Signs of impending death.

[Jo Dirt]

I work in the home health sector but we frequently care for patients even after they qualify for hospice and until their death.

I am caring for a 60 yr. old woman with chordoma (a rare bone cancer). She is one of the sweetest patients I've ever had. You can actually feel the tumors all over her body and yesterday she showed me two new ones on her leg, mainly this is on the left side of her body. She has struggled with is for 11 yrs. and it is finally coming to an end. She has been bedridden for over a month now and the past week or so she seems a little "out of it." She sleeps more than she is awake, she acts very weak and sleepy a lot of the time. But she has a good appetite still. She is not drinking as much and her urine is dark and has a lot of sediment (she has a foley).

I am wanting to say she is starting to go through the stages of dying. Does anyone have any experience with how long we can expect this process to last?

[Curious1alwys, BSN, RN]

midcom said:

I apologize if I'm hijacking this but wanted to thank you for the information. I'm not a nurse yet, heck, haven't even started school yet. I've been reading some of the various speciality forums to see just what is involved with each speciality. Hospice has been an interest to me since my Mother needed the services of our local one 3 years ago.

I was reading the signs of impending death you listed & you've answered some questions I've had since Mom's death, especially one about fear. Mom was a very very strong Christian. When she was diagnosed with stage 4 rectal cancer, she really didn't act too upset. She often would tell people, "I have cancer, I'm dying, and I'm going to heaven to be with Al." (my Dad) She was always so upbeat & even her hospice nurses were surprised by her attitude. Three weeks before her death, we could no longer take care of her ourselves & our hopsice didn't have room in their hopsice house so she went to a nursing home. A few days before her death, my sister & I realized she was slipping & stayed with her around the clock. It was during those days that something happened that really shook my faith. Suddenly she was terrified to die. What she had been begging God for almost 6 years, now had her almost mentally mad. She kept saying, "I'm bad. "I'm bad" and nothing we could say helped.

Req Read said- "During dying process a person’s facade (mask) slowly dissolves… the real person is gradually revealed" and "There will usually come a time of panic… when the fear hits." Now I understand why Mom reacted like she did. She really was scared and I suspect she had been all along. We eneded up asking the nurses to give her more & more of her pain meds because she was physically uncomfortable and eventually they kept her calm.

Although it was her day off, her hospice nurse stopped in at the nursing home to check on Mom & realized she had only a short time. She told me to feel her arms & legs as she would start to run a fever shortly before the end & sure enough it happened.

I can't say enough good things about the wonderful nurse that was assigned to Mom & how she helped our family to accept Mom's leaving us. I'm planning to be a LPN & I don't believe the Hospice in our area hires LPNs so I can't work there but I will always be appreciative of them and anyone who works in that field.

Dixie

Dixie,

Your post hit a chord with me. I feel much the same way as you after watching my father sucumb to lung cancer two months ago. He went thru much the same process as you describe your mom went thru. To see him so fearful in the end was really hard on us; we felt so helpless. Reading all the comments here about the dying process has got tears running down my face as I recall the images of my father. To watch someone die of cancer is an experience like no other, especially someone you love so dearly. It is an absolutely horrifying disease. In a way, my family was lucky. My father had small cell lung cancer, an aggressive cancer, and ended up only being bed ridden completely (couldn't get up) for about four days!

Like you, I observed my fathers hospice nurses and all the love they showed. His home nurse even came to the funeral; that meant the world to us. I won't forget the nurse that consoled me and gave me such wonderful advice when I was struggling with what words to say to my Dad. She is the one that made me feel it was OK to say the things I needed to say, even if I cried and bawled in front of him. She said "He knows he is dying". So why would I pretend he wasn't? Towards the end, when his words became mostly jibberish, he spoke of "pulling the rip cord" and asking me if the sheets on the bed were his "magic carpet". I cried and said "you will get your magic carpet, Dad". Gosh, I can barely hold it together typing this...

Anyway, because of this I hope one day to help families going through similar situations. Right after my Dad's death, a week in fact, I had to do clinicals for school on the oncology floor. I saw patients in that first stage, you know after diagnosis, where they are devastated and no doubt terrified, but still remain positive because hope is all they have. I thought of how that just deteriorates in the end. I thought of how, looking back now, my father lost hope right after the doctor told him "no cure" and "palliative only". While he has a positive fascade for a while, he gave up hope then, really. I remember all the stories on the internet I read of people at the same stage as my Dad beating the odds and living YEARS. So I told those cancer patients, "don't ever lose hope because there is always someone who beats the odds". Don't listen to the statistics as if they are written in stone. I told them that is what I learned from my father's illness. I did not however, tell them my Dad died. How could I?... Already I thought I had shared too much, but I wanted to give them hope so badly. It made me so sad to see them so afraid.

Anyway, now I ramble. Thanks for the post and my condolences to you on your mothers passing.:icon_hug:

[RNDYN2CU]

I totally saw the ears crinkle back and just now remember... I couldn't keep her o2 tube in place, Its like her ears shunk,,, no kidding.

[Jo Dirt]

I worked a shift at the nursing home where I used to work regularly. I haven't been in the facility in about 5 months. Before I left last time, there was a patient who was a very proper and vain lady. Nice, but the kind of person who always wanted her hair and make up on and drank out of a tea cup with her pinkie in the air, always sitting upright and proper. Talked in a very elegant way. Her name is Gladys.

Well, I went to work yesterday and at the beginning of the shift the aide told me Gladys wanted a pain pill. So I get one and take it to her room. But when I got to the bedside it wasn't Gladys. I did a double take. The aide was preparing to feed her. I said..."This isn't Gladys...?!?!?!" The aide said it was indeed Gladys. I saw a woman who had aged 20 years in that bed, wearing no dentures, and when she spoke it sounded like there was a frog in her throat. She was wearing oxygen (nasal cannula). She is dying of cancer, and I guess looking pretty is the last thing on her mind, anymore. Each time I would go in her room to check on her she would be mumbling to herself in this matter of fact way, and she didn't hold back when her roomate would start talking loudly, telling her "shut up!" It's true, the facade melts away. Still a great lady, but we are definitely seeing the different side of her now.