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Guidance For People Facing Serious Illness: When Death Is Close

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Earlier today we excerpted from the Handbook for Mortals: Guidance for People Facing Serious Illness by Joanne Lynn and Joan Harrold. The next excerpt focuses on something we all will experience someday, the approach of death. While I hope this is something you won’t have to worry about for many years, knowledge may ease your anxiety.

“How will I know when death is getting close?”

Just as doctors usually cannot pinpoint the day when a baby will be born, they cannot predict the exact day or hour when you or your loved one will die. You might need reassurance that it is simply not always possible to know when death is near. Some illnesses make prediction difficult. However, many illnesses have a few hours or a few days when it is evident that death is close. The person dying usually is no longer eating or drinking, except for perhaps a few sips of liquid now and again. The person may be sleepy or confused for much of the time and is usually in bed. If the person is dying from cancer or a progressive failure of an organ, he or she will usually have lost a substantial amount of weight. If life support is being stopped, the physician should be able to tell you what to watch for in order to estimate about how long it will be before death.

handbook-for-mortals.jpgMany people near death will have cool hands and feet and a persistent purplish discoloration in the parts of the body resting on the bed. Many also will have uneven breathing, sometimes stopping for many seconds and at other times breathing rapidly. This kind of breathing and discoloration can persist for a few days, but these signs usually mean a person will die within a day.

Some people have some jerking motions or even seizures from metabolic abnormalities near death. As disturbing as it may be for others to watch this happen, the dying person is probably not aware of it. The involuntary motions usually do not need treatment because they do not seem to cause problems for the patient.

If the dying person has been taking opioid medicines, these will be continued because ending opioids abruptly can lead to uncomfortable symptoms. If the dying person is no longer able to swallow, opioids can be given by suppository, injection, skin patch, or intravenous infusion.

Probably half of patients develop very noisy breathing near death — which is sometimes called a “death rattle.” This is the result of relaxation of the muscles of the throat and does not cause the person to feel as though she is struggling to breathe. In fact, most dying patients are not aware of this noisy breathing. However, if family or caregivers find it unnerving, the doctor or nurse can help reduce the noisy sound, either by giving medication or repositioning the dying person in bed.

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2 Responses to “Guidance For People Facing Serious Illness: When Death Is Close”
  1. mike says:

    an hour or two before my mam passed away from cancer , we could hear the ( death rattle ) the build up of fluid , a doctor was called out and he said that she had a few hours left and said he was givving her an injection to ease the fluid in the throat , what is this injection called and what exactly does it do ? also an hour or so before she passed away , her eyes were open and her breathing was slow , we tried to talk to her , what state is the patient in when this happens , its been on my mind for the last month since she passed away , hope u can ease my mind through these questions , mike .

  2. Karyn Vincent says:

    I am a wife who my husband has Ischaemic Heart disease,, he has – left ventricular ejection fraction nuclear scan= 22%/ Type ll Diabetes/ HbA1c? /

    His echocardiogram revealed:
    1. Mildly dilated left ventricle with mild segmental systolic dysfunction.
    2. Moderate biatial dilatation.
    3. mild mitral regurgition
    4. Mildly dilated right ventricle with preserved systolic function
    5. Mild pulmonary hypertension.

    he has been gasping for breath, going fast then going slowly and briefly stopping and repaetly having the similar rythms thruought the night. Apparently he is bleeding on his lungs.

    In the last week or so he has been losing balance and really breathless, also he has been very agitated and abusive, and getting small sightable bruises for unknown reasons.

    I am getting to the point that he is being a burden to me being abusive and demanding that I am being driven away from him that I cant take any more and wont listen to what is required of his health, typical men, he has his medication daily as required.
    I am thinking of having him put in a Nursing Home, but If you could tell me how much time he has left, so I can prepare myself and put up with him at home and have our children near of spending quality time with their father in case he passes on sooner than what we expect.

    Thank you for the time of reading my comments.

    Yours Truly

    Karyn Vincent.

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