Do not be alarmed if the patient's breathing makes a groaning or croaking sound. It does not mean that he or she is in pain. When a dying patient slips into a coma, the position of the neck and body produces the noise, which can be reduced by gently turning the patient's shoulders or body.
The time of death is sometimes difficult for the physician to estimate beforehand. The patient may become unconscious some hours, even days, before death or may remain alert and conscious to the end. Painkilling drugs sometimes produce a state of semi-coma that can be misinterpreted by the family as a forerunner to death. The patient may develop an alarming breathing pattern called Cheyne-Stokes respiration, in which breaths increase in rapidity and volume until they reach a climax, then gradually subside and stop altogether. This period can last from five seconds through a minute before the process begins again. The syndrome is common in sick or elderly persons. Although it can be a forerunner to death, it is just as likely to last for several months or even to disappear altogether.
Another alarming noise the dying patient may make is known as the "death rattle." This happens because the unconscious patient is unable to cough up the secretions that accumulate in the back of the throat.
The attitude of the family and the patient alters at this stage. As the patient suffers from increased weakness, lethargy, discomfort, and pain, he or she begins to come to terms with dying. Death is no longer frightening. Often a person's last days are spent more happily in the knowledge that he or she is dying, than in a state of uncertainty and doubt. It is easier for the family and patient to talk about death in a way that may not have been possible earlier in the illness. It brings comfort to everyone, and often closeness not experienced before.
The patient or family may need additional comfort from a member of the clergy or from a physician. The length of life remaining to the patient no longer matters. The important thing is the quality of the patient's last days or hours. The physician is aware that the application of medical skill can sometimes prolong the patient's suffering and bring no real benefit. Although the physician may prescribe large doses of painkilling drugs if necessary, he or she is unlikely to start the patient on new treatment.
The actual moment of death is difficult to define, and for the family, difficult to accept. Even when the patient has stopped breathing, and a pulse cannot be felt, the heart gives feeble contractions for another minute or two. Even a physician may find it difficult to give an exact time of death, but must leave it to the expert to make the diagnosis.
If the family is present at the moment of death, it is comforting for everyone to stay quietly at the bedside with his or her own thoughts. Each member of the family needs a chance to touch or to kiss the dead relative, and such physical contact helps to bring home the reality of death.
Often no one is present when the patient dies, for he or she may have been left alone to sleep. Although death is expected, it is still a shock for the member of the family who first enters the room. It is sensible to tidy the bedclothes and comb the patient's hair before telling the rest of the family. When they come in to see the body, it has an appearance of calm and peacefulness.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Death of a Baby
The intrauterine death of an embryo ends in a miscarriage (spontaneous abortion). Ten percent of pregnancies end in this way, commonly between the sixth and tenth weeks, and usually because of an abnormality in the embryo. With care, subsequent pregnancies are usually successful.
Care of the Dying - Reaction of Children
A child's reaction to death depends on many factors. A child's first experience with death is often the death of a pet. A child under the age of eight cannot understand that death is irreversible and may expect the mother or father to bring the pet back to life. After the age of eight or nine, the child's understanding is usually as rational as an adult's understanding.
