NO one knows the day or the hour that death will knock at your door, but discussions and preparations surrounding the end-of-life processes can only serve as a tool to prepare caregivers and family members to provide the best care and support for those on their way out.

Just like discussions surrounding the beginning of life or the birthing process, the end of life or death is also a process whereby organs begin to shut down.

Apart from war, natural disasters and terrorism, instantaneous death may be caused by accidents, crime and suicide, which does not require any provision of care or support to the deceased.

However, for the masses who experience natural causes of death, mainly due to non-communicable diseases such as heart disease, cancer, chronic respiratory diseases and diabetes, it may be estimated that half of the number of deaths occur in the 70 plus category in richer countries, and may require assisted care services in their final days.

This is a more obvious requirement in poorer countries where infectious diseases dominate as the cause of death, such as diarrhoeal diseases and HIV, both occurring in all age groups. However, death from infectious diseases may merely require services of support and care for a shorter period of time.

The global death rate for 2022 was 8.4 per 1000 versus 8.8 per1000 in 2021; a gradual decline from 12.5 per 1000 in 1972. These statistics may be the genesis of a global map to providing care and support to those facing end of life.

At the end stage of life basic services such as personal hygiene, nutritional and spiritual support is in dire need by caregivers. In cases of end-stage cancer, which may affect all ages, professional palliative-care services are equipped to offer pain relief and mild sedation to smoothen the transition in their departure from such painful conditions.

There are 10 established signs that death is near. Many persons do not wish to speak about such events for various reasons such as fear, superstition or their individual belief systems. But with such invaluable knowledge, one can be better prepared mentally and emotionally, becoming the anchor to the rocking boat in the storm.

Those signs are:
* Loss of thirst and appetite – choking can occur if feeding is forced. Only sips of water or ice cubes may be tolerated
* Dry eyes or dry mouth – a wet sponge or a lubricating eye drop may provide comfort
* Sleepiness and confusion upon awaking
* Loss of interest in favourite activities and persons – some patients become unresponsive
* The senses of hearing and touch remain activated – comforting words and showing signs of affection are appropriate at this time
* Some persons may experience delirium – restless movements such as sheet or clothes-pulling – in such cases calming music or mild sedation can provide comfort
* Changes in breathing may be observed –irregular breaths sounding shallow or gurgling can be heard as the jaw muscles relax

The organs of the body are all connected and interdependent. So depending on the causative illness the corresponding organs begin their process of shutting down.

Winding down to the final hours before death, some persons’ lips may become bluish, breathing may cease extensively or the dying person may complain of feeling cold. Insulation may be provided using blankets. Sounds of moans and groans in the final stages do not necessarily indicate physical pains experienced, unless they pull away when being touched.

Actual life lessons learnt when compared to reading about a phenomenon is like “chalk to cheese.” Having personally watched death in slow motion for two of my closest relatives in 2022, you are forever changed.

It emphasizes the inadequacies of human beings and the limitations of medical interventions. When your fight is floored, making you feel helpless and fragile, inner strength can be regained from connecting to the source of life.

Death is inevitable for all life forms. However, most humans facing end of life will go through five phases of the emotional cycle; denial, anger, bargaining, depression and lastly, acceptance, which is referred to as the Kubler-Ross’s five-stage model.

The first stage of “it cannot be happening to me” gives the dying person some time to come to terms with the actual reality of the situation. Then having accepted death, one may become angry and ask “why me?”

In all of this transitioning, it is important that the closest relative or caregiver remain emotionally stable and not react to the lashing out, since most likely that person will be the recipient of such outbursts. Not many persons go through the next phase, which is where the person will try to buy extra time by bargaining with God or bartering with the doctor, if they have the resources. Then, having realized that the end result will be the same, depression sets in.

Some persons who would have lost their independence because of a stroke would have initiated this grieving process for themselves over a period of time. So this type of depression would have just escalated when realization hits that this is the final separation from their loved ones.

The final stage is acceptance when they would have reached that point of calm and peace, having worked through the previous phases. Those who are spiritually inclined will actually look forward to meeting their maker and their loved ones who would have passed.

A needs assessment will provide details of the requirements for palliative care for terminally ill patients. The Department of Public Information approximates that 78 percent of those persons requiring palliative or hospice care globally are from low- or middle-income countries.

It may be projected that just less than half, 25.7 million persons out of an average 56.8 million, need this type of service in their last year of existence.

Assisted care may also be required for a subset of the surviving stroke patients. Forty percent may not survive a stroke after one year. Those without male relatives to physically assist with the limited mobility of patients could be extremely challenging.

Likewise, a selected few who are disabled by frequent epileptic episodes may also require such assisted care, especially if mental disorders coexist. Epilepsy, though not considered life-threatening, may reduce life expectancy from two to 10 years, but may impact on quality of life and more importantly, may negatively impact on patients’ livelihoods, although protected by The Equality Acts and The Health and Safety protocols recommended.

Palliative care or hospice comes at a high cost when sought professionally, since it is exclusively offered by private entities. For those caregivers who are the sole bread- winners and may not be able to afford hospice facilities, you are placed in a tight corner to choose between providing financially, physically and spiritually, all of which are required, whilst still maintaining your individual life.

The unequipped caregivers are told by health care professionals to just make their loved ones comfortable, since curative processes are no longer a consideration. However, it can be setting up the caregiver for failure, especially if that caregiver has not been schooled or resourced on providing relief for the dying body. Addressing the fears or anger of the soon-to-be deceased when you are not trained in social work, psychology or religious teachings can in itself be emotionally and mentally challenging.

There are a few pointers to keep in mind, which can smoothen the transition of your loved one from this life to the life beyond. It has been perceived that they can still hear sounds, since the last-activated sense is the sense of hearing, even in comatose states. So telling your loved ones that you love them or attending to their last needs show that you care and will be a great assurance to them. Expression of gratitude for the role they played in your existence or even expression of forgiveness for any wrongs they would have committed, may ease the burdens on their hearts when departing for another destination.

For further discussion, contact the pharmacist of Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.