Dying of Cancer

After losing a battle with colon cancer, the last days of life will be different for every person. For some of us, the end might come swiftly, or it can linger for hours. We will each die as individually as we lived. However, there are some symptoms that are synonymous with the end of life and can be anticipated for comfort. If you choose, you can discuss a palliative care or hospice consult with your loved one's doctor -- these professionals are trained to anticipate and provide symptom relief during the last stages of life and can make a world of difference in the last days and hours.

Pain

One of the foremost feared symptoms of death is pain. If your loved one is dying from colon cancer they most likely have diffuse metastasis -- or the spread of cancer outside of their colon to other organs and lymph nodes, as well as tumors in and around their colon. Pain is anticipated and opioid narcotics, or very strong pain medicines, are most commonly administered. If your loved one is unable to swallow medicine at this point, certain preparations can be ordered and given sublingually (under the tongue) or rectally (as a suppository). 

Many people ask how to tell if someone is in pain if they are asleep, as many people are towards the end of life. Even in rest there are signs of discomfort that loved ones can watch for to include:

  • Grimacing and frowning
  • Breathing fast 
  • Fidgety movements of the arms, legs, and feet

Be sure to check your loved one's environment before assuming they are in pain.

For instance, there may be simple reasons for these signs of discomfort, such as wet bedclothes or an evolving fever. 

Complete Withdrawal

Although you may see this symptom wax and wane weeks prior to the end of life, most people enter a sleeping or almost comatose-like state in the days and hours preceding death.

This is not a voluntary choice -- your loved one is not ignoring you. Similarly, this withdrawal is also not an effect of the medications being provided for comfort, as many family members mistakenly fear. It is not completely understood why we withdraw, but it is assumed that it is a combination of physical and mental exhaustion from fighting illness.

Changes in Breathing

Changes in the way your loved one breathes might be a signal that the end of life is approaching. If you start to see pauses in the space between breaths or hear an audible gurgling noise, also known as the death rattle, your loved one is most likely within hours of passing on. To make him or her more comfortable, try elevating the head of their bed and do not offer anymore fluids at this point. The fluids will add to the saliva pooled in the back of the throat and increase the sound of gurgling -- which, by the way, appears to provide no discomfort to your loved one (likewise, do not offer fluids to someone who is not responding to you under any circumstances).

The sound is distressing to family members due to what it signifies, but it is not hurting your beloved.

Agitation and Confusion

Challenging symptoms at the end of life can include periods of confusion, agitation, and even hallucinations. Your loved one may see insects in the room, angels, or even people that you cannot see. You may not be recognized or your loved one may seem upset and out of sorts for no apparent reason. There are medications to help calm and decrease these symptoms, as well as ways not to escalate the situation. It's best not to argue with your loved one -- try calm, gentle reassurance, especially if the vision is scary. 

The Rally

Not everyone will experience a rally at the end of life, but if they do, it can be confusing to family. During a rally, many people develop moments of complete clarity, alertness, and might even request food after abstaining (not intentionally) for days. Some family members might see this as a hopeful sign that their loved one is improving where in reality, it is just a final gift. We don't know why some people experience this and other people do not -- but I've personally witnessed a rally last up to a few days or be as brief as a moment or two prior to death.

Sources:

American Cancer Society. (n.d.). When Death is Near. Accessed online March 24, 2015.

The National Cancer Institute. (n.d.). The Last Days of Life. Accessed online March 22, 2015.

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