Watch with Me

The greatest fear of the dying patient is that of suffering alone and being deserted. There is less fear of a painful death than of the loneliness and alienation that may accompany it. A patient particularly dreads being abandoned by the physician in the face of death and may need increasing levels of professional support as the illness progresses. This is particularly true if family and friends are not able to cope with the deteriorating condition and begin to avoid contact, thus contributing further to the patient's feelings of loneliness and abandonment. If the patient feels that no one is available to discuss the situation openly and honestly, despair is likely to ensue. The patient's fear of the unknown is easier to cope with if his or her apprehension can be shared with a caring physician who provides comfort, support, encouragement, and even a modicum of hope.

Each new problem of the dying patient should be viewed as a nuisance requiring relief or removal and approached with the vigor that one would devote to an acute, short-term illness. When a fresh complaint arises, the patient should be reexamined and attempts made to relieve the symptom so the patient will not feel unworthy of further attention. If everyday nuisances can be controlled or lessened, the patient will feel that there is sincere concern for making her or his remaining life pleasant. The physician should give attention to details such as improving the taste of food by fixing or replacing dentures or stimulating the patient's appetite; eliminating foul odors; and suggesting occupational therapy to avoid boredom.

The physician should take advantage of every opportunity to touch and examine the patient rather than standing apart. Gentle palpation of areas of pain or merely taking a pulse can convey a sense of concern and warmth and provide comfort for an apprehensive and lonely patient. The physician and other health professionals can provide much support merely through conversation. The tendency to withdraw and reduce conversation contributes to the patient's sense of loneliness. Silence is an enemy of dying patients and increases their separation from society. Conversation is a social bond that affirms life and reduces anxiety by providing a means of catharsis. Saunders (1976) summed up the needs of a dying patient with the words of one patient: "Watch with me," asking that he not be abandoned in his final days. The readiness to listen and personal, caring contact are comforts that cannot be matched by modern "wonder drugs" and procedures.

When dying patients notice that people are avoiding them, they may interpret it as rejection, because their condition has not improved, or as the loss of love from family and friends, which is particularly traumatic because it tends to negate long-cherished relationships; the joys of a rewarding life can suddenly lose their value. The dying patient's contentment depends on maintaining warm relationships with loved ones as well as continuing other satisfying interpersonal relationships, including with the physician. If physicians and others withdraw from interaction with the terminally ill patient, much of the motivation for living disappears and is replaced by despair or terminal depression. The following plea to fellow health professionals is from a young student nurse who was terminally ill (Kubler-Ross, 1975):

I know you feel insecure, don't know what to say, don't know what to do. But please believe me, if you care, you can't go wrong. Just admit that you care All I want to know is that there will be someone to hold my hand when I need it. I am afraid. Death may get to be a routine to you, but it is new to me. You may not see me as unique!. If only we could be honest, both admit of our fears, touch one another. If you really care, would you lose so much of your valuable professionalism if you even cried with me? Just person to person? Then, it might not be so hard to die—in a hospital—with friends close

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