Life in this world is not permanent. There will come a time when all the mortal beings have to die. To some death is sudden, maybe due to misfortunes such as accidents. While to others they literally see death approaching from the horizon slowly, till it takes their life. People who fall into this category are those who suffer from terminal diseases such as cancer and H.I.V and Aids. By nature, all human beings fear death, and many will do anything possible so as to reduce the chance of going down this road where there is no return.
In medical terms, end of life care refers to the care given to a patient who are not only in the last stages of life, but also who suffer from terminal diseases. This care requires a lot of patience and understanding the goal is to make the patient as comfortable as possible. In dealing with terminal patients, the aim is to reduce the pain that may accrue due to the effects of advance in disease.
It is a practice that, when determined that a certain disease cannot be treated further, treatment is stopped and energies are now focused in making the patient comfortable as the day of death is awaited.
People, who work in hospices (places where terminal patients find solace before dying) have reported that the process of dying begins well before the actual death takes place. Patients who are three months prior to death begin to show change in behavior, they withdraw from their surrounding and may decline visits from relatives and friends. They begin to contemplate their life and begin to revisit past memories. At this stage food is rarely eaten and there is a significant loss of weight. They are neither hungry nor thirsty as the body changes anticipate the inevitable.
One to two weeks prior to death, mental changes take shape, hallucination is common at this stage, conversation is made to people not present. Movement at this stage is aimless. Physical changes also take place, body temperature lowers, blood pressure lowers, and there is an increase in perspiration.
A couple of hours before death the patient show a surge of energy, which is unusual. Rapid breathing takes place followed by none at all. Mottling is also observed at this stage and the patient becomes unresponsive to stimuli. The eyes may be open but they are not seeing their surroundings. According to experts, it is believed that the last organ to close is the ear and it is recommended that loved ones keep on talking to the dying at this time. Finally, breathing come to an end and the heart beat stops all together. It makes the end of life.
To take care of patients who know that hope for them is over is always a challenge. Words of encouragement to such people usually are empty words but none the less they are part of us and neglecting them will be neglecting ourselves.
Care in the last days can either be performed at home or in the hospital. This care involves consideration of the use palliative care, patient life rights, medical experiments, ethics, and other interventions that will be governed on how to make the life of the patient bearable as the last days approach.
This care is provided till the patient dies. When signs of death show, it is important to know how to deal with the patient. Proper care should enable the patient to undergo all the stages comfortable and how to comfort the relatives who might be present to see their loved ones leave them.
At this process the will of the patient should prevail. Symptom management should be carried in the most professional manner possible. Morphine is used to control pain. When rattling (a gurgling sound) occurs it should be explained to the family and friends present as this sight causes a lot of pain to hear and watch their loved one suffer. Nausea and vomiting is controlled by use of antiemetics.