How do you prepare or help prepare someone who is dying and then deal with the practical aspects of the aftermath

October 8, 2007 6:52 PM

Questions about the practical aspects of preparing for someone for death and things the survivors need to do after the death.

1. When you know someone is dying, what specific things should they do to "put their affairs in order"?

2. After someone you are responsible for, such as parent, child or spouse, has died, what do you, who do you call, i.e what steps need to be taken to ensure the removal of the body, funeral arrangements etc?

3. Suppose you are caring for someone who is dying, say someone with cancer, and their time is near. Are there specific signs that indicate their death is only a few minutes or hours away, so you can help ease their passing? I've heard it mentioned that the eyes become cloudy almost like they're going blind, is this universal?

4. Why does cancer kill? Wouldn't the virus want to keep the host alive? Or if it does kill, why isn't it contagious, in order to ensure its survival?

posted by Brandon Blatcher to health & fitness (14 comments total)

Regarding 2, I believe the funeral home can take care of the body removal and help you choose the funeral you want your family member to have, assuming he/she hasn't specified what kind of funeral he/she wants in a will or verbally.

3. Yes there are signs; ask hospice workers.

4. Cancer involves the mutation of cells. It's not a virus.
posted by IndigoRain at 6:58 PM on October 8, 2007

4. Why does cancer kill? Wouldn't the virus want to keep the host alive? Or if it does kill, why isn't it contagious, in order to ensure its survival?

cancer is just what happens when there's a bug in your genetic program. the cells go haywire and divide like crazy. it's not a virus.
posted by mpls2 at 6:59 PM on October 8, 2007

How Cancer Works on HowStuffWorks, or if you prefer, here's the Wikipedia entry.
posted by IndigoRain at 7:00 PM on October 8, 2007

1. Get the wills (living care directives and possessions) squared away. Some people like to have some say in their funeral arrangements: songs, sermons, location, cremation vs burial, etc. The person should pick an executor: get copies of the will, keys, alarm codes, passwords and account locations to the executor (or give the executor instructions on where these things can be found).
2. Call the funeral director (with whom you've made the prior arrangements. I highly recommend making funeral arrangements in advance. Doing it while you are wrestling with grief sucks. Even when you know the death is coming, the grief post-death will be stronger than one might expect).
3. With my mom, the color of her skin changed. She developed a pallor, nearly a translucency. Her skin slackened and oddly, many facial wrinkles flattened out. I've read that vision often goes first, but hearing sticks around to the end, so if you're there, speak to the person. Hold their hand.
4. Cancer is a cellular copying error, not a discrete organism with a reproductive drive.
posted by jamaro at 7:10 PM on October 8, 2007

You should peruse AskMe for answers by ColdChef, who is in the funeral business and very knowledgeable.
posted by pineapple at 7:26 PM on October 8, 2007

This answer of ColdChef's in particular summarizes some of the salient points for your first and second questions.
posted by jessamyn at 7:29 PM on October 8, 2007

Actually some cancer is transmissible, just not in humans (yet).

Devil facial tumor disease
Canine transmissible venereal tumor
posted by i_am_a_Jedi at 7:35 PM on October 8, 2007

In addition to the will and living will, some other documents might help. If the person in question is at a point where he or she cannot handle their affairs, a Statutory Durable Power of Attorney can be used to designate someone to do that for them while they are still alive. Likewise, a Health Care Power of Attorney empowers someone to make health care decisions on their behalf. The POAs terminate upon the person's death, and of course the executor of the will administers the estate thereafter.

In addition to the living will, your state probably provides for things like Advance Directives, DNR orders, separate out-of-hospital DNR orders, and so on. Remember that the specific names and formats for all these documents vary from state to state. Get the ones specific to your state from nolo.com or some other online source, or (if the patient is in a health care facility) perhaps a social worker could provide the forms. Or you could consult a lawyer, as my parents did.

On the what-to-do, who-to-call question, it may depend on where the person dies. If he or she dies while in hospice care, the hospice will likely have asked you what funeral arrangements you want at the time the patient entered their care. If the patient dies in a nursing facility or hospital, it's likely that a representative of the facility will ask you what funeral home you want them to call. If the patient dies at home, then you need to contact the funeral home. In any case, make your prearrangements now, before the person dies.

