Fever. When a dying person dehydrates, the temperature control center in the brain shuts down and fever up to 104 may occur. Acetaminophen [Tylenol] usually doesn’t help; just keep the room cool, cover them with a sheet, and wipe them down with a cool cloth.
Poor Circulation. It’s common to see their skin cooling, discolored, and a drop in blood pressure during the last few days.
Confusion. Although most die peacefully, some have “terminal delirium” – confusion, moaning, restlessness, agitation. If increasing pain medications doesn’t help (or makes them worse), other drugs are available. And if all else fails to maintain a comfortable state, there’s an option of last resort called “palliative sedation”: drugs (such as phenobarb) are used to induce a sleep which is continued until death if necessary.
Control of Pain. The dying often become hyper-sensitive to touch and joints may be more uncomfortable when moved. Using morphine or similar drugs makes it easier to turn them every four hours (needed to prevent skin breakdown—along with placing pillows under boney areas and between skin contact points).
For those whose pain does not appear controlled, we may try a different narcotic, add other drugs, or initiate ‘palliative sedation’ as described above.
Decreased Communication. Many families are distressed if they can’t talk with their loved one. Even though the dying person may appear asleep, always assume he can hear everything. Therefore, we encourage families to hold their hand and talk about all the good memories.
Closure is therapeutic and important. There are five things we encourage all family members to say: I love you; I forgive you; please forgive me; goodbye; and, we’ll meet again. Sometimes, patients are waiting for ‘permission to die’: tell them, “it’s ok to go now—we’ll be alright”.