Mario Fonovic seated in the palliative care ward of the Queen Elizabeth Hospital.
At 55 years of age Mario Fonovic is in the final stages of terminal lung cancer. He doesn’t expect to see the end of 2016, but he is refusing to go without a smile on his face.
Mr Fonovic joined the program to discuss a topic most people dread — death.
“I’ve arranged my funeral right down to my flowers — but don’t bring tissues, bring a tambourine,” he said.
Mr Fonovic said he was neither sad nor scared of his approaching death, and had decided to share his journey on Facebook.
“I can see what is happening to my body,” he said.
“I feel it, I can see it and eventually I will end up in a coma.
“If I can help one person accept death or dying or cancer [I will].
“Just accept what is happening in your life and get on with it, because life is short.”
Looking back on his life, Mr Fonovic said he wished he had only done one thing differently.
“My one and only regret is that as a gay man I never fought to have a child,” he said.
Mr Fonovic said he was lucky to have legally married his partner Sid in a ceremony in California before legislation there changed.
The two plan to move into a newly purchased home together this week and Mr Fonovic is determined he will not die in a hospital.
Too many hospital visits
Mr Fonovic has spent his fair share of time in and out of hospital since being diagnosed with asthma eight years ago.
Being a long-time smoker only made his condition worse.
“Four years ago I coughed … after having one of my last cigarettes and blew a hole in my left lung,” Mr Fonovic said.
His left lung had deflated and he struggled to breathe.
After a week in hospital being treated he was sent home, but within six hours he was back in the emergency department — his left lung had deflated once more.
After another round of treatment Mr Fonovic’s life began to return to normal.
Eighteen months later Mr Fonovic was back in hospital — this time his right lung had collapsed.
“I ended up looking like the Michelin Man as air was leaking into my body,” he said.
He was placed in intensive care and surgeons removed a third of his right lung.
In December 2015 Mr Fonovic visited a respiratory physician to check whether he would be suitable for a lung transplant.
Mario Fonovic having his chest scanned
During a routine scan the doctor discovered cancer.
“I was so happy the day that I went on the transplant list … because I wanted my life back,” he said.
“In one breath I went, ‘yes’ — and then it was cancer.”
Getting on with it
A burst of stereotactic intense radiotherapy saw Mr Fonovic end up with an infection and he was once more admitted to hospital.
“On the second of May [my doctor] shook my hands and said, ‘you are in remission’,” Mr Fonovic said.
“In the following week I went downhill to the point where I couldn’t walk down my hallway.
“I felt like a semi-trailer had parked on my chest.”
Three weeks later Mr Fonovic admitted himself into hospital for a follow-up scan and found out the cancer had returned.
“The PET scan actually showed how bad it is,” he said.
“Not only had I got the cancer back, but it had taken over the whole lung.”
The lymph nodes on the side of his lungs had stimulated the nerves on his spinal cord and were causing him immense pain.
With the firm belief he would not see his next birthday, Mr Fonovic said he decided all he could do was face death.
“You just put your feet on the side of the bed, pull your trousers on and get on with it,” he said.
The cancer may have wreaked havoc on Mr Fonovic’s body, but mentally he is nowhere near finished with life.
‘Cohen’s economy of words, the syntax of love, his ability to go straight to the only matter that matters – her death, his mortality, their love – is a thing of beauty and wisdom.’
The songwriter’s letter to Marianne Ihlen in her last hours was beautiful, poetic and to the point. Yet so often we deal with death in an inane, mawkish way
A short goodbye. A few sentences. But words of such clarity, simplicity and beauty. Many of us have by now read Leonard Cohen’s letter to a woman he once loved, Marianne Ihlen, on her deathbed – and those who didn’t know it already have seen that Cohen is a class act, a man you don’t meet every day.
He heard that she was dying and two hours later he wrote to her that he too was old and his body failing. He had, of course, written for her before, with the lyrics of So Long, Marianne and Bird on the Wire. This time he told her: “Know that I am so close behind you that if you stretch out your hand, I think you can reach mine.”
