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5 Things You Should Know When Someone is Actively Dying

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Dying is hard to think and talk about. But it is important to try to understand the process of one’s final days. Chief Medical Officer Dr. Eric Bush talks about some of the signs that someone is actively dying. Just like everything else, the more education you have, the more you know what to expect.

Everyone welcome to our community education video today we’re talking about five things when someone is actively dying and i’m joined by dr eric bush who’s the chief medical officer for hospice of the chesapeake and chesapeake supportive care so tender topic actively dying i feel like we should first start with that term because a lot of people dying is dying so

What does actively dying mean yeah now i appreciate what you’re saying i think especially in the context of the covet pandemic and now unfortunately the us having eclipsed 400 000 lives lost more than in world war ii i i think it’s on everybody’s minds um actively dying is really that final phase of life here uh you know when god’s calling you home so typically

Usually those last three days okay and what you see is you tend to see drop in blood pressure um the patient your loved one tends to be less responsive if responsive at all sometimes they can have a little bit you’ll hear about the rattle that they may have and what that is is the body just relaxing or you can think about it as disengaging is the way i think

About it okay the muscles in the back of the throat are relaxing so people are no longer able to clear those secretions there there’s often changes in breathing pattern so and especially as people get closer they can actually have pauses in their breathing and then may try to recover and have several you know rapid breaths that that chain stokes breathing that

People talk about and and color changes so color changes in their fingers and toes typically the areas that are furthest from the heart um again as the heart relaxes as the body relaxes and there’s less blood flow to those areas furthest from it um you can see almost a purplish lacy discoloration that we call modeling m-o-t-t-l-i-n-g and it doesn’t hurt it’s not

Causing your loved one to stress um it’s just another indicator that things are changing for them you know and and god’s calling them home at that time gotcha so you went over um several of the physical signs which was one of my my second question when you you say sort of that active stage takes you know roughly is the three day is that about is there any like

Specific time period when someone is dying at the end no so usually before that act that quote unquote actively dying time frame there’s a period of time where we call transitioning and that’s usually at least several days before the actively dying phase and at that time somebody is less responsive but maybe they’ll give you one or two word answers to questions

If you give them you know well focused questions or queries or maybe they’ll nod their head yes or no but again it’s all in line with that whole disengagement process um and that three days you know i tell people god keeps me honest what i do uh sometimes it’s three days sometimes it’s seven days um our approach our focus for that time of life is making sure

People are comfortable right and once we’ve been able to achieve that comfort level we just take it a day at a time um because there’s so many things that are still unknown that we don’t understand in this world that as long as somebody appears to be symptomatically managed right um whatever that time frame is it is because it it varies uh from person to person

That i can tell you yeah so all right we covered sort of the definition the timing some of the physical symptoms i want to add a a some question about eating because i’m i’m sure this cause stress for families when their loved one sort of during this end of life process doesn’t want to isn’t engaged in food there’s so much in our culture and in our food is love

Right so that’s that’s one thing that that seems to kind of cause stress for folks can you talk a little bit about that process and and what happens with that sure you’re right so food is so highly ingrained in our culture and as well as illness if you think about the first time you were sick you know was the first thing your mother said to you is that you

Got to eat to get better and um but this time when somebody’s at a time of life it’s it’s different and people take in what they need and they’re not taking anything that’s what they need at that time it’s unsafe for them to eat if you think about back to what we’re talking about with the swallowing and how those muscles relax there’s no way for them to be able

To get food down safely the other piece too is it does not limit someone’s life expectancy people in general can go up to 30 days without food um without fluids seven days is textbook but usually seven to ten uh somewhere in that time frame and so um as you’re disengaging and as you’re going naturally just think about what your body is utilizing from a caloric

Perspective really very minimal and so you’re able to get on day after day without eating it’s not causing anybody pain it’s not causing them harm it’s not causing discomfort it’s just naturally what they need at that time i really i really think it’s helpful that phrase that you use the disengaging because that that really kind of explains it in a in a really

Helpful way right well one thing i did want to mention is that um in that whole disengagement process i actually had the question this morning on rounds uh with from patient son is there are two things that patients can still sense that is touch and it’s almost reflexive in nature and they will respond to their loved ones touch more so than they would to mine in

Addition voice so we know that patience that hearing is one of the last senses to go that patients can hear up until the very end we’re not sure obviously how much they can process but again um they if they’re gonna respond at all they tend to respond better to their loved one’s voice than they would the doc or the nurse that’s in the room seeing them that’s not

Familiar to you to them yeah right so so that would be my fourth question then is is if your hearing is the last thing to go as a loved one are there things that you know in your experience that seem helpful or comforting to say or not to say sort of any guidance in that yeah so treat your loved one as you were treating them their whole lives people’s character

Logic people’s personality does not change at that time of life anything those things are only enhanced so think you know reminisce with them tell them things you think they’d want to hear things that would be comforting or soothing we know that those are things that the patients will find soothing and it’s often you know therapeutic for loved ones too as well

We realize what a you know frightening time of life this can be when you’re losing a loved one and so i think this is an important topic i appreciate bringing it up um especially again context of what’s transpired with covet to become a lot more pertinent um i think just like everything else the more education you have the more you know what to expect and what

You can do to help address those issues the better off you are yeah absolutely i think my final my fifth question that that comes that i’ve heard a lot anyway is about pain management and specifically morphine and the dying process and the the concern that that could speed up or cause harm when somebody’s at the end of their life can you just touch on that a

Little bit yeah it’s so in general it doesn’t obviously each situation can be individual but our approach here is we start with pediatric doses of you know morphine and it is not something that hastens death it only provides comfort whether it’s for pain or shortness of breath that’s another thing a lot of times people don’t realize for a lot of patients with

Pulmonary issues again whether it’s it’s emphysema or pulmonary fibrosis or other progressive issues it really helps relieve the sense of breathlessness for the patient so and these things do not hasten death um you know sometimes you’ll pick up the news and you hear about these situations uh where opioids did cause somebody’s demise those are way higher doses

Than are used you know at this time of life got it got it so this is just another helpful tool for making it exactly exactly possible all right thank you dr bush i know thanks i i agree with you this is a it’s it’s hard to think about to to talk about but it is when you’re in that situation it’s helpful to understand sort of what to expect so thank you thank

You i appreciate it sure thank you i also want to thank the john and kathy belcher institute for their generous support of the community education programs at hospice thanks

Transcribed from video
5 Things You Should Know When Someone is Actively Dying By Hospice of the Chesapeake