Tessa Quinn
Describing someone's dying moments in a hospital setting can be challenging, as it involves capturing the complex emotions and physical changes that occur during this delicate time. It is a privilege to be with someone during their final hours, and it can be a transformative experience. In hospitals, clinical notes are often handwritten several times a day to record updates on a patient's status, and terms like end of life, terminal, and palliative care are used to indicate a patient's deteriorating health. When describing someone's dying moments, it's important to portray the inner work that a person may be experiencing, such as processing unfinished business and letting go of attachments. Additionally, the physical aspects, such as dehydration, enhanced sensitivity to light and sound, and reduced appetite, can also be included.
| Characteristics | Values |
|---|---|
| Language used by healthcare professionals | End of life, terminal, palliative, comfort care |
| Actions by healthcare professionals | Stopping medical tests, physical therapy, and treatments |
| Symptoms | Less active, reduced appetite, confusion, hallucinations, dehydration |
| Actions by caregivers | Keeping the patient comfortable, talking calmly, reducing noise and bright lights, moistening lips |
| Emotional support | Bereavement support groups, counseling, memorial services |
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What You'll Learn
Language used by healthcare professionals
Healthcare professionals use specific language to describe a patient's deteriorating health and imminent death. This language is often documented in clinical notes and used for interprofessional communication. A study conducted at Toronto General Hospital analysed the language used in patients' charts and identified three categories: current state, future state, and implied state.
The "current state" category involves documenting the patient's current condition and symptoms. This includes observations such as decreased appetite, reduced activity, confusion, incoherence, hallucinations, and vital signs. For example, a patient's current state might be described as "the patient is experiencing confusion and has a weak pulse."
The "future state" category describes the patient's estimated prognosis and life expectancy. This may include phrases like prognosis of hours to days or end of life. For instance, a doctor might note that "the patient is not expected to survive beyond the next few days."
The "implied state" category uses the type of care provided to imply the patient's declining status. This includes references to palliative care, comfort care, and end-of-life care. For example, a chart might state that "the patient has been referred to the palliative care team" or "comfort measures are being implemented."
Healthcare professionals also use specific terminology to describe the dying process. Terms such as "dying," "terminal," and "passing" may be used directly. Additionally, phrases like "the patient is unresponsive" or "the patient has stopped breathing" may be documented to indicate that death has occurred.
The language used by healthcare professionals is essential for effective communication, ensuring that all members of the medical team are informed about the patient's condition and can provide appropriate care. This includes discontinuing unnecessary treatments, providing pain management, and offering emotional support to the patient and their loved ones.
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Signs of death approaching
As a person approaches death, they become less active and their body needs less energy. They may stop eating or drinking as their appetite gradually reduces. They may also spend less time awake and become more sleepy.
In the hours before death, a person's organs shut down and their body stops working. They may also start to withdraw from interpersonal situations and become confused or incoherent. It is not unusual for a dying person to experience hallucinations or distorted visions. Their senses may also become enhanced, so loud noises and bright lights can be disturbing and unpleasant.
A person's body begins to dehydrate during the dying process, which can cause uncomfortable dryness of the mucous membranes. It is important to keep their lips and mouth moist with lip balm or water to prevent this. Soft background music can enhance relaxation and ease anxiety, but it may also agitate some people.
The process of dying is complex, but an initial indication that death is approaching is the "death rattle". This is a gurgling sound in the throat caused by saliva and mucus that occurs when a person is unable to swallow.
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Comforting a dying loved one
Creating a Comforting Environment
The senses of a dying person may be enhanced, so it is important to minimise loud noises and bright lights, which can be disturbing and unpleasant. Soft, indirect lighting and quiet moments with fewer people can help create a peaceful atmosphere. Turning off the television, removing phones, and asking visitors to keep conversation volumes low can all contribute to a calmer environment.
Physical Comfort
The body begins to dehydrate during the dying process, so it is essential to frequently moisten your loved one's mouth and lips with sponge sticks saturated with water or lip balm. This simple act can significantly improve their comfort.
