In their pursuit of answers, seriously ill people and their families can use their own resources, religion, counselors, friends and research. They can talk, participate in religious or family rituals or engage in meaningful activities. The most important antidote to despair is often feeling cherished by another person.
The torrents of medical diagnoses and treatments should not be allowed to obliterate the larger questions and the importance of human relationships. During my internship in the late 70s, an old man, wanted me personally to tell the rest of his family members what was the cause of his illness. The old man had cancer of his food pipe (oesophagus).
The reason behind the disclosure was to share the good news to his family members that the cause of his illness did not arise from his younger wife claimed to have bewitched him. When I broke the news and explained that it was cancer of the food pipe that was killing him, he shook hands with me and said “thank you doctor and I will die in peace and no fear of witchcraft in the family”.
Preparing for death often means finishing a life’s work, setting things right with family and friends, and making peace with the inevitable. Spiritual and religious issues are important to many dying people and their families. Often, there are characteristic signs that death is near. Doctors cannot predict when death will occur.
Consciousness may decrease. The limbs may become cool and perhaps bluish in light skinned individuals or mottled. Breathing may become irregular. Secretions in the throat or the relaxing of the throat muscles can lead to noisy breathing, sometimes called the death rattle. Repositioning the person or using drugs to dry secretions can minimize the noise.
Such treatment is aimed at the comfort of the family or caregivers, because the noisy breathing occurs at a time when the dying person is unaware of it. This breathing can continue for hours. At the time of death, a few muscle contractions may occur, and the chest may heave as if to breathe.
The heart may beat a few minutes after breathing stops, and a brief seizure (convulsion-degedege) may occur. Unless the dying person has a contagious infectious disease that poses a risk to others, family members should be assured that touching, caressing, and holding the body of a dying person, even for a while after the death, are acceptable. The person dies with dignity, when death occurs in the presence of kith and kin. Generally, seeing the body after death is helpful to those close to the person.
Doing so seems to counter the irrational idea that the person really did not die. When death occurs, death must be pronounced by an authorized person (such as a doctor) and the cause and circumstances of death must be certified. A death certificate is necessary for making insurance claims, getting access to financial accounts, payment of pensions, conveying real property titled to the deceased and settling.
The family may be reluctant to ask for or approve an autopsy (post-mortem). Although it will not help the deceased, an autopsy may help the family and other people who have the same disease by revealing more about the disease process. Many families have some sort of reception to honour the memory of the loved one. Some choose to have a small service soon after the person has died; whereas others choose to have a large memorial service a few weeks like six weeks or even months later.
Getting on with life after a loved one has died depends on the nature of the relationship with the deceased, the age of the deceased, the kind of dying that was experienced and the emotion. Also, the family needs to feel sure that they did what they should. Having a talk with the doctor a few weeks after the death can help answer lingering questions.
The loneliness, disorientation and the feeling of unreality experienced during the period near the death improve with time, but the sense of loss persists. People do not “get over” a death as much as they make sense of it and go on with life. Confidentiality still prevails, even now than ever before, the dead must be respected.
It will be up to the senior member of the family to speak in public if the family has agreed and given him or her mandate to declare the cause of death. I salute the old wise man, the former President of South Africa Mzee Nelson Madiba Mandela, who said at the funeral of his son, “he died of AIDS.”
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