In the final stage of your friend or loved one's terminal illness your anxiety may reach its peak and your anticipation of the unknown will prompt many questions. We attempt to answer these questions for you with the following information.
The physical, emotional, spiritual and mental signs and symptoms of impending death that follow are offered to help you understand the natural kinds of things which may happen. Not all of these signs and symptoms will occur with every person. They will not occur in this particular order. Each person is unique and needs to do things in his/her own way. This is not the time to try to impose change, but the time to give full acceptance, support and comfort.
The following signs and symptoms describe how the body prepares itself for the final stage of life:
Decrease In Appetite And Hydration: Dying persons may not want to eat or drink. Some refuse food and may take in little fluids. The nurse will instruct you on mouth care to keep their mouth from feeling too dry. Offer, but do not force food or fluids. Persons who are close to dying are comfortable without food or fluids.
Sleeping: As the body weakens, a dying person will sleep more and begin to withdraw from his or her surroundings. Let the person sleep. Hold his or her hand during this time. Touching will make him or her aware that you are there and that you care. At this point, being with the person is more important than doing for him or her.
Mental Changes: A dying person may speak of or claim to have spoken to persons who have already died. He/she may see places you don't see (for example their old home) or may express a desire to join those who have already died. Encourage him or her to join or talk with the person. Give him or her permission to go home. These experiences are not abnormal for the dying patient.
A dying person is beginning to detach from this life and is preparing for death. Do not make light of or contradict what the person reports to have heard or seen. Just because you cannot see or hear it does not mean that it is not real to the person. Affirm these experiences. They are normal and common. If the dying person is frightened, explain to him or her that these experiences are normal.
Decreased Urine Output: A dying person may produce urine less often and in smaller amounts. As a result the urine will become dark and concentrated. He or she may lose control of bladder and bowels. If this occurs use adult diapers. They will help protect the skin and prevent discomfort.
Restlessness: You may notice periods of restless, pulling at the bed linens or saying things that do not make sense. This is a time for sitting and quietly reassuring the patient that you are there. Listening to music, reading or praying may be comforting to the patient.
Circulatory Changes: Arms and legs may become swollen with slight purple discoloration and progressively cool to the touch. Raising the affected area may provide some relief if the swelling is painful. The person's complexion often appears gray or dusky.
Breathing Pattern Changes: A dying person's pattern of breathing usually changes. You may notice irregular breathing patterns or periods where the person does not breathe while sleeping (apnea) which can last 30-60 seconds. This symptom is very common and does not require any action on your part as caregiver.
Congestion: A dying person may develop gurgling sounds coming from the chest like a percolator. These sounds may be very loud and can be very upsetting for you to hear. They do not mean, however, that the person is uncomfortable. Suctioning is usually not effective and may be difficult for the person to tolerate. You may raise the head of the bed or prop them up in a sitting position. If you are concerned, discuss this with your nurse.
Saying Good-Bye: Although this may be difficult this is the time to say "good-bye" if you are able to. You may want to hold the person's hand and recount favorite memories, activities or places shared or you may want to pray. Tears are normal and a natural part of saying "good-bye."
At the Time of Death - DO NOT CALL 911.
Although you may be prepared for the death process, you may not be prepared for the actual death moment. The signs of death include:
Penn Wissahickon Hospice will call your physician. A hospice team member will be able to assist you. If desired, we will contact your funeral director, the hospice chaplain or clergy of your choice. During this time, you may want to spend some time alone with the deceased. Remember that Penn Wissahickon Hospice is available to you, especially in terms of pastoral and bereavement care. Your comfort is very important to us.