Preparing for the Death of a Loved One

The impending death of a loved one is always a difficult emotional time, but knowing what to expect during a loved one’s final days can help you prepare to handle the event.

The physical and emotional-spiritual-mental signs and symptoms of impending death which follow are offered to help families understand the natural kinds of changes which may happen during the dying process and how to best respond. All these signs and symptoms will not occur with everyone, nor will they occur in this particular sequence. Each person is unique and needs to do things in his or her own way. The body prepares itself for the final days of life in the following ways:

Fluid and Food Decrease

There is usually little interest in eating and drinking. Allow the person to eat and drink whatever is appetizing to them, but any nourishment should be taken slowly and in small amounts. Let the person decide how much and when to eat and drink. Be careful of decreases in swallowing ability, and do not force fluids if the person coughs soon after. Reflexes needed to swallow may be sluggish. Small chips of ice, frozen juices, or Popsicles may be refreshing in the mouth.

The person’s body lets him/her know when it no longer desires or can tolerate foods or liquids. The loss of this desire is a signal that the person is making ready to leave. This is not a painful process. Dehydration no longer makes them uncomfortable. Glycerin swabs may keep the mouth and lips moist and comfortable. A cool, moist washcloth on the forehead may also be welcome.

Decreased Socialization

The person may want to be alone with just one person or with very few people. Speech is often slow or difficult or the person may not have the ability to speak at all. It is natural to not feel like socializing when feeling weak and fatigued. It can be disturbing to the dying person to have more than a few people in the room.

Think about taking shifts in order to be with the person but also keep the environment quiet and calm and reassure the person that it is okay to sleep.

Sleeping

The person may spend an increasing amount of time sleeping and become uncommunicative, unresponsive, and difficult to arouse at times. This normal change is due in part to changes in the metabolism of the body. Sit with the patient, gently hold his or her hand; speak softly and naturally. At this point, “being with” is more important than “doing for.” Never assume that the person cannot hear; hearing is said to be the last of the five senses to be lost. Hearing may still remain very acute although the person may seem asleep, so do not say anything in their presence you would not say to them when awake.

Restlessness

The person may make restless and repetitive motions such as pulling at sheets or clothing or have visions of people or things that do not exist. These symptoms may be a result of a decrease in the oxygen circulation to the brain and a change in the body’s metabolism. Do not be alarmed or interfere, or try to restrain such motions. Talk calmly and reassuringly with the confused person so as not to startle or frighten him/her further. Lightly massaging the hand/forehead, reading to the person, or playing soft music can also have a calming effect.

Disorientation

The person may seem confused about time, place, and identity of people around him/her, including close and familiar people. Identify yourself by name rather than asking the person to guess who you are. In conscious moments the person may speak or claim to have spoken to people who have already died, or to see places not presently accessible or visible to you. This is not a hallucination or a reaction to medication. It signifies a person beginning a normal detachment from this life, preparing for the transition so it will not be frightening.

Accept this transitional time. There is no need to contradict, explain away, belittle, or argue about what the person claims to see or hear. Listen with respect to whatever the person has to say, allow free expression of feelings and offer comfort through touching and/or talking reassuringly and calmly.

Incontinence

The person may lose control of urine and/or bowels as the muscles in the area begin to relax. Diapers or chux may be helpful to protect the bed and assist in keeping the person clean and comfortable.

Urine Decrease

Urine output normally decreases, becomes more concentrated, and may become the color of tea. This is due to decreased fluid intake and to a lessening of circulation through the kidneys. The hospice nurse may suggest that a Foley catheter be inserted or irrigated.

Breathing Pattern Change

The person’s usual breathing patterns may change with the onset of a different breathing pace. Breathing may become shallow, irregular, fast, or abnormally slow. A particular pattern consists of breathing irregularly with shallow respiration or periods of no breaths for 5–30 seconds, followed by a deep breath. The person may also have periods of rapid shallow panting type breathing. Sometimes there is a moaning-like sound on exhale; this is not distress, but rather the sound of air passing over relaxed vocal cords.

Changed breathing patterns are very common for a person nearing death and indicate decreased circulation in the internal organs and buildup of body waste products. Elevating the head and/or turning onto the side may increase comfort.

Congestion

Oral secretions may become more profuse and collect in the back of the throat. The person may develop gurgling sounds coming from the chest. These sounds can become loud and distressing to hear. These normal changes come from fluid imbalance and an inability to cough up normal secretions. It is helpful to raise the head of the bed or use pillows to raise the person’s head so that the secretions pool low and won’t stimulate the gag reflex. Turn the person’s head to the side and allow gravity to drain the congestion. You may also gently wipe the mouth with a moist cloth.

