The sadness and inevitability of death brings problems and difficulties that few persons have the knowledge or experience to cope with alone. Most persons would like to die at home close to family and familiar possessions. Every help must be given to the patient who wishes to die at home and not in a hospital. The expense of prolonged hospitalization is often prohibitive, and this is an additional psychological as well as financial burden for the patient and family.
Some persons have more experience of helping with the dying than others. The physician knows about the patient's physical needs and has the skill to prevent or relieve pain. He or she becomes a leader and supports the family during the weeks ahead. A member of the clergy can give a spiritual support that may not have been needed by the patient or the family for many years.
At the onset of a terminal illness, the physician and family are faced with the decision of what to tell the patient. If the course of the illness is rapid, the decision may not have to be made. The problem usually arises when an inoperable cancer is present; when there is an incurable muscular disorder; or when a cardiac condition begins to rapidly deteriorate. Often the patient's mental state remains unaffected and alert.
Every physician must be free to tell the patient what he or she feels is necessary and appropriate. The problem is discussed with the patient's family. The physician does not like to lie to the patient, because the patient will lose confidence in the physician if he or she were ever to discover the truth. Often the dying patient never asks a direct question about his or her condition. This does not mean that the patient is not aware of what is happening, but that he or she prefers to help the family, the physician, and himself or herself by maintaining the pretense that all will be well. The patient may not want to know how many months or years he or she has got to live. It is enough for the patient to know that he or she is not going to suffer.
Sometimes, however, the patient wants to know exactly what is the matter, what can be done about it, the likelihood of successful treatment, and eventually, the length of time the physician expects him or her to live. Most physicians give truthful answers to direct questions such as these. This honesty may in itself help the patient through moments of mental anguish. It also gives the patient a chance to put his or her affairs in order. The patient may not want the family to know that he or she understands the predicament. This makes it easier for them all to maintain a façade of cheerfulness. Recent surveys suggest that patients increasingly want to know about their disease and its exact prognosis, rather than being "protected" from bad news.
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 - 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.
Care of the Dying - Moment of Death
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.
