When Death is Near

All the considerations presented here are framed in the concept of illness as a medical, social and human phenomenon that constitutes one of the most profound experiences an individual, especially a child, can face in a society like ours.

When A Child’s Death Is Near…

Extract of the Conference Humanized Assistance of the Dying Child
dictated by the Colombian doctor Tiberio Alvarez, M.D.
Colombian V National Congress of Humanization in Health
Camilian Centre of Pastoral Health, Bogotá, October 14th and 15th, 1995

Although death constitutes a universal phenomenon present in all the history of humanity, the interest of human sciences (psychology) and medical sciences (psychiatry) over this subject has only been developed in recent years. Talking about terminal patients, especially children, death is particularly feared: the parents don’t want to think about the possibility of the death of their children and the medical personnel prefer not to refer on these subjects (this explains the insufficient bibliography about the dying child). In spite of this difficulty and thanks to different studies, we will present a brief description of what the minor lives through before dying.

The last days

The last days, especially the last moments of the child, constitute a difficult challenge not only for the medical personnel, but also for the family, friends and all the relatives. The doctor’s labor when the curative treatments have failed must be guided by the palliative care: that “active and compassionate care offered to the terminal patient when the disease the person suffers no longer responds to the traditional treatment that looks for healing or prolonging life. On the contrary, the palliative care looks forward to controlling the physical, emotional and spiritual symptoms.” It is necessary to calm the pain, the insomnia, the anxiety, the depression, the hemorrhage, the dysphasia, the gastritis, the nausea, the vomit, the diarrhea, the constipation, the faucal impact, the generalized weakness, the confusion, the compression of the spinal marrow, the hypo, the ulcerations, the bad scents...

If we talk about the emotional aspects, we will find the terminal child crying: he is sad; quiet; he doesn’t want to talk; nothing calls his attention and he seems to be annoyed by the presence of others. Sometimes the terminal child will enter in a frank indifference towards the atmosphere that surrounds them; they have a flat affectivity, they feel fear, they suffer by the different losses (especially the fact of having to separate from the ones loved) and even sometimes, they feel lost. It is good to explain to the parents, to the brothers and sisters and to the close relatives that this indifference or flat affectivity is a normal situation in this final stage. It constitutes the moment when the patient stops fighting. It is the moment when they give up, when they understand the end is near…when life reaches its end.

The spiritual aid is fundamental. It is a great support at moments of infinite pain and suffering. The religious rites produce inner peace and spiritual tranquility: the tranquility of knowing that they are taking their way back to God. When death appears, the doctor and the nurse must accept it with dignity, in silence. No heroic measures should be taken. It must be allowed for the parents to be present and to express their feelings; allow them to cry, to shout, and to express their entire affliction. In this way they will elaborate the duel in a natural and suitable form.