Color Changes

Due to changes in circulation the person’s arms and legs may become cold, hot, or discolored. This may be especially noticeable in extremities where the color may change to a darker, bluish hue. This is a normal indication that the circulation is conserving to the core to support the most vital organs.

Irregular temperatures can be the result of the brain sending unclear messages. Keep the person warm if they appear cold, but do not use an electric blanket. If the person continually removes the covers, then allow them just a light sheet. Sweating may occur and there may be an odor resulting from the many physiological changes taking place in the body. The heartbeat and pulses may become slower, weaker, and irregular.

Permission To Go

When someone enters the last days of dying, their body begins the process of shutting down, which will end when all the physical systems cease to function. This is usually an orderly and non-dramatic series of physical changes that are not medical emergencies and do not require invasive interventions. These physical changes are a normal, natural way in which the body prepares itself to stop. This release may include resolving whatever is unfinished of a practical nature, and seeking or receiving permission from family members to “let go.””

A dying person will commonly try to hold on, even though it brings prolonged discomfort, in order to be assured that those left behind will be all right. A family’s ability to reassure and release the dying person from this concern is the greatest gift of love they can give at this time.

Saying Good-bye

When the person is ready to die and the family is able to let go this is the time to say good-bye in personal ways. It may be helpful to just lay in bed with the person, hold a hand, and/or say everything you need to say. Tears are a normal and natural part of saying good-bye, and do not need hiding or apology. Tears express your love and help you to let go.

At The Time Of Death

It may be helpful for family members to discuss ahead of time what to do when the final moment arrives. At the time of death: breathing ceases, heartbeat ceases, the person cannot be aroused, the eyelids may be partially open with the eyes in a fixed stare, the mouth may fall open as the jaw relaxes, there is sometimes a release of bowel and bladder contents as the body relaxes.

The death of someone in a hospice program, although an anxious event for family and friends, is not an acute medical emergency. While you should call the hospice, it is not necessary to call the medical examiner, the police, or 911. When the death has occurred, take the time needed to call a supportive person or to adjust to the situation. There is no rush. Taking care of you is what is more important now.

The physical and emotional-spiritual-mental signs and symptoms of impending death described above are intended to help families understand what may happen in a way appropriate and unique to the values, beliefs, and lifestyle of the individual patient.

We hope that this information will alleviate some of the natural anxiety and fear that accompanies caring for a terminally ill person.

 

 

 

 

Cucumber & CompanyPreparing for the Death of a Loved One

The 5 Stages of Loss and Grief

The death of your loved one might inspire you to evaluate your own feelings of mortality. Throughout each stage, a common thread of hope emerges: As long as there is life, there is hope. As long as there is hope, there is life.

Many people do not experience the stages in the order listed below, which is okay. The key to understanding the stages is not to feel like you must go through every one of them, in precise order. Instead, it’s more helpful to look at them as guides in the grieving process — it helps you understand and put into context where you are.

1. Denial and Isolation

The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.

2. Anger

As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

Remember, grieving is a personal process that has no time limit, nor one “right” way to do it.

The doctor who diagnosed the illness and was unable to cure the disease might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them.

Do not hesitate to ask your doctor to give you extra time or to explain just once more the details of your loved one’s illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Understand the options available to you. Take your time.

3. Bargaining

The normal reaction to feelings of helplessness and vulnerability is often a need to regain control–

  • If only we had sought medical attention sooner…
  • If only we got a second opinion from another doctor…
  • If only we had tried to be a better person toward them…

Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.

4. Depression

Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.

5. Acceptance

Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.

Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us.

Coping with loss is a ultimately a deeply personal and singular experience — nobody can help you go through it more easily or understand all the emotions that you’re going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing.

 

 

Cucumber & CompanyThe 5 Stages of Loss and Grief

Dealing with Loss

 

See the original article here.

Times of emotional crisis and upset often involve some kind of loss. For example, the loss of a loved one or the end of a marriage or relationship.

Most people grieve when they lose something or someone important to them. Grieving can feel unbearable but it’s a necessary process.

How does grief make you feel?

The way grief affects you depends on many things, such as the nature of the loss, your upbringing, your beliefs or religion, your age, your relationships, and your physical and mental health.

You can react in many ways to a loss. “But, ultimately grief consists of several key emotions. Anxiety and helplessness often come first,” explains clinical psychologist Linda Blair. Anger is also common, including feeling angry at someone who has died for ‘leaving you behind’. This is a natural part of the grieving process, and you shouldn’t feel guilty about that. “There’s also sadness, which often comes later.”

Knowing that these emotions are common can help to normalise them. It’s very important to know that they will pass. Some people take a lot longer than others to recover. Some need help from a counsellor, therapist or their GP. But eventually you’ll adjust to your loss, and the intense feelings usually subside.

