No One In Our Family Knows about Dying; What Should We Expect

Dad is in hospital and we have been told he will die in the next few weeks.  No one in our family knows about dying; what should we expect?

The very first thing your family should do is find a good hospice [like ours] to help you. (Ideally, hospice should begin several months prior to expected death.)  Hospice staff can provide you with the information and emotional support to make this transition much more comfortable for everyone, including how to manage the following common problems we see in the final weeks.

 

Weakness and Fatigue. They start sleeping more—both day and night.  They are tired and it takes all their energy to do what they do.  [with hindsight, we often see this starting months prior to active dying]

Not eating. They have no appetite and so eat progressively less.  Although some continue sipping fluids, most will refuse anything for the several days preceding death.  They are becoming dehydrated, a normal and protective part of dying, which is not painful. ‘Pushing’ them to eat, may cause choking and vomiting and greater distress.  Instead, offer sips of water or juice if they’re alert enough to swallow; flat ginger ale is good.  But, once they stop drinking, just moisten their mouth with wet swabs and keep their lips lubricated. 

Loss of Bowel/Bladder Control. Bowel movements and urination decrease; they may begin losing control.  Sometimes a catheter can be inserted into the bladder, but usually only extra padding is needed.  A daily sponge bath and clean sheets help for comfort.

Breathing Changes. Frequently, a pattern of deep, slow breaths followed by progressively longer intervals of no breathing, will develop.  This may continue for days and then in the final hours, the breaths may become very shallow and rapid.  Patients are not “suffocating” and the addition of oxygen usually only irritates them and may prolong dying.  Often, a small dose of morphine reduces any apparent breathing distress.  If the “death rattle” develops and they are mostly unconscious, putting them in the ‘position-of-safety’ (on their side, with the bed flat and their head down) usually helps to drain the lung secretions they can’t cough up [keeping their head elevated often makes this worse!].

Eyes won’t close. Sometimes a person’s eyes won’t close completely; lubricant
drops/ointment can be comforting.


In Part 2, I will discuss pain control, confusion, fever, and communication.