• Denial and isolation are the first reactions of persons who learn they are terminally ill. People refuse to believe they are dying. They are denying when they talk about the future and avoid talking about their illness. Gradually they begin to face the possibility of death, but some people remain in the state of denial until death. • Anger occurs when they recognize the reality of the outcome of their illness; they ask, “Why Me?” and feel angry that they are dying while others are allowed to live. Do not take the patient’s/client’s anger personally. Anger is normal and healthy. • The bargaining reaction is characterized by the making of promises to God or some other higher power to do something special to change their lives if the dying person is allowed to continue living. They want to buy more time. • Depression occurs when terminally ill persons become weaker and they and those around them are unable to perform even simple tasks because of deep sadness. This is normal. The home care team and the aide need to give physical and emotional help as dying persons grow weaker. They may need to review their lives and their sorrow. Listening may be most important, words may not be needed. A touch of the hand and warm accepting silence is therapeutic. Much will depend on the relationship established earlier. • Acceptance is the final reaction of dying persons. It comes if they are given enough time. They will no longer be angry or depressed, having already mourned their loss. Depending on their awareness, they can make plans from a religious, philosophical, social, and emotional standpoint, almost becoming detached from the situation. Acceptance does not mean that death is near. In prolonged illness, dying persons and their families may go through all these stages, almost in the sequence outlined. But more frequently they may revert back and forth between stages. Death and Dying Summary Sheet Physiological Changes Physical changes occur in the body as death approaches. These changes may be gradual or sudden. Body systems decline further, and the patient/client becomes less responsive. Noticeable signs of death include: • Loss of muscle control. • Gastrointestinal functions slow down leading to abdominal distention, nausea and vomiting, and the patient/client may be incontinent. • Circulatory failure. • Respiratory failure in which the patient/client may have irregular, slow, rapid, or shallow respirations. • Urinary output may decrease.
