Amaury Hernández

Care of the Dying - Gradual Weakening

The physician can help in a positive manner. He or she can prescribe antidepressant drugs to help the patient's mood; a change of treatment to improve the patient physically; and support for the patient's family.

Increasing weakness and onset of symptoms means that sooner or later the patient's period of normal life comes to an end. The patient often suffers from a gradual loss of vitality, and an increasing fatigue makes a full day's work impossible. A relatively minor illness, such as a feverish cold, can develop into bronchitis and rapidly reduce the patient's strength. Other symptoms become worse, or new symptoms develop. The patient may suffer from weight loss, weakness, and a loss of appetite. Other problems that frequently occur with the terminally ill are nausea at the sight of food; vomiting after a meal; and constipation. The patient's weakness and lethargy lead to a feeling of profound depression and misery. The patient's awareness of the developing situation is magnified by worry. He or she is fearful of becoming a burden to the family.

Although the patient is weaker, he or she can remain independent and continue getting up and going to bed, going to the bathroom, and getting dressed and undressed unaided. He or she can still enjoy short walks or drives and visits to friends and neighbors. Such trips should be planned carefully to coincide with the patient's strongest time of day. Although the trips may be exhausting, the patient will enjoy them.

The family routine begins to change. Make household rearrangements small and gradual. The patient needs a chair that is easy to get into and out of. Organize a downstairs room with a day bed. The patient will then be able to be with the family for most of the day without having to use the stairs. Encourage friends and colleagues from work to visit the patient. Work out a sensible daily routine and encourage the patient to relax.

If the patient is not in pain at this stage, his or her anxiety is increased by the onset of vague discomforts and aches. He or she needs reassurance from the physician, who may prescribe mild painkillers, antidepressant drugs, or a sedative to be taken at night to ensure a good sleep for the patient.

If the patient talks about the future, do not ignore his or her comments. He or she needs reassurance about what will happen to the family. It is important to remain both hopeful and realistic about the future, whether or not the patient knows the truth.

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