11-5-2008

THE ATHEIST

Today the subject of death is whispered and not be mentioned and still seen as a subject not to be spoken of unless something actual occurs what is remote and not connected to the family or special surroundings such as friends and close collage’s at work.
Death is still often seen as an event, which can be, deferred rather then being an intrinsic part of life.
To day to say a person is dying means that the persons death is near up hand. Sometimes it is, however, necessary when a person will die of a persistence or choric disease that a prediction of what will follow need to be given to comfort the relatives but also the patient. Most doctors can make a fairly accurate short-term prognosis for an average patient with a certain condition based on experience, statistics of a larger group in similar situations and the patient’s history.

The best prediction a doctor can make is based on experience within the degree of the doctor’s confidence and experience.
Dying can be market by deterioration over a long period of time, with complications and side effects, and usually about a month before death.
The signs of energy function are slipping the patient gets more uncomfortable and are visible failing. The fact that death is near is obvious for all.

The pattern as set out before does not always fit the likely course, increasingly common, however, is dying with a slow decline in capabilities over a long period of time. Honesty here is most important from a doctor to advice patient and relatives op the progress or decline, the doctor has substantial experiences in the care of dying patient and the dealing with the relatives for who most of them it will be the first time that they attempt a dying person which can be very traumatizing. A good doctor is therefore willing to spent time and energy to support the patient and the relatives.
It is unfortunately that the Government is in fact obstructing doctors to do just that by limiting the time they can spent with patients at a time they need to give time and energy as support for the dying person and the relatives.

Patient and their relatives may feel overwhelmed by the occurrence, the illness, and the treatments, while they are unable to control the situation.
Sometimes this sense of having no control is frustrating but preferable to having to take responsibilities.

Patient and relatives vary in the amount of information given and the level of involvment in the information and the discussions taken. However, the patient, the relatives and also the doctor and nursing staff should be realistic in what can be done and the way it should be done, whereby the close relatives can advice the doctor and the nursing staff about the way they think the patient will react, on certain information.

However, the relatives special but also the carers and the doctor should be realistic about the likelihood of death, be prepared so that the situation when death occurs can be managed without exceptional emotional responses.

Relatives should be aware that the patient can feel the change of attitude, and therefore an overload of emotions could hasten the death of the patient. The so much heralded resuscitation attempts are less a problem than is normally suggested No resuscitation for a dying patient makes sense, as the patient is not likely to benefit from a resuscitation attempt. Neither is the supply of water and food via tubes of any usefulness.

However, there are practical measures, which may be more suitable for the patient and the relatives.
One of the most commonly request patient and some relatives is to let the patient die at home instead of in the hospital, going into a hospital can be in such a case declined.

There are two sides in this dying at home, for some patient dying at home in their own surrounding makes to say farewell to the relatives and the world more easy. For other patient is it absolute a must that they die at a hospital as otherwise the dying process could be long and painful even with the doctor and relatives standing by for comfort and care. Such decisions need to be made on realistic ground rather then emotional.

A patient who is dying should be surrounded by all possible comfort and to make sure that the patient does not unnecessary suffers.

The debate about assisted suicide grows, many dying patients who realize that dead is near and do not want to go on suffering want to get it over with and therefore consider suicide. There are two pathways that can be taken in this wanting of suicide, the most common one is desperation and loneliness a sense that all is lost except pain. The other option is the path of endless stream of medicines while in reality there is no progress only more and more side effect. Side effects are in need of more medicines, relatives nor the patients cannot understand the reason behind this as it is obvious by patient and relative that dead is near, and they want it to stop and give up.

It is an absurdity which happens to many times that a near dead patient is kept alive only to die anyway shortly after having consumed extra anxiety and more pain this is in fact barbaric. Discussing this with a doctor or a councilor can help; the doctor can move to decrease the pain and anxiety. The councilor can assures the patient and the relatives that they are in the best of hands and explain the reason why a certain action has to be taken. This will enhance the feeling of reassurance and make dying a more easily to accept fact.

Although we know we will all have to die as one of the certainties of live, the common experience is not to accept it when told that the illness will lead to their dead. They may feel angry, determed, frustrated, and trying to escape to illness.
All those reaction abate when dead is near, it can mean finishing of certain unfinished work, make piece with relatives and friend, while simmering religious issues coming to the foreground.

Coming at terms with the death is not an easy undertaking for neither the patient or the relatives and friends the death of close by relative or friends effect us all, their will be many up and downs, but for patient and relatives it will come down to acceptance and understanding

Pain is one of the most disturbing views for relatives, seeing the one the love and care for in cruciating pain is a very traumatic experience, most people are afraid of pain special when dying, and although most pain can be resolved by medicines when the patient is awake this is not always possible in all cases.

Many symptoms during illness leading to a death produce similar outcomes, such as pain, shortness of breath, bowel problems, and fatigue. Anxiety, depression, confusion, delirium, and disability are some of the added symptoms. Trying to breath is one of the worst scenario’s to die but not always avoidable, various methods can be used to easy the breathing and advice of a doctor will be most advisable.

Bowel problems are also a clear sign such as constipation, a dry mouth, vomiting and nausea and bowel obstruction special if the patient has a history of severe anxiety, but also medicines can be the toxic reason, fatigue is a well recognized symptom of a fatal illness.
Making a patient comfortable and trying to preserve their energy would be useful for things that really matter.

The feeling of sadness by knowing that life is ending is a normal response where as by some patients accept the fact that they are dying and others reject it. Anxiety is more then being tense. A person who does not accept the fact can be in a state of severe anxiety so fearful that it stops the normal reaction and responses. Reassurance and fact complete plus drugs will help such a person to accept and help them to die in comfort. The experience have shown that such a patient but this is accounted for by all other dying patients, that surrounded by relatives and friends if possible will help so will advice and support from a councilor.

If a patient is very ill they become easily confused. Drugs can limit such confusion. The patience need love and understanding, reassurance and reorientation, but it is up to the doctor to take the lead either by advising 24/7 care or a so mild possible sedation.

It has to realize that a progressing disability often is part of a fatal illness. Most people in such a situation want to stay at home preferring a quicker death then to go into a hospital.
Often there is a clear sign that death is near the consciences is declining, the extremities getting colder and breathing gets irregular, however, this is not always the case sometimes dead occurs in the middle of an action by the patient.

What is called the death rattle is the secretion in the throat because the muscles are relaxing, placing the patient is a special position or drugs to dry the secretion can help and is mainly done for the comfort of the relatives or carers, the patient itself is unaware of this.

When death occurs the muscles, the chest and the hearth may go on for a couple of minutes after breathing has stopped.

It is general accepted that seeing the dead person after death is helpful to the relatives close to the death person, it helps the feeling to counter the irrational fear that the person really did not die.

For administrative handling after death by the nearest relative advice is available from local doctors and from the local town or city hall.
GEWK.
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