Slipping into unconsciousness, her friend said that Marianne did reach out her hand. Cohen’s letter also stated that he didn’t need to talk about her beauty and her wisdom, “because you know all about that”. The 10 years they were together on and off, their intimacies, their passions, their endings, those – despite the songs – are all a part of their own personal story. Now he wishes her endless love on her journey – to death. It is everyone’s journey, but few speak so directly of it, not even while whispering in the waiting rooms.
Was Marianne his greatest muse? What does it matter? He loved her for a while. He loved his four bottles of wine a day before he took himself off to the Buddhist monastery where he was given the Dharma name of Jikan which means “silence”. But he knows about silence as he also knows about the tower of song.
Death is so often met with silence or with sentiments that are an inane babble to fill a void. The mawkish inscriptions and epitaphs seek to cauterise the grief, to fix it for a while. For how to write of loss? How do you write to a person you will never see again? I have done it, clumsily, inelegantly, with false jauntiness and then a wish for them to rest. Whatever that means.
So Cohen’s economy of words, the syntax of love, his ability to go straight to the only matter that matters – her death, his mortality, their love – is a thing of beauty and wisdom in itself. His ever deepening voice, the self-mockery, to see him now deadpan and dapper is still quite something. But once she held him like a crucifix and he let her go: “I’m cold as a new razor blade,” he sang.
Some think of him as a doom-monger but he is deadly funny and the faith was always there. “I think I was touched as a child by the music and the kind of charged speech I heard in the synagogue, where everything is important,” he said in his eighth decade, adding ironically that he was singing “a lot of Jew-sounding songs in different keys”.
Yet it is the fact that his words are so charged that is the reason they touch us. In my local park, there is an inscription on a bench for a friend who died and the words are taken from So Long, Marianne: “It’s time that we began to laugh and cry and cry and laugh about it all again.”
Cohen once said: “Poetry is just the evidence of your life. If your life is burning well, poetry is just the ash.” What ash though? Warm, sacred, dancing us to the end of love; young passions, old bodies, a rare and gracious farewell. So long, Marianne. Thank you, Mr Cohen.
Craig Phillips has found that his work as a death doula has given him a greater appreciation for life.
Before he enters the room, Craig Phillips pauses for a deep exhale.
“Just to let everything go,” he says. “And to remember that I’m here for them.”
Until he walks in, he won’t know whom, exactly, he’s about to see. Today it’s an elderly woman in a blue hospital gown. Eyes closed. Jaw dropped open. Breathing loud and labored, but regular.
There is a little green circle by her name on the white board in the nurses’ station. Hospice center code for “actively dying.”
“She doesn’t have anyone with her,” a nurse says. So Phillips goes, pulls a chair up to her bed and introduces himself.
“I’m not here to poke or prod you,” he says softly. “I’m just here to be with you. I’m just here to sit with you.”
The work of a death doula — Phillips’s work, now — is primarily about presence. He is there to ease the passage from this world to the next. And he knows that the most valuable thing he can offer anyone taking that most solitary of journeys is his company. So he sits, silently wishing them peace and comfort.
Especially with patients who can no longer speak, Phillips has learned to slip his hand beneath theirs, palm to palm, rather than rest it on top. This way, he says, “you get an understanding of how well wanted you are.” When his grip is returned, he knows that he is welcome.
Phillips operates alone, but he is part of a growing army of volunteers and professionals who call themselves death doulas. (Some, opposed to that term, prefer end-of-life doulas, soul midwives or transition coaches.) And like the childbirth doulas from whom they draw their name, their mandate is to assist and accompany. Their patients’ experience may be quieter, more sorrowful, but it is no less sacred. Or scary.
