In the End: 10 Things Not to Do During a Loved One's Last Hours

As a volunteer with the Zen Hospice Project, I have witnessed many families struggling with how to be during the last hours of a person's life. And I have wished for an easier way. Mostly, I have been struck by the lack of knowledge and the misconceptions that people have about the needs of a person approaching the very end of their life.

The truth is, being with a loved one during their last days, last hours of life can feel overwhelming. If you are lucky, you may have the support of a caring hospice team, in which case your will not feel so helpless. More often than not, you may be at home alone with family members who are as unfamiliar as you are with the territory of death and dying. Or you may end up standing by a hospital bed in what has to be the most unsuitable environment for a peaceful death, the critical care unit.

Almost always, being present for the dying person involves refraining from our habitual ways of caring:

1) Do not insist on feeding the person.

We are so used to equating caring with nurturing with food. In this case, we need to shift our view to make room for the reality of the dying one. As the body shuts down, the requirements for food progressively stop and it becomes important to not get in the way.

2) Do not give the person a drink.

As with food, the dying one's ability to take in liquids comes to a stop at some point, and it becomes important to not force water intake. You may try to drip a few drops of water from a spoon, or let them chew on ice chips if they can, or hydrate the tongue with a small sponge imbibed with water. You can also moisten the lips with a lip balm.

3) Do not resist pain medications.

Respect the hospice team's decision regarding which and how much pain medications to give. Your loved one's comfort is at stake. If it looks like your loved one is in pain still, signal it to the nurse in charge, and explore ways to maybe increase the medication.

4) Do not talk about the person as if they did not hear you.

Even if the person appears unresponsive or speaks in a way that does not to make sense, refrain from talking in the third person. Do not share information that could be upsetting or disrespectful.

5) Do not argue with the person.

In cases when the person becomes restless and wants to get out of bed, do not argue. Rather reassure them with a calm voice, and decrease any unnecessary stimulation that could increase the restlessness. Holding their hand, gently stroking them may also help lessen the agitation.

6) Do not fight with other family members.

More than once, I have seen family members fight over inheritance or ways that their loved one's death and dying should be handled, right by the bedside. While sometimes unavoidable, such quarrels create unnecessary distress for the dying person. If possible, be an advocate for the person and ask your family to have the discussion somewhere else.

7) Do not be surprised by the look and sound of death.

Instead be prepared for changes in the way the person breathes, interacts, feels and looks. The death rattle can be scary to hear if you have never witnessed it before. So is the sight of tearing, half open, glassy eyes, and the touch of a stiff body, cold as stone. You need to know that these are not painful but rather normal physical manifestations of near death.

8) Do not shake the person into coming back to life.

Several times I watched relatives try to shake their dying loved one out of the immobility of impending death. While you may be unable to accept the reality of her imminent passing, you need to respect the reality of her lying still, in peace.

9) Do not get agitated around the person.

One natural response to a loved one's dying is to become anxious and engage in various activities. This can be upsetting to the dying person and add to their distress. Better instead, is to calm yourself down, and bring gift of your quiet presence to your loved one. Remember this is not about doing for the person but rather being with him or her. Sit quietly, and tune in to your breath. Read them a favorite scripture, or poem. Hold their hand. Gently massage their feet...

10) Do not move the person back to the hospital.

The temptation is sometimes great to try yet one more round of chemotherapy, or another form of invasive intervention to keep the person alive. If you really care for your loved one, don't. The best way to love the person is to let her die naturally, and in peace.

I would like to leave you with two thoughts. The first is to accept what is happening and follow your loved one's lead. Let death be your teacher. This is not about doing but rather being present, not getting in the way of the dying process. The second is to take care of yourself. Get some sleep, eat something, meditate, pray, take a walk and share your grief with others.

 

Follow Marguerite Manteau-Rao on Twitter: www.twitter.com/MindDeep

Comments

[khanti]

09:12 PM on 05/03/2011

It is said that the hearing sense is the last to function even though the persom had stopped breathing. From a Buddhist view point it is not advisable to wail and cry or call the person's name ion front of the body..

[cincinnati]

03:18 AM on 05/04/2011

after telling someone my NDE story they told me
their grandmother had died, but heard the
crying of the relatives and so
came back.....sometimes we
have a choice...

[khanti]

03:33 AM on 05/04/2011

If the body can sustain life otherwise the departed will return in a different form due to strong attachment..

[MLISstudent]

01:19 PM on 05/19/2011

Their grandmother wasn't dead if she "came back."

[desertdreamer]

04:05 PM on 05/02/2011

This is enormously helpful information for those who choose to keep vigil with the dying. I had the sacred privilege of being with my sweet mother-in-law, in our home with the assistance of Hospice when she passed and with my precious mother at a hospice facility for her final hours. Hospice was an incredibly, loving support to us, as well as our mothers, and I remain deeply grateful.

[barbiferous]

11:04 PM on 05/01/2011

Excellent article!! There should be more info on this subject. It's so easy to screw up somebody's last moments and death should be met with, at the very least, dignity.

[buffalogator]

09:00 PM on 05/01/2011

I am a chaplain for Suncoast Hospice. I commend you for this excellent article. I would like to remind everyone, do you family a favor and make you wishes known in writing when you are perfectly healthy.

[llisa]

08:50 PM on 05/01/2011

Very good advice.

