Chapter 1: Paramedics and Palliative Care
Why was the call made?
Watching someone die can be exceedingly difficult. This is compounded when the person dying is significant to one’s life. Most people don’t know what to expect at end of life; few will have witnessed a death before and won’t know what it might sound or look like. Often when a person is close to death, their condition and symptoms can change quickly. Families may not feel adequately prepared and may:
- Believe they’ve done something wrong.
- Question whether they can manage this new situation.
- Worry about what’s coming next.
A family’s bereavement can be impacted by the way these situations are addressed.
- Help them understand what’s happening.
- Address any misconceptions about what suffering looks like.
- Explain the trajectory of end of life.
Families find great comfort in knowing these situations are common and that you’re there to help ensure the patient is comfortable.
Three common reasons for 911 calls
In some cases, the progression of the illness results in challenging symptoms that can overwhelm families such as pain, bleeding, seizures or severe shortness of breath.
They’ll often look to you for expert assistance and to share the burden of symptom management and decision making. In most cases their goals are the same as yours – to ensure that symptoms are managed and the person is comfortable.
Families may interpret common physical changes associated with the end of life, such as restlessness or differences in breathing, as suffering. They may wonder if the symptoms are a signal that the patient is in pain or distress. They may have heard from their health team that it’s important to “get ahead” of pain, and they’ll want to ensure the patient is comfortable.
It’s not unusual before death for some patients to experience a “rally” in their disease progression. This may last up to a few hours, during which time their condition seems to improve dramatically. After hours or days of not communicating or being awake, the patient may become lucid and show signs of physical improvement. Why this occurs isn’t fully understood.
This rally may give the family unrealistic hope that the improvement will last. However, it’s important to know that most often this seeming recovery is followed by a steady and sometimes sharp decline. This second change in direction may be especially disheartening for the family, and as the natural decline resumes, they may feel confused and upset.
See also: When Death is Near article.