The dying process is a challenging time for those who care for the critically ill. We hope these suggestions, thoughts and ideas may give you comfort and help comfort your loved ones.

• Communication with Your Loved One
• Be Sensitive
• What's Not Helpful
• Offer Options
• As Death Approaches
• Grieving the Loss of a Loved One

Communicate with your loved one

We find it difficult to converse with a terminally ill person; especially one we have reason to believe will die soon. Here are some suggestions, some thoughts, some ideas to help you get started:

• Talk to your loved one as you did before you found out he was ill. Talk about your favorite sports team, the news, your church, friends, whatever.
• Hope is important. Talk to your loved one about tomorrow, or next week or next year.
• Listen to your loved one. She needs to talk to you.
• Laugh with your loved one when she laughs. Cry when he cries. Don't be afraid to share your feelings with your loved one - how you feel about what she's going through.
• Say: "I love you." He needs to hear that from you. Your loved one wants you to know that he loves you and might say that quite often.
• Contact your loved one:  visit or phone, write or send a card. Don't put it off.

Be sensitive to your loved one's feelings

• If she says, "I'm not feeling well," don't try to convince your loved one otherwise by saying things like: "But you look so good!" or "You're too young to be this sick."
• If he wants to talk about dying, please let your loved one do that. After all, that is the future; it is the most important thing he is doing right now.
• If it is true that she is dying, don't try to convince your loved one otherwise.
• If he is dying, help your loved one with any concerns he might have.
• If she has questions like: "Will I die in pain?" please get your loved one answers.
• If his faith means a lot to your loved one, he might have questions like: "What will happen with me after I die?" and "Will I see my family and friends again?" Help your loved one answer them as best you can. If you can't, please get his minister/priest/rabbi.
• Your loved one might want to have a say in her funeral arrangements. Ask her about the funeral home, church, cemetery. Your loved one may want friends to hear favorite hymns.
• If he senses that he is about to die and tells you, don't say: "No you're not."

What's not helpful

• Don't tell your loved one about how other people suffered what he is going through.
• Don't tell your loved one she shouldn't feel sorry for herself.
• Don't ask your loved one over and over how he feels.
• Don't make her illness the focus of your time together.
• Don't tell your loved one: "I know how you feel." You don't.
• Actions often speak louder than words: If he doesn't have a contagious illness, touch your loved one, hold his hand, hug your loved one.
• Don't ask your loved one, "What can I do?" Sometimes she can't figure that one out.

Offer your loved one options

• Ask your loved one if you can go shopping for him.
• If she is able to eat, bring your loved one some food (in disposable containers).
• If he feels up to it, take your loved one out to eat, or just for a drive so he can see the outside.
• Your loved one's family needs time to do things they have to do. Be there for them.
• Offer to take the kids out to the playground or the beach.
• Stay with your loved one so his spouse can get out.
• Offer to run errands for the family so they can be together.
• Tell your loved one about support groups for the family or your loved one. She may already know about them or not. That one group may make all the difference in the world.

Finally - Being there for those who are dying and their family helps a lot. If at times your offers and support are rejected, please don't take it personally. Know that your caring and thoughtfulness are appreciated. Try again, or choose a different approach.

As Death Approaches

As the time of death approaches, you will notice changes in your loved one.
There will be less interest in eating and drinking. For many, refusal of food is an indication that they are ready to die. Fluid intake may be limited to that which will keep their mouth from feeling dry. Offer, but don't force your loved one to eat or drink.

Urinary output may decrease. This is natural. If your loved one expresses a desire to urinate and cannot, alert the nurse.

As the body weakens, your loved one will sleep more and more and begin to detach from the environment. Let him or her sleep. Remember being with your loved one is more important than doing for.

Mental confusion may become apparent as less oxygen is available to supply the brain. Your loved one may be disturbed by "strange" dreams. As they awaken from periods of sleep, remind them of the date and time, where they are, who is with them. Do not try to correct their dreams.

Vision and hearing may become somewhat impaired. Speech may become difficult to understand. When you talk, speak clearly but no more loudly than is necessary.

Keep the room as light as the patient wishes, even at night. Remember, hearing is usually the last sense to leave so continue to share your thoughts with your loved one.

Secretions may collect in the back of the throat and rattle or gurgle as the patient breathes through their mouth. They may try to cough. Their mouth and lips may get dry. Placing a person on his side may help the secretions drain. Humidification with a cool mist vaporizer often helps. Cleansing the mouth with glycerin swabs or offering small sips of water using a straw may ease a dry mouth.

As the oxygen supply to the brain decreases, your loved one may become restless -- pulling at the covers, trying to get out of bed. You can reassure him in a calm voice that you are there. Soft music or a back rub might help quiet him. Prevent your loved one from falling if he or she tries to get out of bed.

Your loved one may feel hot one minute and cold the next as the body loses its ability to control its temperature. As circulation slows down, the arms and legs will become cool and bluish in color. The blood pressure goes down and the pulse goes up. You can provide and remove blankets as needed. Sponge with a cool cloth.

Change perspiration soaked clothing and linen.

Your loved one may lose control over the bowel/bladder. Keep chux or waterproof pads underneath and change as necessary to keep him or her comfortable.
Breathing may become irregular with periods of no breathing or apnea lasting 20-30 seconds. Your loved one may seem to be working hard to breathe -- even making a moaning sound. The moaning sound is just the sound of air passing over very relaxed vocal cords. This indicates that the dying process is coming to an end.

Grieving the Loss of a Loved One

• Feel your emotions. The healthiest way to deal with your emotions is to feel them as they happen. Don't try to put them off. They will just intensify.
• Express your loss. Make your feelings known. It can help you heal faster and more completely.
• Talk about it. Often this loss will bring to mind other losses. Talk about these as well.
• Different is normal. You may act differently during these difficult times. It is okay. It is normal.
• Let a sense of community form around you. Accept what others offer as a sign of respect that you are valuable to them. Allowing them to help you helps them as well.
• Appreciate attempts to help you. Those who try to assist you have a difficult role. They often don't know what to say or what to do. Be patient with them.
• Listen to your own needs. No one understands your needs, what is going on inside of you, but you. Take care of yourself with proper eating, drinking, rest and exercise.
• Choose how you respond to your loss. Remember, experience is not what happens to you; it is what you do with what happens to you.
• Trust your own timing in the healing process. You are a unique individual with your own feelings and appreciation for what you have lost.
• This time of loss can lead to a new awakening. Only you can decide how you will grow from it.
• Why did this happen? Why here? Why now? You may not find answers. People have been asking these questions in the face of misfortune for many years. Check with spiritual leaders.
• Discover yourself! A time of loss can become a time of personal discovery. You'll be able to know yourself in ways you never have and with strengths you've never seen.