(1) Patient reactions. The patient:

(d) May withdraw from all except a special loved one.

NOTE: The patient wants to be left alone or have someone sit near, but in silence.

Family often needs more support than the patient. This is the time when it is too late for so many words, and yet the time when relatives cry the hardest for help--with or without words.

(2) Health care provided by the medical specialist.

(a) Respect the patient's need for quietness and offer reassurance by being there as much as possible.

(b) If the patient is unresponsive, do not discuss the patient in his room-hearing is the last sense to cease function.

(c) If the patient does not want to talk, communicate nonverbally to indicate a sense of caring and concern.

(d) Keep the patient as comfortable as possible.

(e) Maintain emotional support for the family.

(f) Communicate to the patient that he will not be forgotten.

NOTE: The medical specialist can be of great help during those final moments if he can understand the family's conflicts at this time and help select the one person who feels most comfortable staying with the patient. Those who feel too uncomfortable can return home knowing the patient will not die alone, yet not feeling guilty for having avoided the moment of death which, for many people, is so difficult to face.

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