In the Midst of Life

or bladder, and because they cannot verbalise this, it needs to be checked by those caring for the person. These issues can be settled relatively simply with the insertion of a catheter into the bladder, or by a professional assessing whether they have a full rectum and therefore administering anenema to relieve the symptoms. Other causes may be a dry or sore mouth, stiff limbs, which can be settled with some gentle passive movements, and painful wounds, or the developing of pressure sores. The latter may indeed require medications to manage symptoms of pain: however, simply changing a soiled dressing and repositioning the patient may often be enough to assist.
    The golden rule is always to firstly treat anything which can be reversed without drugs. Some of these may take time to work, such as administering an enema: in this case it may be appropriate to give a small amount of medication to settle the patient in the meantime, as it is very hard for relatives and family to watch them in this way.
    To illustrate, here are two examples of when simple measures are more appropriate than medications. The first one concerns a gentleman who was dying. He was not expected to live for more than a few days and he appeared agitated. The professionals caring for him administered opiates, which appeared to settle him, but only for very short periods. On visiting him, a nurse specialist giving mouth care noticed his mouth was very sore, full of ulcers and thrush. She suggested regular mouth care with thrush medication and oral gels to hydrate the mouth. Within a few minutes he became very settled, and with a routine of good mouth care he did not require any further medication, and died peacefully the next day.
    The other example concerns a lady who had had a massive stroke and was deteriorating in a care home. She, also, appeared very agitated, and was also given strong pain relievers, which did settle her. However, she was becoming more and more drowsy, less responsive, and was requiring quite large amounts of medication to keep her comfortable. One very attentive care assistant noticed that one of her hands was curled tightly into a fist caused by the stroke. She carefully uncurled the hand to find that the lady’s nails had grown considerably and were digging into the palm, had broken the skin and the wounds had become infected. With some careful and much needed dressings and cushioned protection to the hand, as well as by cutting this lady’s nails, she became muchmore comfortable and again did not require the massive amounts of medication she had appeared to need before.
    When someone is dying, those caring for them must act as their advocates: they must be the eyes and ears for that patient, and careful assessment and interventions can make sure they are comfortable, and that their family and friends recognise how respected and cared for they are.
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