As the baby boomers move into retirement, fresh consideration is being given to what it means to grow old, which measures to take to treat illness and, ultimately, how we die. There’s a growing recognition among hospice workers and palliative-care givers that pain management is not enough. That the spirit must be attended to as much as the body. And that the soon-to-be-bereaved need help along with the dying.
It’s out of this recognition that death doulas are emerging. Most say they feel almost inexplicably called to the role. And profoundly touched by it.
A good death
On a sunny spring day in Alexandria, Virginia, 30 women and one man sit in a windowless hotel conference room, having traveled from all over the East Coast and paid $600 to learn to serve as death doulas.
“Our role is to walk alongside” the dying “in their journey,” says Henry Fersko-Weiss, president of the International End of Life Doula Association (INELDA), one of several organizations offering certification in the field.
The weekend-long training will cover the best ways to touch a dying person, when to use aromatherapy and guided visualizations, strategies to relieve overburdened family members, how to organize a “legacy project” to help capture the patient’s life, assisting at the moment of death and helping loved ones process their grief in the weeks that follow.
On the first morning, Fersko-Weiss, a social worker who worked with hospice facilities for decades before creating an end-of-life doula program in 2003, asks each of the students to recall a death that affected them. How it smelled and looked and felt. How it shaped their concept of what constitutes a “good death.”
One woman talked about her daughter’s stillborn baby.
“That was the hardest hurt I ever felt,” she said. “I didn’t understand how you could take a baby who was full-term.”
Fersko-Weiss nodded and observed that she may be able to transform her pain into something that could aid dying patients and their families.
“If we can touch that place of angst and anguish and despair,” he said, “it may help us to be more present to other people experiencing it now.”
Later, the prospective doulas talk about their reasons for coming. Several had had negative experiences with the death of a close relative. A few were birth doulas who wanted to assist with the exit from, as well as the entrance into, life. One woman had suffered a brain injury and a near-death experience. All said that they wanted to be of service in a way that would make this final transition somehow better for others.
They will be called upon to fill all kinds of roles, Fersko-Weiss told them. Sometimes patients may need help with physical care; other times, families will need assistance with errands or household chores. In all cases it will be a doula’s job to listen, without judgment, to honor the experience of both the dying person and their loved ones, and to facilitate meaningful interactions between them.
“As a doula, it’s important to encourage people to say everything they need to say,” Fersko-Weiss explains, “so that they don’t look back and really regret it.”
Beautiful souls
Craig Phillips’s path to end-of-life doula work wasn’t straight, but he thinks he was always inching toward it. He grew up in Wilkes-Barre, Pennsylvania, next door to a cemetery that served as his playground. In college, he had a chance meeting with Elizabeth Kubler-Ross, the famed psychiatrist whose groundbreaking work shaped our modern understanding of death. And all through his life, Phillips has had an intense awareness of his own mortality.
At 61, he has the look and presence of a yogi, but he spent most of his adult life in the corporate world. Several years ago, his sister called, saying that her ex-husband was suffering from advanced ALS and living in a facility very close to Phillips’ Baltimore home. So Phillips went to see him. And kept going, two or three times a week, for the last 2 1/2 years of the man’s life.
“I’d bring him flowers,” he recalls. “I’d tell him stories. I’d take oil over and rub his feet, stuff like that. Just devoted myself to him. And it was a beautiful thing.”
A man in Phillips’ running club mentioned volunteering as a death doula, so when he retired last fall, he linked up with Gilchrist Hospice Care, which serves more than 750 patients daily in the Baltimore area and established its own end-of-life doula program in December 2009. It has since grown to more than 150 volunteers.
After 20 hours of training in January, Phillips spent a morning shadowing a mentor doula at Gilchrist’s facility in Towson.
“We walked into a patient’s room, and she said, ‘Isn’t this person beautiful?’ I could see that they were. And she said, ‘Yes, all my patients are beautiful,’ ” he recalls. “You walk into a room and there’s someone there with their mouth open, looking very near death. Perhaps no teeth in their mouth and a three-day beard or whatever. And I look at these souls and they’re beautiful. It’s the oddest thing. Their guard is down. They’re just who they are in their most real, beautiful state.”
