Preparing for Approaching Death
in
Hospice Hands
by the Hospice
of
North Central Florida
Gainesville, FL
When a person enters the final stage of the dying process, two
different dynamics are at work which are closely
interrelated and
interdependent. On the physical plane, the body
begins
the final
process of shutting down, which will end when all the
physical
systems cease to function. Usually this is an orderly
and undramatic
progressive series of physical changes which are not
medical
emergencies requiring invasive interventions. These
physical changes
are a normal, natural way in which the body prepares
itself to stop,
and the most appropriate kinds of responses are comfort
enhancing
measures.
The other dynamic of the dying process at work is on
the
emotional-spiritual-mental plane, and is a
different
kind of
process. The spirit of the dying person begins the
final process of
release from the body, its immediate environment, and
all
attachments. This release also tends to follow its own
priorities,
which may include the resolution of whatever is
unfinished of a
practical nature and reception of permission to "let
go" from family
members. These events are the normal, natural way in
which the
spirit prepares to move from this existence into the
next dimension
of life. The most appropriate kinds of responses to the
emotional-spiritual-mental changes are those which
support and
encourage this release and transition.
When a person's body is ready and wanting to stop, but
the person
is still unresolved or unreconciled over some important
issue or with
some significant relationship, he or she may tend to
linger in order to
finish whatever needs finishing even though he or she
may be
uncomfortable or debilitated. On the other hand, when a
person is
emotionally-spiritually-mentally resolved and ready for
this release,
but his or her body has not completed its final
physical shut down,
the person will continue to live until that shut down
process ceases.
The experience we call death occurs when the body
completes its
natural process of shutting down, and when the spirit
completes its
natural process of reconciling and finishing. These two
processes
need to happen in a way appropriate and unique to the
values,
beliefs, and lifestyle of the dying person.
Therefore, as you seek to prepare yourself as this
event
approaches, the members of your Hospice care team want
you to
know what to expect and how to respond in ways that
will help
your loved one accomplish this transition with support,
understanding, and ease. This is the great gift of love
you have to
offer your loved one as this moment approaches.
The emotional-spiritual-mental and physical signs and
symptoms of
impending death which follow are offered to help you
understand
the natural kinds of things which may happen and how
you can
respond appropriately. Not all these signs and symptoms
will occur
with every person, nor will they occur in this
particular sequence.
Each person is unique and needs to do things in his or
her own way.
This is not the time to try to change your loved one,
but the time to
give full acceptance, support, and comfort.
The following signs and symptoms described are
indicative of how the body prepares itself for the
final
stage of life.
Coolness
The person's hands and arms, feet and then legs may be
increasingly
cool to the touch, and at the same time the color of
the skin may
change. This a normal indication that the circulation
of blood is
decreasing to the body's extremities and being reserved
for the most
vital organs. Keep the person warm with a blanket, but
do not use
one that is electric.
Sleeping
The person may spend an increasing amount of time
sleeping, and
appear to be uncommunicative or unresponsive and at
times be
difficult to arouse. This normal change is due in part
to changes in
the metabolism of the body. Sit with your loved one,
hold his or her
hand, but do not shake it or speak loudly. Speak softly
and
naturally. Plan to spend time with your loved one
during those times
when he or she seems most alert or awake. Do not talk
about the
person in the person's presence. Speak to him or her
directly as you
normally would, even though there may be no response.
Never
assume the person cannot hear; hearing is the last of
the senses to
be lost.
Disorientation
The person may seem to be confused about the time,
place, and
identity of people surrounding him or her including
close and familiar
people. This is also due in part to the metabolism
changes. Identify
yourself by name before you speak rather than to ask
the person to
guess who you are. Speak softly, clearly, and
truthfully when you
need to communicate something important for the
patient's comfort,
such as, "It is time to take your medication", and
explain the reason
for the communication, such as, "so you won't begin to
hurt." Do not
use this method to try to manipulate the patient to
meet your needs.
Incontinence
The person may lose control of urine and/or bowel
matter as the
muscles in that area begin to relax. Discuss with your
Hospice nurse
what can be done to protect the bed and keep your loved
one clean
and comfortable.
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