Approaching deathIn some situations, cancer cannot be cured nor the progress of the disease contained. This is when terminal care becomes appropriate. And this is also when it is necessary to think about death and the issues surrounding it. The purpose of terminal care is to alleviate the suffering caused by the physical, psychological, social and mental impact of cancer, and to support patients and their relatives as death approaches. Terminal care aims to ensure that death is as symptom-free and safe as possible and that family and friends are able to cope with the loss of their loved one. Terminal care Terminal Care Guide (in Finnish) Letting go is one of life’s most difficult and painful situations. Death is frightening both for the patient and his or her loved ones. Sometimes, though, death is a release as pain and illness come to an end. An incurable and progressive illness can mean that the patient is helpless in the face of it and the loss of his or her powers of decision-making and functional capacity. The disease can radically alter the way a patient thinks and feels, and even cause changes in personality. For many terminal care patients having a severe illness and the prospect of death trigger anxiety and depression. Loved ones can ease a patient’s psychological distress by taking as natural an attitude as possible to the situation. Patients and relatives can turn to the hospital priest for advice and solace, in addition to nursing staff. Drugs can be used to help alleviate a patient’s psychological symptoms, such as anxiety and depression. The loved ones of a patient in terminal care approaching death can do much to create feelings of security and intimacy. But if it turns out that a loved one was not able to be with the patient at the moment of death, it does not diminish the difference that she or he was able to make in the patient’s life. Loved ones’ grief The thoughts and feelings of loved ones about the impending death of their family member or friend may be conflicted. On the one hand, they want the patient’s death to be painless and an end to suffering, and yet they want the patient to live as long as possible. The closer the patient is to you, the harder it is to let go. Death is always an upset no matter how used you have got to the idea that the disease is incurable. The initial reaction is shock and a feeling of depression. It is best to arrange the funeral only after a couple of weeks of the loved one’s death so that the memory of it is lasting and you can be emotionally present at the occasion and be receptive to expressions of consolation. Fast track funerals do not expedite the process of grieving and recovering from it. It may take some weeks after the loved one’s death before questions and difficult feelings associated with the loss start to surface. If there are questions that need answering, the family and friends of the patient can get in touch with the patient’s doctor, home care nurse or hospital ward. For example, remembrance and grief groups are arranged at hospices and churches. The death of a loved one and the ensuing grief is a long process with many stages. It is a natural human response to loss. Grief is a personal process. It is not a single emotion but covers a range of emotions – missing, unease, anger, guilt. It can affect you physically as well as mentally. Having trouble concentrating, memory lapses, fatigue and various illusory sensations are common experiences prompted by grief. The main thing is not to refuse or dismiss feelings of grief. Every one must grieve their own loss. Anxiety does not vanish by trying to suppress your feelings. Crying and talking openly relieve your feelings. Support from family and friends are a source of strength. Visiting the loved one’s grave, burning candles, prayer and other rituals are also part of grieving and often provide relief. Grief is often depicted as coming in waves. At times it feels as if life is returning to normal, and then every so often feelings of grief are resurgent. As day-to-day sorrow subsides, feelings of missing become stronger around the times of the deceased’s birthday or date of death. Sometimes mourning is impeded, for instance because of another difficult life situation, in which case it may get channelled into physical illness or drug or alcohol dependence. The feelings involved in mourning and grief may also become prolonged and turn into depression. Not everyone has the opportunity to share their grief with others. In such situations it is good to seek professional advice. Grief in children Children comprehend death according to their age and level of development. Only when children reach adolescence do they perceive the finality of death. Before that stage, children comfort themselves with thoughts of guardian angels or of life continuing. Children often recover from grief more quickly than adults. Sources Hänninen, Juha (2015) Saattohoito-opas. Helsinki: Etelä-Suomen Syöpäyhdistys. Suomen Syöpäpotilaat ry. Pieni vihkonen surusta. Helsinki, 2003. Suomen Syöpäpotilaat ry. Selviytyjän matkaopas. Helsinki, 2014.