out for a number of reasons at the end of life. Using dark colored towels or blankets to cover the blood could reduce patients’ or their family’s anxiety.
The signs of death are no breathing, no heartbeat, release of bowel and bladder, pupils enlarged, jaw relaxed and mouth slightly open. Some religious practices might be undertaken if patients or their family wish to do it.
For many patients, dying is very peaceful. If you have any queries and would like to have an opportunity to discuss any related issues, you can drop-in to the reception desk in the palliative care inpatient unit to see how we can help and support you.
Our address
11F, 2nd Medical Building, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan 40705, ROC.