Dealing with the emotions

“Grief always requires a period of adjustment,” Blair says. “Give yourself time to adjust and recover. Be respectful of yourself and your grief. You might feel hopeless for a while. Be patient with yourself.”

There’s no instant fix. You might feel affected every day for about a year to eighteen months after a major loss. After this time, the grief is less likely to be at the forefront of your mind.

There are practical things you can do to get through a time of crisis or loss:

  • Express yourself. Talking is often a good way to soothe painful emotions. Talking to a friend, family member, health professional or counsellor can begin the healing process.
  • Allow yourself to feel sad. It’s a healthy part of the grieving process. Crying enables your body to release tension.
  • Maintain a schedule. Expert Linda Blair recommends keeping “simple things in your routine. It reduces the panicky feelings. It’s important that you see other people at least once a week because it grounds you.”
  • Sleep. Emotional strain can make you very tired. If you’re having trouble sleeping, see your GP.
  • Eat healthily. A healthy, well-balanced diet will help you to cope with your emotions.
  • Avoid things that ‘numb’ the pain, such as alcohol. It will make you feel worse once the numbness wears off.
  • Go to counselling if it feels right for you, but perhaps not immediately. “Your emotions can overwhelm you at the beginning. Counselling may be more useful after a couple of weeks or months. But only you know when you’re ready,” says Blair
Cucumber & CompanyDealing with Loss

Giving Thanks

“God’s goodness has been great to thee. Let never day nor night unhallowed pass but still remember what the Lord hath done…” – Shakespeare

Perhaps it was always this way but it seems that in today’s frantic “rat-race” existence, many of us are so busy trying to get more of everything that we fail to e thankful for what God has already seen fit to give us.

There is peace, contentment and satisfaction in the mere act of giving thanks.  Enumerating the things for which we should be thankful brings a realization of well-being.  Realization of our unworthiness should bring great humility.

Our staff is happy to join this week with our many good friends and neighbors in giving, with great humility, our thanks to the Almighty.

Cucumber & CompanyGiving Thanks

Significance

“The significance of a man is not in what he attains but rather in what he longs to attain…”     Kahil Gibran

We all tend to measure the worth of an individual by his achievements.  If a person has succeeded as a great scientist, statesman, or literary giant, we assign to him the status of great significance.

Gibran, a talented Lebanese novelist, poet and artist of the early 1900’s, suggests that a person’s aspirations are perhaps a more accurate measure of his significance.  We may “attain” by chance but what we desire to attain reveals the kind of person we really are.

A death in the family can be sudden and shattering.  At such a time, our dependable advice and counsel can be extremely comforting.  This is the basis of our profession.  Call us.

Cucumber & CompanySignificance

Economy

“Economy is the art of making the most of life.  The love of economy is the root of all virtue…”

–        George Bernard Shaw

Maybe you never thought of “economy” as anything except scrimping and doing without.  Actually, as Shaw tells us, we economize in order to conserve our assets.  Thus we are able o derive even greater pleasure at some future time.

We can practice economy in the use of our time as well as with our money.  We expend our time and money where benefits are the greatest, l which gives us the most out of life. Being economical does not have to mean being unhappy, as we learn when we practice it.

Many people find comfort in pre-arranging their own funeral service.  This relieves loved ones of the need to make painful decisions under emotional stress.  Let our staff explain other advantages, too.

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When grief doesn’t go away

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as you accept the loss and start to move forward. If you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.

Symptoms of complicated grief include:

  • Intense longing and yearning for the deceased
  • Intrusive thoughts or images of your loved one
  • Denial of the death or sense of disbelief
  • Imagining that your loved one is alive
  • Searching for the person in familiar places
  • Avoiding things that remind you of your loved one
  • Extreme anger or bitterness over the loss
  • Feeling that life is empty or meaningless

 

 

Cucumber & CompanyWhen grief doesn’t go away

Coping with grief and loss tip 2: Take care of yourself

When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

  • Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.
  • Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to him or her.
  • Look after your physical health. The mind and body are connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.
  • Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.
  • Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.
Cucumber & CompanyCoping with grief and loss tip 2: Take care of yourself

Coping with grief and loss tip 1: Get support

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

Finding support after a loss

  • Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Draw loved ones close, rather than avoiding them, and accept the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them what you need—whether it’s a shoulder to cry on or help with funeral arrangements.
  • Draw comfort from your faith – If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you—such as praying, meditating, or going to church—can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
  • Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers.
  • Talk to a therapist or grief counselor – If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.
Cucumber & CompanyCoping with grief and loss tip 1: Get support