AboutMargot RN BScN CGN Expertise I nursed my own Mother and Grandmother at home when they were dying so I have personal experience with the emotions involved. I have also spent the last 15+ years as a Registered Nurse caring for The Elderly and Terminally Ill and it has brought me great satisfaction. I am willing to answer any questions I can.
Experience
Past/Present clients Hundreds of Long Term Care Residents as well as hundreds of Cleitns and families in the community (including my Mother and Grandmother).
Question My best friend's Mom (she's my 2nd Mom) is right now dying from Small Cell Lung Cancer. She had part of a lung removed and had chemo and other treatments about 4 yrs ago. The cancer returned and is now also in Lymph nodes and brain. She doesn't want anymore treatments since they will not really give her more days. She is in another state and family members have flown in and are helping to care for her. Last week she was showering herself this week she is in a wheel chair. She is taking anti anxiety meds, some kind of steroids (they have made her very chatty and writing in a journal all the time), morphine pills and now the liquid under the tongue. Its seems that her lungs have filled with fluid and the hospice people told the family they should take her to the hospice facility and she would be aspirated. When they got there the facility told them that they do not do these agressive types of treatment. My 2nd Mom is in a lot of pain and they are not able to manage it. No one knows what death will look like from this type of cancer. Can you please tell us in detail? I realize each person is different, but if we had symtoms of death from Lung cancer, it would be helpful even if she doesn't get the all or has additional things too. I was a caregiver for a dear friend of mind as she died from Ovarian cancer. My friend and her family are afraid they their Mom is in pain and not being properly cared for at this hospice facility. They say that if they do not take the fluid from the lung she will have congestive heart failure. Is this how one normally dies from Lung Cancer? Someone else has asked for a detailed description of what exactly to expect. But no one responded to this direct question. I saw your post from http://www.hospicenet.org/html/preparing_for.html "Preparingfor Approaching Death". We would like to know what it will be like if lung fluid is removed ? Maybe dying from conjestive heart failure is a better option? Please describe. Thanks in advance for your help.
PB
Answer Hi Pat and thanks for writing,
This is very general and may not be the course your 2nd Mother follows, but I can tell you how an average CHF patient may proceed.
Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs. The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. The most common symptoms are respiratory in nature. Failure of the left ventricle causes congestion of the pulmonary capillaries. The patient will have dyspnea (shortness of breath) on exertion.
Basically the CHF deprives the body of oxygen and the patient becomes short of breath, tires easily and will rest more and more as they grow weaker. Occasionally Blood Transfusions will provide temporary relief if the Haemoglobin falls too low, this can also cause Angina (chest pains).
Eventually the patient will be so weak they don't want to move around too much and may stay in bed or sit in an easy chair most of the day; just washing and dressing will be exhausting. They often lose their appetite due to decreased energy so it's a vicious circle: low oxygen causes low energy & weakness which decreases appetite, and decreased appetite leads to weakness.
Treatment is generally "Comfort Measures" like oxygen to ease shortness of breath, maybe some medications to ease the heart's workload, and some puffers to open the airways, but it's not typically aggressive treatment as CHF is progressive and irreversible. You also want to watch for increased edema (swelling) in the ankles and lower legs or increased shortness of breath or wheezing which are signs of fluid retention and can usually be treated with medication adjustments. Diuretics increase the loss of salt and water through the kidneys. This reduces the congestion and excess fluid in the lungs improving shortness of breath, the most prominent and limiting manifestation of heart failure. Drugs that dilate blood vessels lower resistant to blood flow and decrease the heart's workload.
In the end the patient is often weak and bedridden and simply slips away quietly after a slow peaceful decline. The patient will feel weak and will be short of breath after exerting themselves, but do not "gasp for breath". Low oxygen levels can cause confusion though and occasionally the confused patient can become agitated. The most common symptom of CHF is Anxiety related to feeling of not being able to catch your breath – doctors often prescribe anti-anxiety medications such as Ativan for their CHF patients, but use these only as required as these medications are sedating and can increase weakness and increase the risk for falls in the elderly. You’ll also want to watch for red areas on the skin as CHF patients are more prone to skin breakdown due to the extra fluid and decreased circulation; you’ll want to ensure she is turned regularly, there are no wrinkles on the sheets and his skin is kept dry but hydrated.
I hope this has helped to answer your questions and I wish you both all my best; please write again if I can be of any more assistance.
