Dealing with the Dying, by A Healthcare Couple

This essay is a joint effort from a healthcare couple.  My wife is a hospice nurse and I work at a long-term care facility.  Together, we have witnessed numerous patients die.  The purpose of this essay is to educate you in helping to take care of a dying group member (will use the term patient for this writing).  The first time that I experienced death up-close and personal was when my best friend B. died a few years ago.  We were both in our 20s and he had cancer.  Over the course of more than a year I was with him as he went through chemo, radiation and surgery.  At that time my experience with death was limited to my elderly grandfather and a few friends of my parents.  Death seemed pretty sterile and did not happen directly in front of my own eyes.  Now in my early 30s, I’ve experienced the death of more friends, their newborns/young children, more grandparents, and numerous patients of ours of all ages.  I’ve learned a lot since then and would like to share it with you.

In a TEOTWAWKI scenario, the reality is that people are going to die.  People you cared deeply for as well as people you never met.  Depending upon the scenario, the death-rate could be high and the possibility that you may have to help with the care of a dying person is likely.   
Take for example some of the current big killers for the U.S. population:

  • Heart disease
  • Cancer
  • Stroke
  • Diabetes
  • Respiratory Diseases
  • Influenza

Now add in potential TEOTWAWKI scenarios and the list could be expanded to also include these potential deadly killers:

  • Gunshot and other puncture wounds
  • Lack of availability for life-sustaining medication
  • Influenza epidemics
  • Worldwide diseases that are relatively low here in the U.S. but may increase do to unsanitary conditions and/or lack of access to quality health care (such as AIDS, Cholera, Hepatitis, Malaria, Meningitis, Rotavirus, Tuberculosis, Typhoid, etc.)
  • Labor complication
  • Drowning
  • Burns
  • And the list could go on and on…

Whatever the case, if you are called upon to help with the care of a dying person, it is best to know a little about the subject. 
In this essay I’m not going to write about emergency room procedures or survival medicine that you can use in the field to save lives, but rather, I want to focus on when medically you can do no more for your patient.  Depending upon the preparation of your group, the threshold could vary widely for when you can do no more.  It is my hope that you have taken necessary steps to prepare and practice lifesaving techniques for you and your group. 

For hospice patients, they usually are given six months life expectancy or less.  In your case, the patient may have those few months to live, but more likely they will have much less time than that.  Know that when the body is going through the dying process, many changes are happening.  I understand that each person and situation is different, but I am going to try and cover the dying process in general terms.    

In hospice, when a patient is getting close to dying, it is referred to it as active dying.  Leading up to this active dying stage, the patient may have reduced appetite and you may notice weight loss.  Don’t force the patient to eat food.  The body is dying and has not need for the nourishments.  I’ve seen all too often family members trying to get their loved one to eat, only causing that patient to become nauseous.  In addition to the reduced appetite, the patient my sleep more and be very tired.  They may become disoriented, have delusions, or hallucinations (speaking to people who aren’t there).  This is very common and may times if the patient is talking to someone that is not there, it is highly likely that they are speaking to someone who has already died.  These hallucinations are a very interesting phenomenon to me.  I usually try not to change the subject, but rather gather information from the patient such as who they are talking with, and what they are talking about.  Don’t miss this opportunity as the patient may be trying to tell you or a loved one something.

Currently in hospice, we have many methods to use to make patients more comfortable.  For patients suffering from pain, we have a whole host of drugs available.  Many of these stronger drugs are opiates which diminish the experience of pain by the patient.  Some of the more common drugs used are Oxycodone (Oxycontin), Morphine (Roxanol), Fentanyl (patch, Actiq), Methadone (Dolophine), or Hydromorphone (Dilaudid).  In a TEOTWAWKI scenario, it will likely be difficult to obtain these drugs and you may be left with more common household drugs such as acetaminophen, ibuprofen, or aspirin to help relieve pain.

For patients suffering from breathing problems, we currently have oxygen [concentrator] machines that we can hook-up directly to the patient [typically via a nasal cannula.]  In addition, many of the opiates also help relieve breathing problems.  Without either of these two resources, you can try to reposition the patient by placing more pillows under their head or having them sit at an incline.  You can also try creating a light breeze directed at the patient’s face to see if that helps.  If the patient’s lips become dry, try using a lip balm.  If the inside of their mouth become dry and they are conscious, try giving the patient ice chips if available (if not, you can wipe the inside of the mouth with a cotton swab, cotton ball or damp washcloth.  This dryness in the mouth can cause irritation to the patient, so make sure to provide ice or dab the inside of the mouth every two hours.  For patients lying in the same position for any length of time, they may develop pressure ulcers (sores).  Try to reposition the patient if possible every few hours.
When a person is actively dying, there are some signs you can look for to know that the person is close to death:

  • The body has a difficult time regulating its temperature, so you will notice the body temperature beings to gradually lower (normal body temp is 98.6 -98.2F if taken orally) or if an infection is present, the temperature may spike
  • The pulse begins to become irregular, sometime speeding up with other times slowing down (normal pulse is 60-100 beats per minute)
  • Blood pressure begins to lower (normal pressure is 120/80)
  • The patient may begin to perspire and feel cool to the touch
  • Skin beings to change color as blood circulating within the body begins to diminish (you will usually notice it in the lips or fingertips as they begin to turn a bluish/purplish color)
  • Breathing usually becomes more difficult, sometime rapid and shallow and others time gradually slowing to just a few breaths per minute (normal is 12-20 breaths per minute)
  • While not as noticeable, it is very common to have a surge of energy for a short period of time (the patient my want to get up out of bed, may want to talk to friends/family, eat after going days without eating, etc.)

When pulse, blood pressure and respirations cease, the patient has died.  The deceased should always be handled with the utmost care and respect.  We are all going to die someday, so treat the body as you would want someone else to treat your body.  It is appropriate to do a small ceremony at the bedside with all who are present.  I typical being with a prayer and then have those gathered say something about the deceased.  Due to infection control, I would recommend that the deceased be buried immediately.  If at all possible, have everyone coming into contact with the deceased, the bed, clothes, etc., wear rubber gloves.  If possible, wrap the body in a blanket or sheet.  You may then want to wrap the body in a plastic trap, as body fluids may begin to be excreted from the body.  You will want to wash bedding in hot soapy water and then use a bleach solution to wipe down any infected areas.  If you are in a location to bury the body, dig an area away from water sources.  The typical grave is 4 feet deep, 8 feet long and 3 feet wide.  Use whatever measurements fit for the deceased.  If you are unable to bury the body, the next best solution would be to burn the body.  Make sure to have plenty of your fire source, as you want to dispose of as much of the body as possible. 

On a final note, throughout this the dying process, don’t forget how powerful human interaction can be.  Especially for patients who are experiencing high levels of anxiety, human touch can do wonders to help calm a person.  Touch helps to convey care, solace, and comfort.  Even if the person is no longer conscious, talk to them.  Many times the patient can hear you even if they are not alert, awake and conscious.  Have people introduce themselves as they enter the room.  Have them talk directly to the patient.  Encourage visitors or those gathered to talk directly to the patient.  Lastly, take time to mourn the loss of life.  In a TEOTWAWKI scenario, you may not be able to have much time to mourn, but make it a priority when you have the time to remember all those that died.          

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