Phillips has helped long-term-care patients communicate with a letter board and even washed a dog for one family. On his weekly visits to an elderly man who was still alert, Phillips brought videos of the patient’s favorite big band performances.
But with many patients, Phillips just sits, quietly meditating and sending good wishes. He tells them that they are safe. And that they are not alone. One woman was unable to speak, but when he said goodbye after three hours, “she mouthed the words ‘Thank you’ and held out her hands like I was dear to her,” he says.
The work has also produced an unintended side effect. It has pushed Phillips’ awareness of mortality even further to the forefront of his mind.
And happily so.
“The more immediacy, for me, that I have of this,” he says, “the more appreciation I have for every day, every minute.”
It is illegal to help someone kill themselves in Malta. But what if someone is dying in great pain?
It is illegal to help someone kill themselves in Malta. But what if someone is dying in great pain?
Opioids usually administered in these times are sometimes not enough to stop the agonal stage of death. Agony comes from the Greek word ‘to struggle’. The process of dying, as seen by an observer, is that of a struggle. The stage right before an older person dies is often accompanied by disorientation, struggling to breathe with long pauses in between loud, laboured breaths – called Cheyne-Stokes breathing.
Sometimes a death rattle is heard in the breathing when there is liquid in the lungs. Sometimes the person may start convulsing. This agonal process is eloquently described in the Tibetan Book of the Dead. This is not the way we want to die.
In one study looking at what people said is their ideal way to die, Gilbert Meilaender from Valparaiso University in Indiana suggested a one-word answer: Suddenly! The idea is to live as long as possible at the peak of our vigour and then, when the time has come, to die quickly and painlessly. But this is not the way we die.
With our advancing and encroaching technology, it is more likely that dying will become a more protracted affair despite our wishes. Surprisingly, when we try and hasten the process we, as a society, have responded by punishing those who are trying to help us achieve a painless death.
In the US, one of my neighbours, Sharlotte Hydorn, before her death in 2013, gained a measure of notoriety by offering to mail you, for only $60, a package containing GLADD exit bags – Good Life and Dignified Death. The kit included a plastic bag, medical tubing, two canisters of helium and instructions on how to commit suicide – by placing the bag on your head and filling it with helium, which deprives the body of oxygen. The body does not know it is being denied oxygen since the helium mimics the oxygen molecule. You die peacefully. In the US, more than a quarter of us will likely die in an emergency room, our final departure looking more like a chaotic medical soap opera. Our death will be seen as another medical failure. For the majority of us, this is not what we want or what we deserve.
In Europe and the US, hospice care is gaining ground as the gold standard for end-of-life care. The Malta Hospice Movement is today caring for over 1,000 patients and their families. However, Malta Hospice, as most hospice services, is used by too few people. And when these services are used, they are used too late. The result is that most older adults still experience widespread distress in the final stages of life.
The result is that we deal with dying underhandedly. In hush hush tones we conspire to give the dying person a good death. In Malta, Jurgen Abela from the University of Malta’s department of family medicine conducted a survey of 160 doctors. The results are revealing. One in seven doctors were asked by their patients to help them die. Despite this, nine out of 10 would refuse such requests for moral reasons – since a majority were Catholic and this was important to them – despite half of these same doctors accepting the right of individuals to hasten their death. Such schizophrenic response harbours a sense of bigotry.
The religious fervour to curtail euthanasia has not slowed the growing number of states that have legalised physician assisted death. With four US states and four countries that today openly and legally authorise active assistance in dying of patients, the list of states/countries is growing.
There is nothing absolute in these situations. Physicians cannot determine with infallible certainty that someone is going to die, sometimes the medication used does not work as intended, or is delayed, the process of injecting a person with enough opioids to kill them is not family-friendly and it is killing without consent. These are all valid criticism that pose moral challenges.
