Treating symptoms

Persistent symptoms that are inadequately treated can lead to feelings of abandonment, guilt, suffering or even of spiritual despair.

The most important changes often take place over the last two or three weeks: the patient becomes dependent, weak, confused and incapable of dealing with the most elementary acts or gestures (personal hygiene, walking, and continence).

The patient finds this dependence difficult to cope with and feels uncomfortable for and with his family and care circle.

The predominant symptoms may not be considered as ‘noble’ by the lofty doctor, however they are of considerable discomfort and embarrassment to the patient: extreme asthenia, anorexia, pain, nausea, constipation, insomnia, dyspnea.

Moral and spiritual suffering

The patient can convey great moral sorrow, and essential spiritual needs based on the sense of his life. The comfort offered by his family, by memories of the happy moments of his life and of his positive acts and deeds, as well as the presence of his children or grandchildren are of great spiritual importance since they give meaning to the patient’s life.

For many patients, it is of paramount importance to make peace, first of all, with himself, then with his family, or with God. The presence of a chaplain, according to the patient’s personal beliefs, can often be useful.

Gentle death

If symptoms are adequately dealt with, death is generally peaceful, and free of any acute incident such as haemorrhage, major dyspnea or deglutition disorder.

Confusion is occasionally observed, or disorderly arm or leg movements (patients pushing away or pulling at their bedsheets), together with agonising groaning. These symptoms can be treated by anticholinergic agents. Over a third of terminally ill cancer patients are conscious immediately before their death.

The patient’s family often has great difficulty in staying close to the patient and coping with these death-related symptoms (terminal groaning and incoherent language are far more unpleasant for the family than for the patient himself). Many of our fellow citizens have never seen death before, or a deceased body, and they discover these fundamental and existential realities with a beloved one. We can therefore fully understand their distress, particularly that of adolescents and children.

Bereavement rites

The ever-increasing absence of bereavement rites around hospital deaths amplifies the psychological difficulties experienced by the deceased patient’s family.

These rites represent a form of social protection for each individual. Since childhood, each and every one of them has observed parents or other family members and therefore knows what attitude to adopt in each circumstance. These rites are a natural way of expressing the pain of bereavement (wake, black clothing, family gathering, religious ceremony, condolences etc.).

The gradual modern disappearance of rites leaves survivors more and more vulnerable to their spontaneous reactions which have barely changed over the generations.

It is noteworthy that funeral parlours often replace the religious ceremonies organised in churches with a form of farewell ceremony to help and guide disconcerted families with no particular religious conviction.