By Linda Hochstetler, MSW RSW, writer of 21 Days to Die: The Canadian Guide to End-of-Life. Publish date of October 13, 2021. Click right here to preorder e-book (with 20% low cost).
What wouldn’t it be like for those who acknowledged that your member of the family had solely 21 days left to stay? Would you make any completely different selections collectively? Would their values be any completely different? Would they need something completely different from you? Can you think about the fearlessness it takes to look loss of life within the face, figuring out your loved ones members has solely 21 days left to stay?
For most individuals with advancing illnesses, there are indicators that loss of life will probably be quickly. Diseases have many trajectories, however at a sure stage, the ceasing of life turns into sure. At 21 days, there are normally no extra therapy choices with any actual promise of high quality of life. At 21 days, there may be normally no likelihood of restoration or reprieve.
21 days is just not the exact variety of days to acknowledge all deaths, and I don’t imply to suggest that loss of life may be managed or wants to be predicted exactly. Death is a thriller, and we don’t need to take all the thriller away. However, there are a variety of indicators of impending loss of life and so they observe in a predictable sequence. It is my want that every one Canadians will come to acknowledge these indicators. Together we are able to share this info and be prepared to welcome loss of life when the time is true.
For most individuals, the most effective preparation for one’s personal loss of life is being a supportive member of the family of a cherished one. Being one step faraway from loss of life permits one to step again and see the phases. First the dying individual’s power drops, and it’s unimaginable to do as a lot as they used to. Next, the legs cease working and falls occur except the dying individual agrees to keep in mattress on a regular basis. After this, swallowing turns into tougher and the dying individual stops consuming fully. After this, even consuming water turns into unimaginable because the dying individual depends solely on water within the physique. And lastly, the breath ceases, because the dying individual lets go into loss of life.
As a member of the family, it’s useful to keep in mind that the dying individual is seeing all these phases as properly. It’s no secret, even to a dying one who’s by no means studied the dying course of, that dying is imminent. Hopefully, the dying individual can have a crew of healthcare professionals (palliative care medical doctors, nurses, and PSW’s) round to assist help the breakdown of the physique. If you’re lucky, you’ll additionally search out non secular care chaplains, social employees, and perhaps even a loss of life doula to handle the non secular and emotional elements of the method. These guides may be accessed in hospital, in residential hospices, and infrequently even at dwelling, though you might want to ask particularly for the referral, and even pay out of pocket for the companies. Guides are helpful not solely for the dying individual, but additionally for the family members.
In addition to skilled assist, there may be loads that a member of the family can do help the dying individual. The most necessary half is being with the dying individual, and slowing down to simply maintain the area. This means sitting quietly, not requiring the dying individual to do something for you, At finish of life, the perspective of acceptance and never attempting to change the motion towards loss of life may be calming and useful. This may be laborious for a cherished one, who desperately needs the member of the family to keep alive, however the stress may be intense, awkward, and an excessive amount of for the dying individual.
Within the context of acceptance of loss of life, there could also be some issues that you would be able to additionally do and that also really feel good to the dying individual, like mild contact, equivalent to hand-holding, massaging ft, or gently laying a hand on a head or arm. The dying individual might also like to have their hair brushed or fingers run via their hair. Be conscious that sensitivity is usually heightened at finish of life, and temperature is essential (each too scorching or too chilly), pores and skin is papery and bruises simply, and food and drinks is greatest appreciated nearer to room temperature.
There are additionally issues are greatest not to do round a dying individual. One of the subjects that comes up nearly universally is the wrestle to watch the dying individual cease consuming. Eating is considered the factor that retains folks alive, as if it’s an intervention itself, and relations fear that stopping consuming is painful, like it’s after we’re residing absolutely. But it’s not like that for the dying individual. Stopping consuming occurs for everybody at some stage of dying, usually weeks earlier than loss of life, however typically solely hours earlier than. Eating may be painful within the remaining 21 days as a result of the physique usually can not swallow meals or digest it correctly. This is a pure course of and no trigger for alarm. It is useful to let the dying individual determine whether or not they need to eat, how a lot, and when they’re prepared to cease fully. 
Hopefully, collectively you see the ultimate 21 days coming, and as a household you’ve stated every little thing you need to say to one another earlier than you attain this level. The remaining 21 days are sometimes spent floating out and in of responsiveness, whatever the quantity of ache medicine administered, and it could not be potential to have deep and profound conversations. Unlike in movies, remaining conversations are most frequently about signs and bodily features and never relational. The time for these conversations is lengthy earlier than the top.
Dr. Ira Byock, a palliative care physician and author of 4 Things That Matter Most, encourages conversations that embody 1. Please forgive me. 2. I forgive you. 3. Thank you. 4. I really like you. These seminal conversations enable for closure and put together a household to half with no regrets.
Coming collectively round a dying individual needn’t be a traumatic expertise. Rather, it may deliver collectively a household and assist everybody have fun a life properly lived. Talking about loss of life and dealing with it collectively requires solely a bravery and a fearlessness to do and expertise what numerous generations have been doing for eons.