Thanks for asking this. Writing this out is oddly therapeutic for me. I just went through this process with my father in July and I'm now facing the same situation with my mother. She entered hospice care at a nursing facility last week, and I had to provide all the information that hospice needs. Both my parents had the great foresight to make their prearrangements years ago, and to have their wills and nearly all their other documents in order. The only thing I had to complete on behalf of my mother was an out-of-hospital DNR -- not exactly an easy thing, but I knew it was what she would want. My siblings and I are now conducting a discussion on what memorial arrangements to do for her so that we will be prepared when I talk to the funeral home. That also was something she did not say in advance, and at this time she is too heavily medicated to say what she wants.
posted by Robert Angelo at 7:58 PM on October 8, 2007

Call Hospice first. They are your very best source.

I was once a hospital chaplain at Duke University Medical Center while a student at Duke Divinity School. We cared for the dying and their families all the time.

One thing surprised me until I got used to it was how well the hospital itself handled death. When someone's death was imminent, they would call me (or another chaplain). I would stay with the family (if they wanted me to) all the way to the very end, and when the family was ready to leave, they did. All they had to do was tell their nurse which funeral home they had chosen, and then they could leave the hospital.

The hospital staff would then call the funeral home, who would come and pick up the deceased. The funeral home and family would get in touch to plan the burial or cremation and funeral/memorial service (if there was to be one). I would fill out what the hospital called "decedent care" paperwork, and that was it.

Those experiences, combined with eleven years of pastoral work, have taught me these important things.

- Make as many plans beforehand as the dying person is comfortable with, and no more. This can include funeral requests, burial vs. cremation, organ donation, etc.

- Preplanning with the funeral home is very, very, helpful, so the Coldchef recommendation is a great one. I have never, ever, had a bad experience with a funeral home, but it is better to plan now, when your head isn't swimming.

- Hospice, Hospice, Hospice.

- One of the most moving scenes (to me) I have ever seen in any film is the scene in Titanic when the ship is listing and the designer of the ship is setting the clock in the dining room. It seems odd, but we all do it sometimes, because in impossible in impossible situations, we want to feel in control of something. Just remember that when someone, including the dying person, inevitably lashes out or seems impossibly obstinate on something, especially related to planning a funeral/memorial service.

A colleague who has been a hospital chaplain for nearly three decades once described this process to me as "walking them to the door." Just being with them is so important, even if you don't know the answers, even if you don't even know what to say.

All the best to you.
posted by 4ster at 8:04 PM on October 8, 2007

After posting, I remembered that Duke now has something called the Institute on Care at the End of Life that could possibly be helpful to you. It is pretty broad in its scope, but it brings together a number of disciplines, so it might be worth a look.
posted by 4ster at 8:19 PM on October 8, 2007

On your third question about "specific signs," I just read this page from hospicenet.org yesterday. I found it, and the other pages on the site, very interesting.
posted by Robert Angelo at 8:31 PM on October 8, 2007

See also this page: Home Care Guide for Advanced Cancer: What To Do Before and After the Moment of Death.
posted by Robert Angelo at 8:36 PM on October 8, 2007

For your first two questions, see if any of these checklists help: 1, 2 3.

For your third question, you could try reading "In the Presence of Death," by Christopher Bamford, where he describes his experience with his wife's death. I found it in this book, but a full-text version starts on p. 12 here [pdf].
posted by salvia at 1:56 AM on October 9, 2007 [1 favorite has favorites]

I've heard it mentioned that the eyes become cloudy almost like they're going blind, is this universal?

no it isn't universal. it is nothing i recall witnessing in many years nursing.

towards the end you will notice the person is no longer responding to visual stimuli (but it's not ocular failure, so much as the brain failing). what becomes obvious is the lack of movement. the eyes become stationary, no longer tracking the world; the pupils stop accommodating for light; and the eyelids too become relaxed. true enough the dying person does become blind to the world and the inactivity of the eyes is acutely conspicuous. you will be aware of an absence.

but there is no opacity. no.
posted by de at 8:57 PM on October 9, 2007