Helping Loved Ones Through the Process of Dying

Communication
Families and friends are often concerned about how to express their feelings:

“I’d like to talk about how I feel and what is happening,
but I don’t know what to say.�?BR>"What if I cry? I don’t want to make him/her feel bad.�?/P>

It is normal to feel sad and tearful when someone you care about is dying. These emotions can be difficult to express.

�?It may be helpful to share your feelings with a facility chaplain or with your clergy. He or she can help you and your loved ones find ways to discuss these difficult topics.

Weakness
As a person’s strength gradually decreases, he or she will spend more time resting. Sleep will become deeper and longer. With the loss of energy, a person will usually show less interest in activities, people and surroundings.

�?Be aware of the person’s energy and consider limiting the number of visitors and the length of visits as appropriate.

Changes in Appetite
As the body’s needs change, the appetite frequently changes. The person will gradually stop eating and eventually may even refuse fluids. Watching someone refuse to eat and drink can be difficult. Although you may be used to offering food as a way of showing love and concern, please understand that the person is more comfortable this way.

�?Ask the nurse for suggestions about what foods and fluids the person may tolerate more easily during these changes.
�?Respect the person’s decision; do not try to force foods or fluids.
�?Offering touch, conversation or supportive silence becomes important now.

Decrease in Urine
When the person begins to drink less, he or she has less need to urinate. Urine color changes from yellow to tea color or dark brown. The odor may also become stronger because the urine is more concentrated.

Loss of Bowel and Bladder Control
As weakness increases and muscles relax, the person may experience the loss of bowel and bladder control. This change can be upsetting to both the patient and the family; however, it is a normal result of the changes in the body.

Restlessness
For a variety of reasons, the person may become restless or agitated. Some of the reasons include changes in the body, a decrease in the oxygen level, fears, and physical or emotional discomfort. The nurse may have helpful suggestions for easing restlessness. Here are some to try:

�?Do not try to restrain the person’s movements. Restraints may actually increase the restlessness.
�?Speak softly in a calm, natural way.
�?A light massage to the forehead, hands or feet may soothe the person.

Confusion
Changes in the body can also cause confusion. Sometimes medication also causes confusion. If you are concerned that medications are causing confusion, talk to the nurse.

�?When approaching someone who is confused, always identify yourself.
�?Using simple statements, tell the person what you plan to do, such as “I’m going to put this cool washcloth on your
forehead�?

Vision-like Experiences
As a person approaches death, he or she may begin talking to someone who is not physically present in the room. Often this someone is a family member or a friend who has died. Sometimes the person will also report seeing the place to which he or she will travel after death. These experiences are usually very comforting to the person. They are a normal and natural part of the dying process.

�?Encourage the person to talk about visions and experiences he or she is having. Try to be open to hearing what the person is sharing. Let the person know that these experiences are normal.

Decreased Responsiveness
As the dying process continues, the person may sleep more. It may become increasingly difficult to awaken him or her. The ability to hear continues long after the ability to respond is lost. Being spoken to and hearing familiar voices can be very comforting to the person.

�?Speak naturally. Know that you will be heard.
�?Do not try to awaken the person.
�?Notice if gentle touch soothes the person.

Congestion
As the person becomes less responsive, congestion may occur in the chest and throat. Congestion causes a variety of gurgling and rattling sounds. Suctioning is not usually recommended because it can cause discomfort and increase congestion. Although the gurgling and rattling sounds cause little or no distress to the person, they can be disturbing to the family. The nurse can tell you if medications or treatment would minimize the congestion.

�?Raise the head of the bed or turn the person onto his or her side to ease congestion.

Breathing Changes
Breathing changes as death draws closer. The person may experience periods of faster, shallow breathing, followed by deeper, irregular breaths, including periods of up to a minute when no breaths are taken. Sometimes a moaning sound occurs when the person breathes out. This does not mean the person is in pain or is suffering - it is simply air moving over relaxed vocal cords.

�?Raise the head of the bed slightly.
�?Share any concern with the nurse.

Temperature
The person’s skin, especially on the hands, legs and feet, may become increasingly cool to touch and may appear darker or blotchy. The brain may send confusing messages to the body, causing the person to experience periods of hot and cold.

�?Put on or remove blankets according to what the person wants.

Saying Good-bye
It is hard to let go of someone you love, but is a great and necessary gift. A dying person sometimes lingers, even at the risk of discomfort, if he or she feels that the family is not prepared to let go.

You can reassure your loved one by letting him or her know that it is alright to die whenever he or she is ready and that you have the strength to carry on.

�?Say good-bye in your own way. This may include offering words of love, forgiveness or gratitude; quietly holding a hand and sending love; or talking about meaningful or funny times.
�?Tears are a natural part of saying good-bye. You don’t need to hide your tears or apologize for them. They are normal expressions of grief and love.

Dying the “Right Way�?/STRONG>
Our ultimate gift is to allow someone to die in his or her own way. This is not the time to try to change someone; this is a time to offer acceptance, comfort and support.

�?It is natural to want to share your thoughts and feelings in an open and significant way. Discuss your desires with any member of the staff. We will support you in any way we can to make this time easier and more meaningful for you.