Physical changes
Pain
Today it is possible to ensure pain reduction for almost all people in their last phase of life. Treatment of pain by opiates usually brings freedom from pain while sustaining consciousness. It is necessary to overcome the fear of morphine and other opiates which is widespread. Modern pain treatment uses this medicine with a clear goal: to sustain the highest possible quality of life of the dying person for as long as possible. Doctors educated in palliative care are able to use these preparations very sensitively. They balance their effect against pain with unwanted effects (short-term sleepiness, constipation etc.) and if the pain goes away they are able to stop the use of the medicine easily. We must realize that the dying person has only a short time to live and they deserve to live it without pain that would exhaust them.
Skin care
From the medical point of view and for the comfort of the sick person it is important to give maximum attention to the skin of the dying person and to ensure a suitable positioning. It is good to change the position on the side and on the back, but only as often as is pleasant to the sick person. If they cannot hold themselves up it is possible to bolster them carefully so that they stay in the required position on the side. We should strive to have the critical spots in danger of bedsores protected from pressure by bolstering with soft pillows or foam mats. We should do everything after agreeing with the sick person so that they can lie comfortably and so that frequent positioning does not tire them or cause them pain.
We should keep the skin of the sick person clean and dry especially in places that are endangered by the sweat or other secretions. This is for instance the area of the genitals, the space under the breasts and other skin folds. Skin regularly treated and protected by a suitable cream is more resistant to the creation of bedsores, sores and the like.
Temperature
The physical temperature changes: the hands and feet may be colder because of the worsening blood circulation. We can try to sustain the physical temperature by using socks or hot water bottles. On the other hand, if the dying person has a higher temperature, then only a thin cover or just a sheet will be comfortable for them. Sometimes a good thing is a cold compress put on the forearm or on the groin. A fever in this state is the sign of a failure of the thermoregulatory center – not of pneumonia or infection.
Breathing
The breathing often changes: it can be faster, or very slow (up to 40 breaths per minute) or much slower, with long breaks between individual breaths. We might consider each of these breaths the last one. Sometimes the dying person loudly gasps while breathing out. The breathing can also be irregular. In the throat a kind of rattling or “gurgling” can result from expectorations that the sick person is not able to cough out. For us it may be a very uncomfortable sound, because we have the feeling that the person will suffocate at any moment. However, it is important to know that it is much more displeasing for us than for them. They are usually not bothered by it – as we can make out from their gentle signs. If they are bothered by something, for instance pain, we can tell so by mimic or small gestures. Changes in breathing come and go. A person is able to breathe for quite a long time in a way that every breath seems as the last one.
Usually we may provide relief by raising the position of the head or the upper part of body or if we put the dying person on their side. The head should not be bent back. It also helps if we ensure good ventilation of the room and if we humidify the air.
For us accompanying people it may be painful and alarming when we listen to irregular breathing. It is important that we ourselves breathe deeply and regularly and from time to time leave the room to gain strength. Perhaps in this context we can be helped by a comparison with birth pains and the special way women breathe for relief when giving birth. These are pains leading to a new life.
See also
