Dying

Dying refers to a gradual movement toward the end of life. The length of time it takes is related to the rate of organ failure, with the terminally ill gradually losing their ability to move around and unable to communicate with the outside world.

Not all people shall the same dying process. The following signs are for reference only. If you have any questions, please consult the medical staff.

End-of-life signs and symptoms

1. Appearance: Severe weakness, malnutrition, dull, soft and inelastic skin all over the body, paleness and coldness from the end of the limbs with respiratory decline, purple nails and lips, sometimes accompanied by sweating or excessive sweating.
2. Breathing: Breathing becomes shallow, short, and irregular, with apnea lasting 10 to 30 seconds. Opening the mouth for breathing on and off is an important indicator of patients before death.
3. Dying sound: A sputum-like rattle is made when exhaling due to the weakness of the pharynx and larynx muscles to cough up the oral secretions gathering at the back of the larynx or the increase of the lung secretions.
4. Pulse: weaker, faster or irregular than usual. If the pulse is faint, the number of pulses cannot be checked by force.
5. Vision: Gradually blurred vision, glassy eyes without focus, gazing ahead.
6. Hearing: Hearing is the slowest to disappear. They can hear but do not necessarily respond or answer, so speaking softly is needed.
7. Taste: Dry mouth, bitter mouth, altered taste, sensitivity, difficulty swallowing, burning sensation at the root of tongue, being prone to tongue coating, angular cheilitis and cheilosis, reduced appetite or apastia due to degraded swallowing ability.
8. Consciousness: Most people are conscious but close their eyes to rest or sleep. Some people have fits of delirium, such as talking to themselves, looking blankly, greeting to the air, talking to relatives who have passed away, referring to events or people they usually miss, grabbing or waving in the air with their hands, and in serious cases, feeling restless, even shouting.
9. Sleep: Rest or sleep with eyes closed most of the time except for conversations and basic activities such as urination and defecation.
10. Urination: urine is less and dark, released once a day or once every 2 days, possibly with incontinence.
11. Diet: Due to the gradual decline of body organ function, the amount of diet is small or even no appetite.
12. Pain: Some people have pain changes. Most of the pain is relieved or painless, but some people feel sore all over the body.
13. Deathbed awareness: The patient knows that his or her death is near and indicates that he or she is leaving.

Ways of care

• Physical care:
  1. Keep the body clean. Mouth is easy to dry due to mouth opening and breathing. To enhance cleansing and moistening, you can also use wet gauze to cover your mouth and use a lip balm.
  2. Keep skin smooth: Keep the clothes flat and smooth, turn over regularly to prevent skin dryness and bedsores.
  3. Prevent odors: Strengthen body cleanliness, especially urinary organs, skin wrinkles and wounds. When there is peculiar smell in the air, essence, sandalwood and deodorant can be used.
  4. Safety: It is necessary to prevent accidents such as falls due to confusion.
  5. Incontinence: Use diapers and check and change regularly to clean buttocks.
• Psychosocial spiritual care:
  1. The patient's decision should be respected and all efforts should be made to provide pain relief and medical assistance, so that most patients can pass away painlessly and peacefully.
  2. Dying patients have no appetite or do not want to eat due to organ failure, which indicates that they have lost the function of swallowing and absorption. Do not force feeding or insert an nasogastric tube to avoid increasing the burden on them.
  3. The caregiver's attitude should be friendly and calm, which can reduce the anxiety of patients and their family.
  4. When relatives and friends come to visit, they can softly inform patients who are visiting, and do not pull patients or ask them to answer questions.
  5. If relatives and friends are grieved, they can give vent to their emotions freely outside the room and do not cry beside the patient.
  6. Avoid whispering beside the patient. Play soft music or religious music or a Buddhist chant that the patient likes to listen to.
  7. Keep the lighting in the ward soft and leave a small light at light.
  8. For a dying rattle sound, changes in posture such as sleeping on one's side or changing the height of the shoulders and neck can improve the volume of sound. If there is no sputum, there is no need to draw sputum because it will only increase the patient's pain.
  9. Affirms the contribution and achievement of patients to family life and work in their lifetime.
  10. Tell him/her to relax, don’t be alarmed as everyone is around.
  11. If the patient is a Buddhist, they can recite a Buddhist chant; if he/she is a Christian or Catholic, they can ray and sing hymns to help him/her calm down.
  12. If necessary, please ask their respected elders and religious personnel to help them express their true repentance and then forgive them.

How to tell if there are no signs of life (death)?

1. The pulse (carpal artery, carotid artery) cannot be detected, or the heartbeat on the left chest cannot be found.
2. Breathing: Put a piece of toilet paper in front of the patient’s nose for observation. Toilet paper drooping motionless means no breathing or put a mirror in front of the nose for a few minutes, no moisture means no breathing.
3. Pupils: Shine a flashlight on the pupils. Appearing dilated and unresponsive indicates death.
4. If unsure, repeat steps (1) - (3) three minutes later.