There’s a term that is used in hospice care called “active” or “actively dying.” Before I trained as a chaplain, I had never even heard of it. It’s the point near the end of a patient’s life where more pain medication is often needed, as the person’s systems start to shut down. It can be a scary, chaotic time for the family, as the hospice staff works closely to monitor the situation and make sure that all needs are met.
When my brother John was actively dying, the nurse and social worker kept me informed as to what to expect next, as well as explaining what the stages meant. It was helpful for me to know what to expect next, and the knowledge calmed me at the time.
This is what the hospice staff tries to do with the family and the patient, to keep the situation as calm as possible. Sometimes the family panics as emotions peak. A lot depends on each person’s view of death and acceptance of the patient’s terminal status.
The chaplain is sometimes called to sit with the patient and the family, calmly speaking with them, praying when requested, being a centered presence at a difficult time.
Sometimes death is relatively easy. My own father died in his sleep. Sometimes a patient slides into a semi-conscious state, not responding to those around him or her, but still aware of their presence.
As systems start to shut down, heartrate lowers, respirations may speed up and then slow noticeably, and hands and feet get colder. Lips may turn bluish while the patient is still alive.
Death eventually comes, with the cessation of breathing and heartbeat.
December is an active month for dying, it seems. I have lost one to two patients each week. How do I handle this? With prayer, with the knowledge that this is one of the purposes of hospice, to ease and prepare the patient and family for death. The other purpose of hospice, in my thinking, is to allow the patient to make his or her own choices and live the final days with as much control and purpose as possible. The goal is to follow a good life with a good death.