Emotional and Spiritual Support
Your loved one may be processing unfinished business and letting go of attachments. You can support them by sitting quietly beside them, holding their hand, and sending thoughts of love. If you practice prayer or meditation, this can be a powerful way to create a safe and loving space.
Communication
Speak softly and sparingly, using words that help your loved one with their inner work of letting go. Remind them that they are loved, that they have lived a good life, and that it is okay to let go. Respect their need for silence, and only speak when necessary, conveying calm and confidence to reduce the risk of startling them.
Practical Tasks and Emotional Support for Family
End-of-life care also involves supporting the family of the dying person. Practical tasks, such as helping with funeral arrangements, can be a way to show your support. Emotional distress is common, and bereavement support groups, individual counselling, and memorial services can provide valuable assistance during this challenging time.
Remember, every person's end-of-life wishes are unique, so always check with the person's healthcare team to ensure your actions align with their preferences and needs.
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The grieving process
The death of a loved one is never easy to cope with. It is important to give yourself time and space to grieve. Everyone deals with grief differently, but there are some common feelings and experiences that people may want to share.
Before the passing
When a person is terminally ill, they may experience a decrease in appetite and spend less time awake. They may also start to withdraw from interpersonal situations, becoming confused or incoherent at times. It is important not to take this personally and to continue to keep them company, speaking softly and calmly to reduce the risk of startling them. You can remind them that you love them, that they have lived a good life, and that it is okay to let go.
After the passing
You may find comfort in connecting with others who are facing similar experiences. Support groups can help people explore their grief in a consoling environment. Alternatively, individual counselling may be preferred. It is important to lean on friends and family for support during this difficult time.
Creating a comfortable environment
When spending time with a loved one during their last few hours, it is important to create a comforting mood. Bright lights and loud noises can be disturbing, so it is advisable to keep the room softly lit and quiet. Soft background music may enhance relaxation and ease anxiety, but for some, it may cause agitation. It is also important to keep the dying person's lips and mouth moist to prevent dryness and discomfort.
Managing pain
Caregivers and family members can help manage a dying person's pain. It is important to administer pain medicine as prescribed by the doctor and to inform health professionals if the pain is not being controlled. Palliative medical specialists are experienced in pain management for seriously ill patients.
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Physical symptoms
As a person approaches death, they become less active and their body needs less energy. They may stop eating or drinking as their appetite gradually decreases. They may also become confused or incoherent and experience hallucinations or distorted visions. It is common for people who are dying to become detached from reality and unaware of their surroundings. They might also become drowsy and spend more time sleeping.
In the last few weeks of someone's life, they may experience both physical and emotional changes. They may become less able to do things for themselves, and new symptoms may appear or existing ones may worsen. Older people, in particular, may have been living with chronic illnesses and may have needed significant care for days, weeks, or months before death.
In the final hours before death, the body's normal systems start to operate more slowly. The heart beats a little more slowly or with less force, causing the brain and other organs to receive less oxygen and function less well. The person's skin may also start to cool.
It is common for people nearing death to feel tired and weak. They may also become very calm and peaceful. However, they may also express feelings of boredom or depression, or feel tired of being a burden.
The moment of death is usually peaceful. The person's heart stops, and they stop breathing.
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Frequently asked questions
A person who is dying may stop eating or drinking, and spend less time awake. They may also withdraw from interpersonal situations and become confused or incoherent.
A death rattle is an initial indication that someone has died.
It is important to set a comforting mood by reducing loud noises and bright lights. Soft background music can also enhance relaxation and ease anxiety. Caregivers can also play a significant role in managing a dying person's pain by providing prescribed pain medication.
The hospital staff contacts the funeral home on the family's behalf. It is important to give yourself time and space to grieve and seek support from friends, family, or bereavement support groups.
Healthcare professionals may use terms such as “end of life”, “terminal”, “palliative”, and “comfort care” to describe someone who is dying. They may also refer to the patient's prognosis in terms of hours or days.
