How to Take Care of a Dying Patient
End of Life Issues & End of Life Care Needs of the Terminal Patient
Oct 18, 2008
What to say to the dying patient is not the only difficult end of life care issue. Questions like whether people actually choose to die alone and how to respond to the terminal patient who refuses food are addressed by hospice worker Margaret Bromberg, LCSW.
Dying Patient Refuses Food
Question: Family members get upset when the dying patient refuses food. They feel like they must help the person eat.
Answer: It is very common for a dying patient to lose his or her appetite. Food may be more of a strain on the body to digest at that point than to simply not have it. We are not harming the patient by letting him or her refuse food. Just be present for the person without trying to fix anything.
What death means is that we don’t need this body anymore. Loss of appetite is a natural reaction. Eating can be more taxing than not eating.
Patient Died as Soon as Visitors Left
Question: We often hear stories of family keeping vigil at the dying patient’s bedside and as soon as they leave for one minute, the person dies. Do you see this a lot?
Answer: Yes, this happens a great deal. I believe that some people want to die alone. Whether it is to protect the loved ones, or because the patient can’t focus on dying or leaving when there are loved ones around.
Family members should not feel guilty about leaving or not being there when the person died. The person may have chosen to go that way.
Question: What about stories of dying patients who hang on just long enough to see a particular person?
Answer: Dying patients, just like people in every situation, need information. If a family member is on his way to come and see her, let the patient know. If the caregiver is leaving and will be back in two hours, tell the patient, even if she appears non-responsive or unconscious.
Alzheimer's or Unconscious Patients Can Hear and Comprehend
Question: There are stories about patients with Alzheimer’s and serious dementia having moments of great lucidity during the death process. How does this happen?
Answer:Lucidity at the end of life happens a lot. Even in cases of Alzheimer’s. Or patients who are unconscious will have periods when they are quite lucid. At hospice we never assume the person can’t hear us. We tell families if they are talking about things that would upset the patient, have that conversation in the other room. Even patients who are very hard of hearing are somehow able to hear what you are saying.
Dying Patient is Withdrawn
Question: What about family members trying to keep the terminal patient active and busy because he seems to be uninterested and withdrawn?
Answer: Patients at the end of life may close themselves off and lose interest in everything. Family members shouldn’t try to keep them stimulated and draw their attention back to things of this world, and force activities on them. End of life is an opportunity to withdraw from the things of this world...to turn off all of this stimulation. Why should dying patients be interested in this world? They are trying to leave this world. We have to let them.
People have to adjust to the needs of the patient at the end of life. Patients will lose the desire to get out of bed. Family members sometimes bring physical therapists and try to keep the person moving, but this may not be the best idea.
A Comfortable Death
Question: Do you have any other thoughts you wish to share?
Answer: I believe it is possible to achieve a comfortable death in all areas: spiritual, emotional and physical.
Margaret Bromberg, LCSW works at East End Hospice in Westhampton Beach, Long Island, New York.
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