Many of us ask the question, "How much time is left? The dying do not always cooperate with the predictions of the doctors, nurses or others who tell family members or patients how much time is left.
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Hospice staff have frequently observed that even the predictions by physicians about the length of time from the original diagnosis till death is often inaccurate. Many families report that "the doctor told us he [the patient] only had so much time left, and he's lived much longer than that. Statistical averages do not tell us exactly how long a particular patient has to live; they can only serve as a general guideline or point of reference.
Although statistical averages do not help much in an individual case, there are specific signs of approaching death which may be observed, and which do indicate that death is approaching nearer. Each individual patient is different. Not all individuals will show all of these signs, nor are all of the signs of approaching death always present in every case.
Depending on the type of terminal illness and the metabolic condition of the patient, different signs and symptoms arise. An experienced physician or hospice nurse can often explain these signs and symptoms to you. If you have questions about changes in your loved one's condition, ask your hospice nurse for an explanation, that is one of the reasons she is serving you.
There are two phases which arise prior to the actual time of death: the "pre-active phase of dying," and the "active phase of dying.
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We say "on average" because there are often exceptions to the rule. They might not respond when you try to wake them. Hearing may be one of the last senses to be lost. So it is important not to stop talking to them and comforting them. You can sit close to them and hold their hand. It's also a good idea to tell them when you go into or leave their room.
End-of-Life Signs, Symptoms & Changes - Crossroads
There will come a time when the dying person won't want to eat or drink anything. It is important not to try and force them to eat or drink. This will make them uncomfortable. You can give them small pieces of ice to suck or sips of fluid, if they are still awake. This will keep their mouth moist. You can put lip balm on their lips to help stop them getting dry and sore. Your GP or district nurse can get you the swabs. The dying person might lose control of their bladder and bowel. This can be distressing to see and you might worry that they may feel embarrassed. The nursing staff will do all they can to protect the bed and keep your relative or friend as clean and comfortable as possible.
If you are caring for the person at home, the district nurses and specialist nurses can arrange for you to have protective sheets or pads for the bed. They might also be able to arrange a laundry service for you, if necessary. As people become very close to death and are not eating or drinking, the amount of urine and stools they produce gets less and less. Many people who are dying, and the people around them, worry that they will be in pain.
Some people don't have pain. But if a person is in pain, it can usually be well controlled and people can be kept very comfortable. The doctors and nurses looking after the dying person will do all they can. Sometimes restlessness is a sign of being in pain. There may be times when they stop breathing for a few seconds.
Being with someone when they die
This is called Cheyne Stoke pronounced chain stoke breathing. They may breathe with their mouth open and use their chest muscles to help them catch a breath. It can help to raise the head of the bed with pillows or cushions. Just sitting with them, speaking gently and holding their hand can be very reassuring for them. Morphine can help to make breathing easier. You may hear gurgling or rattling sounds as the dying person takes each breath.
This is coming from their chest or the back of their throat. Raising their head and turning it to the side can help gravity to drain the secretions. Let the medical team know if your loved one has noisy breathing like this. Sometimes a nurse or doctor can suck the fluid out through a thin tube put down into the person's windpipe, but this is not usually needed. Hearing the gurgling sounds can be very upsetting, but they don't usually seem to cause distress to the dying person. Their skin might also become pale and look blotchy or mottled.
This happens because there is less blood circulation to these parts of the body. Thick socks can help to keep their feet warm. Just keep it at a comfortable temperature. You might hear your loved one say things that make no sense. For example, they might shout at you or physically push you away. This can be very hurtful and upsetting. They are not aware that they are doing these things.
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It happens partly because of the chemical changes going on inside their body. At the end of life, the chemical balance of the body becomes completely upset. The dying person then slips into unconsciousness. This is usually right towards the end, maybe only a few hours or days before death. Their breathing will stay irregular for some time and will stop at some point. And someone leaving behind young children will have different worries from someone whose children are grown up and able to take care of themselves.
You are likely to feel some very strong emotions during the time your relative or friend is dying.