IntroductionNo one likes to talk about dying and death, for yourself or your loved ones. Yet, birth and death are two aspects of life, which will happen to everyone. Dying and death are painful and personal experiences for those that are dying and their loved ones caring for them. Death affects each person involved in multiple ways, including physically, psychologically, emotionally, spiritually, and financially. Whether the death is sudden and unexpected, or ongoing and expected, there is information and help available to address the impact of dying and death.
What Is Hospice?
Hospice is a specialized program that addresses the needs of the catastrophically ill and their loved ones. A team approach is provided in hospice that may involve physicians, nurses, social workers, clergy, home health aids, volunteers, therapists and family caregivers. Hospice workers can help a dying person manage pain, provide medical services and offer family support through every stage of the process, from diagnosis to bereavement.
Hospice services are available in the comfort of your own home, in a hospice facility, or often in settings such as nursing homes and hospitals. Many people who use hospice tell of a wonderfully positive experience with a compassionate staff who focus on caring for the whole person and their families.
Individuals enrolled in hospice have to have a doctor give them a diagnosis of six months or less to live. Many persons in the last stages of dementia-related illnesses, cardiovascular disease, and respiratory and pulmonary illnesses are now enrolled in hospice. Often, health insurance covers hospice services.
Palliative care is an approach to health care that improves quality of life for individuals and their loved ones with complications from life-limiting illness. The goal of palliative care is often accomplished by treating the physical and psychological effects of illness, especially pain.
Palliative care treats dying and death as a normal life process and intends to neither hasten nor postpone it. Instead, this type of team care offers a support system to encourage patients to live as actively and comfortably as possible until the end.
Dying is a different experience for everyone involved. A member of your loved one’s health care team can give you a more accurate idea of what to expect. Nevertheless, these signs and symptoms are typical:
- Confusion – about time, place, and identity of loved ones; visions of people and places that are not present
- A decreased need for food and drink, as well as loss of appetite – this may be caused by the body’s need to conserve energy and its decreasing ability to use foods properly
- Drowsiness – an increased need for sleep and unresponsiveness
- Withdrawal and decreased socialization – can be caused by mentally preparing for dying, decreased oxygen to the brain and decreased blood flow
- Loss of bowel or bladder control – caused by relaxing muscles in the pelvic area
- Skin becomes cool to the touch – especially in the hands and feet, skin may become bluish in color caused by decreased circulation to the extremities
- Rattling or gurgling sounds while breathing or breathing that is irregular and shallow, decreased number of breaths per minute, or breathing that switches between rapid and slow
- Involuntary movements (called myoclonus), changes in heart rate, and loss of reflexes in the legs and arms also mean that the end of life is near
At its most simple, grief is the reaction to a significant loss. Most often, it is the acutely sad and painful emotions you experience when a loved one dies. However, you can grieve if you are suffering from a terminal illness or if you have been diagnosed with a chronic condition that limits your autonomy. Ending a significant relationship, such as a marriage, or a long-term partnership, can also result in grieving. Many people are resilient and will cope with grief with the personal support of family, friends, and clergy. Some grieving individuals who experience grief in ways that impact their ongoing ability to function may need to seek professional help.
It takes time to cope with and accept your loss. You will never stop missing your loved one, yet the pain may ease with time. The best thing you can do is give yourself permission and time to grieve.
Yes. Grief is multi-layered and can impact many areas of your life – physical, social, spiritual and psychological. People who are grieving will often report difficulty sleeping and eating, frequent crying spells, irritability, an inability to focus, and be productive at work.
Grief is personal. Everyone grieves at a different pace. Again, the best thing you can do is to be patient and give yourself time to grieve.
Young people feel the loss just as acutely as adults do, yet may not know how to express their grief. It’s important to be honest with our children when they lose someone they love and offer them age-appropriate information.
A parent’s death can be especially difficult for young children, impacting their sense of security or even survival. It’s especially confusing when well-meaning adults try to protect children from the truth or even from their surviving parent’s display of grief. Very young children can also revert to earlier behaviors, ask what appears to be insensitive questions about the dead or even invent games about dying. This is all very normal behavior.
Forcing a child to attend a funeral may not be in the best interest of the child if they don’t want to go.
It is important for children to have a meaningful ritual to observe the death, such as lighting a candle, whispering a prayer or goodbye, talking to the deceased, or sending a balloon to them symbolically.
Bereavement is the period directly after the loss of a loved one when you may mourn, and feel a number of emotions or a lack of emotions. Bereaved individuals can experience shock, numbness, relief, depression, anger, sadness, acceptance, and at different points during bereavement. Bereavement is considered by many professionals to last for at least a year after someone has died, but in reality, the thoughts and feelings in bereavement often are triggered over a lifetime, but typically lessen with time.
Many people are very uncomfortable with the notion of death, even avoiding discussing it with the dying person. You may experience a range of feelings both before a loved one dies and long afterward.
The noted expert in dying and death, Dr. Elisabeth Kubler-Ross, identified the stages that dying people and their families typically experience. Knowing these stages can help you to understand a dying person’s reactions, as well as your own. While these stages do not necessarily progress in the order listed, they are predictable and normal.
They are:
- Denial, or disbelief, numbness
- Anger, blaming others
- Bargaining (e.g. “If I am cured of this, I swear, I will go to church every Sunday!”)
- Depression, sadness, crying, feeling despondent
- Acceptance or coming to terms with loss and death.
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