If we look at how physicians die, what we find is that a majority of them do not go for invasive treatment if they know that it is unlikely to improve the outcome. They chose quality of life over quantity of life and self-medication is high. It takes a special person to go through with euthanasia.
In the state of Oregon in the US, only a small fraction goes through physician-assisted-suicide. In 2013, a total of 71 people went through physician-assisted-suicide out of nearly four million people in Oregon. In Malta this would translate to less than five people a year. There is no ‘thin end of the wedge’. These people, nearly exclusively white, were educated with a diagnosis of cancer (since we know a lot about the progression of this disease.)
Different older adults need different support. Some end-of-life options may not appeal to you, but the option needs to be made available for others that it might help. Euthanasia is about diversity of needs. Not everyone might want or need it but it should be an option for those very few for whom it might help alleviate the pain of dying.
Look for Part 1 and 2 of this series HERE and HERE!
1. Do what feels natural.
There’s no right or wrong way to die. For some people, it may be desirable to spend as much time with friends and family as possible, while others may find comfort in solitude, choosing to face things alone. Some people might want to kick up their heels and make the most of the last days, while others may want to go about the same basic routine.
Don’t be afraid to have fun, or to spend your time laughing. Nowhere does it say that the end of life is supposed to be a somber affair. If you want to do nothing more than watch your favorite football team and joke with your relatives, do so.
It’s your life. Surround yourself with the things and the people that you want to be surrounded with. Make your happiness, comfort, and peace your priority.[6]
2. Consider pulling away from your work responsibilities.
Few people receive a terminal diagnosis and wish they’d spent more time at the office, and one of the most common near-death regrets is of working too much and missing out. Try not to spend the time you have left, if there isn’t much, doing something you don’t want to be doing.
It’s unlikely you’ll be making a marked financial difference for your family in a short amount of time, so focus on what will make a difference: addressing the emotional needs of yourself and your family.
Alternatively, some people may find energy and comfort in going about the routine of work, especially if you’re feeling physically strong enough to do so. If it feels natural and reassuring to keep working, do it.
3. Meet with friends and loved ones.
One of the biggest regrets those who are facing death express is not staying in touch with old friends and relatives. Remedy this by taking the opportunity to spend a little time with them, one-on-one if possible, and catch up.
You don’t have to talk about what you’re going through if you don’t want to. Talk about your past, or focus on today. try to keep things as positive as you want them to be.
If you want to open up, do so. Express what you’re going through and release some of the grief you’re experiencing with people you trust.
Even if you don’t have much energy for laughter or conversation, just having them sit by your side can bring you worlds of comfort.
Depending on your family situation, it might be easier to meet with people in big shifts, seeing whole families at once, or you may prefer focusing on individual meetings. These have a tendency to help slow down time, focusing on quality, rather than quantity. This can be a great way of maximizing the time you have left.
4. Focus on unwinding your relationships. It’s common for those near death to want to uncomplicate complicated relationships. This can mean a variety of things, but it generally means trying to resolve disputes and go forward less burdened.
Make an effort to end any fights, arguments, or misunderstandings so that you can move forward. You shouldn’t engage in arguments and keep fighting, but rather, agree to disagree when necessary and end your relationships on a good note.
While you probably can’t be around the people you care about all of the time, you can plan to see them in shifts, so that you rarely feel alone.
If you can’t see your loved ones in person, making a phone call to someone you care about can make a difference as well.
5. Decide how much you want to reveal.
If your health situation is unknown to your friends and family, you may elect to let everyone know what’s going on and keep them up to date, or you may prefer keeping things private. There are advantages and disadvantages to each choice, and it’s something you’ll have to decide for yourself.
Letting people know can help you get closure and feel ready to move on. If you want to grieve together, open up and let your friends family in. You can tell them individually to make it feel more personal, and tell only those people that you really care about, or make it more public. This can make it difficult to avoid the issue and focus on lighter subjects over the next weeks and months, though, which is a negative for many people.