[JHKH]

05:40 PM on 05/01/2011

Thank you for this article.

[bartle6]

11:10 AM on 05/01/2011

Don't hesitate to tell them, yes, there is a hell.

[B Kleitz]

01:55 PM on 05/01/2011

What the he11 is wrong with you?
Are you just making hateful comments to be funny, or what?

I would suggest that any of your loved ones who are dying demand that YOU be kept completely away from them.
You are very scary person.
Hope you don't have kids.

[edgraham]

12:26 PM on 05/04/2011

No, there isn't.

I would write more about your comment, but it wouldn't be printed.

[mavjade]

10:44 AM on 05/01/2011

What a wonderful and truthful article. Thank you.
I don't work in hospice but I do work in a hospital where I see people dying and their loved ones quite frequently and this is very good advice.

I think a lot of these things no only apply to those who are dying but also to those who are very sick and yet still may live for quite sometime.
My biggest piece of advice, please check with a nurse before doing something such as feeding and giving water. I can't say how many times I've seen people try and feed a person while they are on a ventilator (life support) and while you may think you are helping, doing so will only make things worse.

[thinkingwomanmillstone]

09:08 AM on 05/01/2011

This is a wonderful article. It's sage advice without any preachiness. We need to accept that death comes to us all...it is not the enemy and the body has many ways of quietly shutting down on the way to the end. People need to read it and re- read it as necessary before dealing with the death of a loved one so that you are prepared and your emotions will not interfere with what is best for your loved one...not necessarily the same thing as what is best for you.

[WysWoods]

05:13 AM on 05/01/2011

I hope every hospice Volunteer will share this article.

[bartle6]

10:18 PM on 04/30/2011

11) Do not hesitate to ask where the money and jewelry is. They cannot take it with them.

[B Kleitz]

01:53 PM on 05/01/2011

Wow.
Just wow.

At ones death bed? Really?

[MLISstudent]

01:24 PM on 05/19/2011

I keep reading and hearing about someone who has a terminal illness and that fact is kept from them. BEFORE we get sick we need to express our wishes. If I am terminally ill it is not someone else's right to keep the information from me and it is MY decision if I want to share the information with others. Besides the fact that I think most people probably know if something serious is going on, even if they haven't been told, it gives the person the opportunity to make a will, throw out old or hidden stuff that they wouldn't want to share, make preparations for their own funeral and services (if they want to), visit a grave again, reread a book, rewatch a favorite movies, and...you get my point. If you know, then you can do exactly what you want to do before it's too late.

[impatient]

10:08 PM on 04/30/2011

My mother died Nov 10, 2010, at home in her own bed, with me at her side. and it was for me the hardest experience of my life. But my doctor (and hers) pointed out that it was the best way to handle death. One thing the author left out is that it can go on for quite a while. My 80 year old mother had had a pacemaker installed 10 months earlier and that really kept her "alive" for 4 days after she seems to have slipped into a coma or perhaps worse---with no brain function at all. It it not possible to remain unemotional during that time, so the author was unrealistic in that regard. But as to the rest? Yes.

[paxatman]

02:16 PM on 04/30/2011

Tell the person that you appreciate all they have done for you. Gracious gratitude, lovingly given from friends and loved ones, would seem a nice gift for the start of a new journey.

[VA Jill]

11:03 AM on 04/30/2011

I always tell my dying patients' families that hearing is the last sense to go, and that even if their loved one does not respond, they can hear. I tell them always to tell that person that they loved them, and to keep voices low and other noises at a minimum. Music is often helpful, particularly if it is important to the person and family. I also believe that for some time after clinical death occurs the person's spirit is present and I have always behaved, and encouraged families to behave, as if it were. I have been present at deaths in the hospital and in the home, and no matter where, it is a sacred moment.

[B Kleitz]

01:50 PM on 05/01/2011

My mother's death, while expected, came much quicker than anyone ever imagined it would. She had throat and lung cancer, but she had a massive heart attack while in the hospital getting oxygen treatments. My cousin and I were with her, and she was trying to convince us to go home and get some sleep. As I sat there watching my mother, contemplating whether or not to actually leave, she started convulsing, changing color...it was and is the most horrible terrifying event in my life. I screamed for the docs and nurses and through my screams and tears it's as if she called to me in my mind(soul?) and I went to her, grabbed her hand. She was continuing to struggle and convulse and I said to my mommy "I love you mommy, it's o k, you can go...I will be alright...I love you mommy I love you mommy". Almost immediately the convulsions stopped and she was gone(crying now remembering, even 17 years later).
Even though I feel often as though her presence is with me, I miss her desperately. The only reason I welcome death when it comes is so I can see my mom again. I am not afraid of death because I know she will be there when my time comes.
It is my hope anyway.

[llisa]

08:59 PM on 05/01/2011

Our family always sang together. During my Dad's last hours, there we all were at his bedside--daughters, grandchildren, brothers, and aunts--singing softly anything that came into our heads: Simon and Garfunkle, old rounds, old barbershop staples, familiar hymns. . .At one point, we stopped and my brother-in-law was going to go get drinks for everyone so we were just talking quietly. This is when my Dad stopped breathing. Maybe he really was listening.

[ezwalker]

07:37 AM on 04/30/2011

Thanks for writing about death. Our society won't face it and we're at a loss when it happens. I'm glad it's finally being dealt with.