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Facing Death that Lingers

CHOICES IN THE END 

Person lying in hospital type bed is a reminder that some death lingers for a long time.
An old woman lying on the ground with her head on a woven pillow waiting for death

More people die a lingering long life death than any other type of death. You have heard it said that dying is “messy business”. It surely can be protracted.  

Three-quarters of all deaths occur in people over age 65. Most people have on their death certificate one of the following causes of death (in that age group):

• Heart disease
• Cancer
• Stroke
• Diabetes
• Alzheimer’s Disease

Signs that people are at the end of life include:
• Coolness to the touch
• Confusion
• Sleeping (a lot)
• Incontinence
• Restlessness
• Congestion
• Urine decrease
• Fluid and food decreased intake
• Change in breathing
• Fever

If you haven’t experienced seeing these behaviors in a loved one, you probably will. It is best that you are prepared.  

There are choices to be made at the end (very different from the sudden death discussed in my last blog). This is the “practical” side of death. What sorts of machines, medications, tests, and other treatments do you want to have done? 

If you have the information, you can talk about death in real terms and not just in vague wishes. You will be better prepared to make informed decisions in the face of death.









Most of us blindly choose a treatment because it will fight a disease – which is a good goal. However, is it a futile effort? Do you need to establish goals and an endpoint? Define help. How long will you allow the “trial” to continue? If the treatment doesn’t accomplish the goals, what is the alternative? 

 

Maybe you promised your mother that you will never put her on a ventilator. But her condition may warrant the use of a ventilator for a short time to just get her through a medical crisis. You can say that if she has not regained consciousness or shown signs of regaining strength after X time you want the ventilator removed. You can change course!



As time marches on and you watch a loved one struggle without any quality of life, what do you do? You need to answer that question in terms of what the patient wants – not in terms of what you want. That will take inner fortitude. 



If you can, take time to think. Get a second opinion if possible. Talk with other loved ones. Grieve. But heed the wishes of your loved one. Don’t be swayed by what other might think. You have to trust yourself.



Machines, life support, DNR vs. CPR, artificial nutrition, and brain dead are all terms thrown out often at the end of life. It will help to at least know a bit about them and what they mean.



You may have responsibility for someone you love who seems to just linger – not be responsive to much and not able to make their own decisions. It is very hard on you to watch.



My dear friend has been sitting wringing her hands and cleaning her mother’s brow and bottom for well over a year. She can’t afford to hire a care manager or a care giving company. It is heartbreaking to watch what the lengthy death is doing to my friend. No one is gaining anything. 



You on behalf of the patient can say no to any treatment. Your loved one does not have to go back into the hospital or into a rehab center. You have to have a loud and committed voice (and constitution) and know that you are doing it as your loved one would want.



 There is plenty of time to say good-bye in this lengthy death. Is it better or worse than the sudden almost instant death with no time to say goodbye? Face it please - you don’t get to pick! Just be prepared!

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