Keeping your situation private can help to maintain your dignity and privacy, a desirable thing for many people. While this might make it difficult to share and grieve together, if you feel like this is something you want to take on alone, you might consider keeping it private.
6. Try keeping things as light as possible.
Your final days probably shouldn’t be spent pouring over Nietzsche and contemplating the void, unless you’re the sort of person who finds pleasure in these things. Let yourself experience pleasure. Pour yourself a glass of whiskey, watch the sunset, sit with an old friend. Live your life.
When you face death, you don’t have to make an extra effort to come to terms with it. It will come to terms with you. Instead, use the time you have left to enjoy the people and things you enjoy, not to focus on death.
7. Be open with what you want from others.
One thing you may have to deal with is the fact that the people around you are having trouble coping with your death. They may look even more upset, hurt, and emotional than you feel. try to be as honest as seems kind with your family, when discussing your feelings and desires.
Though you may want nothing more from them than comfort, optimism, and support, you may find that they will be having trouble in their own grief. That’s perfectly natural. Accept that people are doing their best and that they’ll need a break sometimes, too. Try your best not to be angry or disappointed at how they’re reacting.
You may find that some of your loved ones are showing little emotion at all. Don’t ever think that this means that they don’t care. It just means that they are dealing with your health quietly, in their own way, and that they’re trying not to upset you with how they feel.
8. Talk to a religious advisor, if necessary.
Talking to your pastor, rabbi, or other religious leader can help you feel like you’re less alone in the world and that there’s a path laid out for you. Talking to religious friends, reading religious scriptures, or praying can help you find peace. If you’re well enough to attend your church, mosque, or synagogue, you can also find peace by spending more time with people in your religious community.
However, if you don’t subscribe to a religion, don’t feel compelled to change your mind and to believe in the afterlife after all if that’s not really true to who you are. End your life as you’ve lived it.
An advance directive is basically just a written document or a series of documents explaining what you want to have happen during your end-of-life care. It may outline a variety of topics, including your wishes for your care, should you become incapacitated, as well as naming proxies and a power of attorney.
These documents will need to be drawn up by attorneys and notarized. These aren’t likely things that you’ll want to have to spend a lot of time dealing with yourself, so it’s common to delegate these tasks to others.
There’s a lot of comfort in knowing that you’ve taken care of everything ahead of time and haven’t left big or stressful decisions to be made after you’re gone. If you’re up to it, it’s important to have legal documents drawn up..
A living will describes the type of healthcare you hope to receive and whether or not you’d like to remain on life support, and under what circumstances, should you become incapacitated and unable to make your own decisions. Living wills can be prepared by attorneys and should be prepared ahead of time.
Last wills are designed to designate property to beneficiaries, assign guardians for minor children, and elucidate any last wishes. This is somewhat different than a living trust, which will transfer property immediately, as opposed to after your death.[3]
In some cases, it may be good for you to delegate these responsibilities instead to a proxy, in the event that you’re unwilling or incapable of making these decisions for yourself. This is often an adult-aged child or spouse, who will be tasked with making choices regarding your health care as things progress.
In some cases, it may be difficult to choose or assign proxy responsibilities to a private party, and you may wish instead to assign them to an attorney. This is extremely common and can be a relatively stress-free way of turning over technical responsibilities to someone else, allowing you to deal with your own comfort and emotional responsibilities.[4]
A health care power of attorney is different than a general power of attorney, which provides for financial assistance after death. While both of these may be appropriate options, it’s important to distinguish between them.[5]
Though it may be slightly unnerving, it’s important to decide what you want to happen to your body after you die. There are many options and considerations, depending on your culture and religious background.
If you want a funeral, or religious ritual to be performed after your death, you may want to arrange the ceremony yourself, or delegate the responsibility to a loved one. Make the arrangements in terms of churches, funeral homes, if it helps you to find closure.
