CANCER DEATH
The end of life cannot be predicted for any of us. We do not know when it will happen, who will be with us, how it will occur, or what we will feel. We do know more about the answers to these questions for people living with advanced cancer, however. Cancer is a chronic illness, which means that it takes time for it to grow worse. Dying with a chronic illness is very different from dying because of a sudden illness or event, such as a heart attack or an accident. Certain things about dying (and living) with advanced cancer can be predicted and discussed, including the cause of death, when death will finally occur, and how we know when a person is living the very last days of his or her life.
Many misconceptions exist about what can happen during the final days and weeks of a person's life. One stubborn myth about dying from cancer is that the person will finally die from only one cause. Someone might say, "It'll be the heart that goes last." When people have a chronic illness such as late-stage cancer, however, they usually do not die from one major event or for only one reason. Instead, they die because of many different factors that combine to slow down the body's important systems, such as the heart and lungs. In a sense, the physical body slowly "gives up."
We cannot say exactly how long someone will live with a chronic illness. Many times, family members and friends want to know this information. They want to prepare themselves, make plans, or understand what will happen in the next few weeks or months. Doctors and nurses can give predictions of how long the person has to live, but these are only estimates or best guesses. Sometimes, the guesses are accurate; sometimes, the guesses are not. For example, some people have lived much longer than the their "predicted" 3 or 4 months. In fact, some of these people have gotten better, returned to work, taken up their hobbies again, and enjoyed life for much longer than expected. It was not until months later that they finally slowed down, became weaker, and died.
Certain physical signs warn us that the end of life is growing close. Most people with an advanced, chronic illness such as cancer spend more time in bed or on a couch or chair. People with any type of advanced cancer eat much less food, and they drink fewer liquids. They also sleep more, lose weight, and become much weaker.
Not every warning sign is physical, however. People may talk about "leaving" or "having to go." Their dreams make them feel as if they want to "get going" or "go home." Although this is not common in every situation, this language and the emotion behind it are ways of talking about dying. The patient also may ask to see special friends or relatives, and some haziness or confusion can occur as one day blends into another. Keeping track of the day of the week becomes less important, as do other details.
The last days of life are unique for each person as well. They are very personal, and they are very private. People usually are less interested in the outside world, and they want the closeness of only a few people - or maybe just one other person - to comfort them. Exceptions do occur, of course. Some want many friends and family members around them, but this is rare.
So, this is the general picture of a patient in the final weeks of life: very weak; drowsy, with much sleeping; unable to eat any food and difficulty swallowing fluids; less able to talk and to concentrate; bodily comfort (as long as medicines are continued); and peace with dying.
You will know when people with advanced cancer are uncomfortable. They may tell you, or they may be tossing or moaning. If they are not conscious or awake, they may be frowning. Call the hospice or home care staff for help. If home care nurses or hospice staff are not available, call the doctor's office and ask that a visiting nurse or hospice nurse come to your home because the person is uncomfortable and, at this point, you do not know what to do.
Occasionally, being confused about the time of day, day of the week, or the date is normal, but severe confusion can upset people with cancer as well as you. Severe confusion might mean that they do not know where they are or who they are with. This can be a real problem if they are unhappy about where they think they are or afraid of what they see or hear. They may even see things that are not there. Sometimes, these visions are of people who have already died, such as a mother or a child. These are called hallucinations. If these visions comfort the person, they are not a problem. If they scare or upset the person however, or if the hallucinations are affecting or upsetting the family, they are a problem. Call about severe confusion or upsetting hallucinations.
Try to understand what is frightening the person, but do not make assumptions. You could be wrong, and that would hinder your ability to help. It is okay to ask the person what worries them most. This allows you to focus on the real issue rather than guessing about what the person is afraid of. For example, you may assume the person is afraid of dying when, in reality, he or she is afraid of being left alone or running out of money.
Sometimes, anxiety is caused by medicine. If so, the medicine can be changed, and anti-anxiety medicines can be used. Visiting nurses can talk with the doctor and ask to have these medicines ordered.
Letting the patient plan the day will show respect and support his or her dignity. Let the person plan what to do, what to eat or drink, when to sleep, and when to visit with others. Some people find watching television helpful.
Even if the person is sleeping much of the time or slips into a coma, touching and talking remain important. Touch can include back rubs or holdings hands. Visitors can read scriptures or stories or review old times. Some people read poems, and background music can help. All of these decrease a person's sense of being alone and can be very comforting.
Forcing food will distress the person with advanced cancer as well as the family. It is natural for a dying person to want less food. This is the body's natural way of approaching death - by shutting down.
It is hard to give up trying to feed someone you care about. Using intravenous (IV) fluids or special tube feedings for nutrition are not part of dying naturally, but if the person with cancer wants these treatments, that is his or her right. Talk this over with the home care nurses, hospice staff, and physician. You can still offer sips of water. Cut a straw into a shorter length so that he or she can sip liquids. If the patient is too tired to sip, drop water into his or her mouth just to freshen it and give comfort. This will be very much appreciated.
The person with cancer has a right to control the social scene. He or she may not want to see certain people or, if it is a bad day, anyone.
Original article can be found here: http://www.acponline.org/public/h_care/7-final.htm