Questions about death

Nesher, BSN, RN · Jul 13, 2005

Bottom line - no one should suffer pain at death. Plenty of options...

Super_RN, BSN, RN · Jul 13, 2005

I agree. NO ONE should suffer. People deserve to pass away pain free and with dignity. I just recently lost my grandfather to cutaneous T-Cell lymphoma and he had an agonizing death. I live 500 miles away and I couldn't actually get off of work until he passed away, but when I went home for the funeral my grandmother showed me the pain medicine he was recieving...hardly enough. I feel so horrible, because I would have asked for more for his comfort had I known...and she didn't know to. He was recieving Hospice care and grandma took care of him in his final days. Death is different for everyone, depends on the circumstances and nothing can really prepare you.

Jaime

Nesher, BSN, RN · Jul 13, 2005

I think the biggest issue is that people EXPECT that death should some horrible painful event, and don't ASK for more/different pain medication.

danu3 · Jul 13, 2005

I have been reading some blogs from the families of terminally ill patients. I want to know if dying has to involve suffering.... It seems like often-times the pain is uncontrollable before death.
I know that no two people are alike, but I am looking for what to expect when someone is at the end of life, especially in regards to pain.
Thanks!

I think everyone is different. My mother died in front of me after a long illness. As far as I can tell, she didn't have any pain. A few minutes before she died, she actually got up and had some jello, a small drink, and then she just went, as if to sleep. I even took a picture of her because she just look like she is asleep.

-Dan

katwoman7755 · Jul 14, 2005

I remember having a couple of exceptionally difficult cases where symptom management was hard....but ultimately, no patient I had died in pain. Before hospice, I never knew how peaceful death could actually be. I think we as a society have plenty of misconceptions, as death in general is still something we don't want to talk about...which is so funny, considering it's the one thing we all have in common.

Kathryn

leslie :-D · Jul 15, 2005

.... It seems like often-times the pain is uncontrollable before death.
I know that no two people are alike, but I am looking for what to expect when someone is at the end of life, especially in regards to pain.
Thanks!

i don't know about community hospice nsg as my experience is in an in-pt hospice facility. it has been my experience that those that die in pain are the exception and not the rule. in this day and age, there is no valid reason for one to die in pain. yes, there are those ca's that make pain mgmt. the greatest challenge of all but when push comes to shove, you can always sedate them to where they're unconscious. that's a last resort and even when sleeping, pain can be felt. thank God, these cases are a rarity.

now doing community hospice, you have less control as you're leaving it in the hands of family members to administer the pain meds. there i can see where there may be some obstacles as family members often have their own set of beliefs and knowledge deficits. long-acting opioid analgesia is an option whether inpatient or in the home.

finally if the patient is dying of natural causes, pain is not even an issue. a natural death is always pain free. it's those with a pathologic process that you may or may not see pain but the prototype is ca which often involves pain-manageable pain given the right resources and support.

hopefully you found this helpful.

leslie

txspadequeenRN, BSN, RN · Jul 15, 2005

this is not exactly true. everyone reacts to pain different, but to say that your patients that are dying of natural causes dont have pain, is somewhat scary. i have taken care of many hospice patients dying of natural causes and they require morphine and intensols , maybe not as much as the ca pt , but they still need it. the fear of dying and the unknown can cause pain , the body shuting down and the chemical imbalances of neurotransmitters also plays a big part. any one who is dying on my floor has a comfort pack and if they need it, they get it. regardless if it is natural or pathological.....

*****" finally if the patient is dying of natural causes, pain is not even an issue. a natural death is always pain free. it's those with a pathologic process that you may or may not see pain but the prototype is ca which often involves pain-manageable pain given the right resources and support"****

hopefully you found this helpful

leslie

katwoman7755 · Jul 15, 2005

yeah...I found that most people had some sort of symptom, whether it was pain, agitation, air hunger, etc...always managable...although not always easily. I can only remember like a couple who didn't require anything. I agree that dying doesn't always cause pain, but it can...and even more likely..as previously mentioned...issues with dyspnea, fluid overload, death rattle, etc.

Kathryn RN CHPN

leslie :-D · Jul 15, 2005

This is not exactly true. Everyone reacts to pain different, but to say that your patients that are dying of natural causes dont have pain, is somewhat scary.

i stand corrected.

i was referencing physical pain.

and yes, there are those that suffer the mental pain as well and require appropriate interventions.

but generally speaking, the older generation handles their impending deaths with grace and in the absence of mental/physical pain.

**RosesrReder, BSN, MSN, RN** · Jul 15, 2005

I think everyone is different. My mother died in front of me after a long illness. As far as I can tell, she didn't have any pain. A few minutes before she died, she actually got up and had some jello, a small drink, and then she just went, as if to sleep. I even took a picture of her because she just look like she is asleep.
-Dan

Wow, so sorry to read about your loss, but it seemed like she had a peaceful transition and that is the most important thing. Especially if you watched her pass on.

leslie :-D · Jul 15, 2005

yeah...I found that most people had some sort of symptom, whether it was pain, agitation, air hunger, etc...always managable...although not always easily. I can only remember like a couple who didn't require anything. I agree that dying doesn't always cause pain, but it can...and even more likely..as previously mentioned...issues with dyspnea, fluid overload, death rattle, etc.
Kathryn RN CHPN

agreed re: symptoms but not necessarily synonymous w/pain. rather how the body manifests itself when shutting down. so even those that died of natural causes, there would typically be the restlessness/agitation and fluid build-up; i just didn't equate that w/pain.

and i've still dealt w/sev'l pts where none of these happened and peacefully died in their sleep w/o any pharmocologic interventions.

leslie