What are your stories? I have a patient, advanced colon cancer, a couple of years away from 100 years old, was completely unresponsive, cheyne-stokes, low sats, elevated temp, etc. all day (and most of the night) yesterday. I fully expected to hear she had passed when I woke up this morning, but she was awake and chatting it up to her CG when I called to check on things. I made a visit, I do believe she is still active, just on a 'rally'.
Dec 15, '14
Had a dementia pt up and down for MONTHS..unresponsive for 5 days...I walk in one day and she sits up and tells me she is feeling pretty good (The whole time I had her she did not speak sensically)...next day she passed. It is amazing
Dec 23, '14
We had an 88 yr old lady who'd had a catastrophic hemmorhagic stroke, and she came to our unit (med oncology) because we did comfort care. She had a big family and they spent days visiting and saying goodbye.
A week later, the patient was laughing and even eating. She went back home, where she'd been living with son and DIL.
The hospitalist said this could only happen in such an aged person, the deterioration of the cerebral mass was such that the hemmorrhage was 'accommodated' within her skull. It would have flat out killed a younger person, but because the lady had extra skull room (natural byproduct of reaching old age), she was able to recover.
Jan 1, '15
I"ve got one now> Sunday he was unresponsive with terminal secretions and fixed pupils then his brother showed up and started shaking his shoulder and speaking to him in a loud voice> As of last night he was alert enough to sit up and eat some soup> His family has been carrying on so much this past week especially his wife who flat out fainted when she was told he was about to pass> Im worried the family is going to make THEMSELVES sick trying to prevent the inevitable>
Jan 12, '15
The main thing to remember with rallies...they are a marker. Just as a women goes through stages of labor. There are stages of dying. They may differ in length of time, but they ALWAYS happen.
The "rally" generally occurs 48 to 72 hours. Can happen in 24, but usually it is about a two day window of time for the family to prepare. Use this time wisely. It is our job to alert the family to this. I always ask, "do I have your permission to be honest with you at any point as I work with you?" I have never had a family say no! So, I use this as an opportunity to remind them of our agreement for honesty and gently tell them to fully enjoy this time, it does NOT mean Grandma is getting better, it means Grandma is saying goodbye!! I tell them the dying person is leaving you with the gift of a very good memory, make use of it.
Other markers...not eating. Can give you a marker of 10- days to a month.
Having "unseen" visitors...generally 24 hours. This goes along with "air picking or pointing to things unseen.
I have never had a family become angry with me, they may cry but they always thank me for giving them the "present" of time.
"Everything I have learned in life is from those with no life left"
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