If you want to be buried, decide where you want to be buried and which family members you want to be buried near, if you haven’t made those decisions already. Secure a burial plot by making a down payment, and make arrangements with a funeral home in your area, if necessary.
If you’d like your body to be donated, make sure your donor status is up to date and accurate, according to your wishes. Contact the university or foundation to which you want your remains donated and make the necessary arrangements.
Tomorrow, Part 3 — Making the Most of Your Last Days
Managing emotional and physical pain is the most difficult part of end-of-life care. You can learn to face the worst, when it comes, with dignity and grace. Make the necessary arrangements ahead of time and make the most of the time you have left.
1. Talk to your doctor about your pain management options.
It’s important to make your physical comfort a high priority in end-of-life care. Depending on your condition, you may be taking a variety of medications, or undergoing a variety of different procedures, so it’s important to discuss all treatment options with your doctor and ensure your comfort is provided in addition to these considerations.
Morphine is commonly prescribed to terminal patients, sometimes on a constant need-basis. While there’s some debate about whether or not morphine may shorten your life span, it’s efficacy as a powerful pain-reliever is proven. If you’re in serious pain, talk to your doctor about the option.[1]
In some cases, it may be appropriate to pursue additional non-traditional methods of pain management, like holistic medicine, medical marijuana, or other non-western treatments. As long as these treatments don’t get in the way of other care you’re receiving, it’s likely they’ll be approved by your doctor, and might be worth a shot.[2]
2. Be at home as much as possible.
While not everyone has the luxury of paying for home palliative care, you should think about what will bring you the most comfort and peace in your particular situation. There may be more help available in a hospital but you may feel more comforted and peaceful in your own home.
If you’re able to leave the hospital, try to get out as much as possible. Even going for short walks can help to get away from the beeping of hospital machines and be a nice change of pace.
3. Address the symptoms of dyspnea quickly.
Dyspnea, a general term for end-of-life breathing difficulties, can affect your ability to comfortably communicate, leading to frustration and discomfort. It’s something you can address and care for yourself, with some simple techniques.
Keep the head of your bed raised and keep the window open, if possible, to keep fresh air circulating as much as possible.
Depending on your condition, it may also be recommended to use a vaporizer, or to have additional oxygen supplied directly, through the nose.
Sometimes, fluid collection in the throat can result in ragged breathing, which can be aided by turning to one side, or by a quick clearing procedure your doctor can perform.
4. Address skin problems.
Facial dryness and irritation from spending lots of time in a prone position can be an unnecessary discomfort in end-of-life scenarios. As we get older, skin problems become more significant, making them important to address swiftly.
Keep your skin as clean and moisturized as possible. Use lip balm and non-alcoholic moisturizing lotions to keep chapped skin softened. Sometimes damp cloths and ice chips can also be effective at soothing dry skin or cotton mouth.
Sometimes called “bed sores,” pressure ulcers can result from prolonged time in a prone position. Watch carefully for discolored spots on the heels, hips, lower back, and neck. Turn from side and back every few hours to help prevent these sores, or try putting a foam pad under sensitive spots to reduce pressure.
5. Try to manage your energy levels.
The routine of being in the hospital will take a toll on anyone, and the constant blood pressure checks and IV drip can make it difficult to sleep. Be honest about your energy levels, any nausea, or temperature sensitivity you’re experiencing to get as much rest to be as energetic as possible.
Occasionally, in end-of-life scenarios, medical staff will discontinue these types of routines, when they become unnecessary. This can make it much easier to relax and get the rest you need to stay energetic and somewhat active.
6. Ask questions and stay informed.
It can get quickly overwhelming, confusing, and frustrating to be in the hospital and feel like you’re not in control of your own life anymore. It can be very helpful emotionally to stay as informed as possible by using your doctor questions regularly. Try to ask these types of questions to the doctor in charge:
