What is a cerebral coma and its causes. What can people who have been in it tell about a coma? The woman who miraculously survived in a hospital bed answers

When a person falls into a coma, it becomes an ordeal for loved ones. They communicate with him, believing that he hears them, understands and feels everything. Is it really?

The amazing story that you will now learn about will understand how a person in a coma feels.

The story that surprised everyone

It all started suddenly and became a real nightmare for the whole family. The son found his mother unconscious at night. Linda Swap, 45, fell into a coma for twelve days.

After a consultation, the doctors came to the conclusion that the case was hopeless. And they advised relatives to disconnect the woman from the life support system.

The decision was not easy for the family. But her husband knew that Linda wanted to become a donor after her death by donating her organs. Out of respect for her wishes, he made a difficult decision.

The moment of farewell has come. Children began to approach her and whisper farewell touching words. The husband was the last to come up and, with tears in his eyes, gently whispered: “You must fight, you are a fighter.” After that, he leaned over to kiss her goodbye. And then the incredible happened. The woman barely audibly whispered: "I will fight ...".

A real miracle happened. After all, Lindy did not speak, did not give any signs, did not move. But it turns out she's been fighting all this time!

The family couldn't help themselves. They had already said goodbye to his wife and mother, the life support system was turned off, then the woman continued to live and at the same time remained conscious! She never stopped fighting for her life.

When Linda recovered fully, she told what exactly parting words allowed her to return. “If a person has fallen into a coma, this does not mean at all that he does not feel or hear anything. Do not stop talking to your loved ones in such a situation, they hear you and understand, ”the woman says.

How does a person in a coma feel?

Here is how scientists describe this state.

Imagine that you woke up and found yourself in a tightly closed box. The box is perfect for you. It is, however, strange, because you all hear what is happening, but for some reason no one hears you.

The box fits all parts of the body, enveloping the face, lips, and this is what makes it impossible for you not only to speak, but even to make sounds. At first it seems like some kind of game. Then comes the realization of what is happening.

And the worst thing is to hear when your fate is being discussed and those close to you decide whether you should live. It throws you into the heat, then into the cold. Relatives and relatives visit you less and less. And there's nothing you can do.

In fact, a person in a vegetative state does not sleep, although he does not respond to external stimuli. It seems that he has no emotions, memory, intentions, but this is not so. The patient feels and thinks to a certain extent, and Linda's case confirms this.

History proves that one should never lose hope! Tell your relatives and friends about it, because such facts are impressive.

By definition, coma is a state characterized by a complete loss of consciousness. A person in a coma does not have active movements, the process of respiration and cardiac activity is disturbed. Often, doctors and relatives of the patient are faced with the question of whether a miracle should be expected, or whether the patient should be disconnected from the life support apparatus and allowed to do so. However, a person in a coma can be much more alive than it seems.

The patient is more alive than dead

A person lying in a coma, as a rule, is visited by relatives and relatives. They read to him, tell him the latest news and events from their lives. Outwardly, the patient does not react in any way to their presence, but if you connect special equipment, a different picture emerges. For example, scientists have discovered an interesting phenomenon in young man, who fell into a coma after a serious accident and received head injuries as a result of it. Whenever an unfortunate motorcyclist came to visit a loved one, the patient began to beat more often, which was recorded by the equipment. Subsequently, when the young man went on the mend, it was the presence that had on him beneficial effect and contributed to recovery.

Paying attention to the brain of those lying in a coma, you can also find that it is not. Based on ripple changes, patients respond to the presence of loved ones, as well as what they say to them, according to research conducted at the University of Tübingen in Germany. Every fourth person has this ability. Hugs or touch also affect heart activity and brain activity. The more pronounced such reactions are, the more chances the patient has to get out of the coma.

Responding to the words of others and external stimuli, as well as experiencing emotions depending on their content, is capable of not only people lying in a coma, but also patients under anesthesia. curious case occurred in a German clinic during an operation on a particularly obese patient. While he was unconscious on the operating table, the doctors took the liberty of cracking a couple of jokes about him. excess weight. Waking up

Coma is translated from Greek as deep, very deep sleep, is a condition characterized by a complete loss of consciousness, breathing, reflexes, and total absence reactions to any stimulus.

Cerebral coma represents complete depression nervous system and inhibition of its work without the death of body tissues with medical maintenance of basic vital important functions: breathing, heartbeat, which can stop periodically, and artificial nutrition directly through the blood.

Coma unconsciousness can develop in a person as a result of any damage to the organs of the brain, either instantly or in a few hours. A person is able to stay in it in an individual case from several minutes to several years.

Classification of coma, their causes:

Coma is not independent disease- this is a symptom characterized by the shutdown of the brain under the influence of others or its defeat of any traumatic nature. There are quite a lot of varieties of coma, subdivided according to the causes of development and the nature of the course:

• Traumatic coma is one of the most frequent varieties caused by traumatic brain injury.
• Diabetic - develops if the glucose level of a diabetic patient has critically increased, which can be identified by the rather noticeable aroma of acetone from his mouth.
• Hypoglycemic - the opposite of diabetic, which develops due to a critical drop in blood sugar. Its harbinger is severe hunger or a complete lack of saturation until the sugar level is raised.
• Cerebral coma - slowly developing state due to the growth of neoplasms in the brain, such as tumors or abscesses.
• Hungry is a common condition caused by extreme dystrophy and lack of protein in the body due to malnutrition.
• Meningeal - due to the development of meningitis - inflammation of the membranes of the brain.
• An epileptic coma develops in some people after an epileptic seizure.
• Hypoxic develops due to cerebral edema or suffocation due to oxygen starvation CNS cells.
• Toxic is the result toxic injury brain due to poisoning, infections, or alcohol or drug abuse.
• Metabolic - quite rare variety caused by a strong failure of vital metabolic processes.
• Neurological coma can be called the most difficult type not for the human body, but for his spirit, since in this state the patient’s brain and his thinking are not turned off with complete absolute paralysis of the whole body.

In the layman's view, the coma has a rather cinematic image and looks like a complete loss self-fulfillment vital functions of the body, the absence of any reactions and loss of consciousness with rare glimpses of reactions to the world, however, in fact, medicine distinguishes as many as five varieties of coma, which differ in their symptoms:

• Perkoma is a transient condition that lasts minutes to hours and may be characterized by confusion, incoordination, and sharp drops from calmness to excitement, with the preservation of basic reflexes. AT this case a person hears and feels everything, including pain.
• Coma of the first degree is accompanied by an incomplete loss of consciousness, but rather by stupor, when the patient's reactions are inhibited, communication with him is difficult, and the patient's eyes usually move rhythmically from side to side or strabismus occurs. A person in a first-degree coma may be conscious, in a stupor, or like a dream. He is able to feel touch and pain, hear, understand.
• During a coma of the second degree, he may be conscious, but at the same time in a deep stupor. He does not understand what is happening, does not react to light, sound, touch, does not make contact, in general, in no way. At the same time, his pupils constrict, his heart begins to beat more often, and sometimes spontaneous physical activity limbs or bowel movements.
• A person in a third-degree coma is completely disconnected from outside world and is in a state of deep sleep without any external reaction to external stimuli. At the same time, the body does not feel physical pain, its muscles rarely begin to spontaneously spasm, the pupils dilate, the temperature drops, breathing becomes frequent and shallow, and it is also believed that mental activity is completely absent.
• Coma of the fourth degree is the most severe type of coma, when the vital activity of the body is completely provided artificially with the help of ventilation of the lungs, parenteral nutrition(nutrition with solutions through a vein) and other resuscitation procedures. Pupils do not react at all muscle tone and all reflexes are absent, and the pressure is reduced to a critical level. The patient cannot feel anything at all.

Any coma is characterized by a flow from one degree to another with respect to changes in the patient's condition.

In addition to natural comatose states, one more thing can be distinguished - an artificial coma, which is correctly called medical. Such a coma is the last necessary measure, during which, special medicines the patient plunges into a temporary deep unconscious state with the shutdown of all reflex reactions of the body and almost complete inhibition of activity, both of the cerebral cortex and subcortical structures responsible for life support, which is now supported artificially.

Artificial coma is used if necessary general anesthesia or when it is impossible to avoid irreversible changes in brain tissue in another way during hemorrhages, edema, pathologies cerebral vessels, severe damage, accompanied by the strongest pain shock and other pathologies life threatening patient. It inhibits not only the activity of the central nervous system, but also almost all processes in the body, which gives doctors and regeneration processes precious time.

With the help of an artificial coma, cerebral blood flow is slowed down, as well as the movement of cerebrospinal fluid, which allows narrowing the intracranial vessels, removing or slowing down cerebral edema with an increase in intracranial pressure, and as a result, to avoid mass necrosis (death) of brain tissues.

The reasons

The main cause of any coma is a violation of activity under the influence of any traumatic, toxic or other factors that can cause severe damage to brain tissues that are responsible both for the unconscious work of the body and for thinking and consciousness. Sometimes a coma is caused not by damage to the neurons of the brain, but only by the inhibition of their activity, as, for example, with artificial neurons. Almost all diseases can cause a condition on last stage, any severe poisoning or injury, as well as extremely strong pain or shock stressful effects that cause overexcitation of brain neurons, due to which their work fails.

There is also a common version that a coma, like loss of consciousness, can be one of defensive reactions organism, which is designed to protect human consciousness from shocks caused by the state of his body and painful sensations, as well as protect the body from consciousness when it needs time to recover.

What happens to a person

During a coma, a person completely stops or very strongly slows down any brain processes. With a deep coma, they become weak or absent altogether, so they are unable to even cause reflex actions organism. If the structures of the brain responsible for the sense organs are damaged, then, accordingly, the brain can in no way perceive information from the outside world.

What does a person feel

If the physiological processes that occur inside the body during a coma are fairly well studied, then there is no way to look into the thoughts of the patient.

Almost all people whose loved ones are in a coma are primarily interested in how a person feels, whether he can listen to what they say and adequately perceive the speech addressed to him, feel pain and recognize loved ones or not.

A person does not feel pain or feels it badly, since in coma and unconsciousness this function is turned off primarily for self-defense of the body.

In the most, when the activity of neurons is completely absent or slowed down to such an extent that one can talk about the death of the brain, and the body still continues to function, the answer to all questions is, of course, no, but there are disputes even among doctors about other cases.

With neurological coma, brain and, most importantly, rational activity is preserved, but the functioning of those structures that are responsible for the work of the body is completely paralyzed, so we can safely say that such patients can think, and as a result, perceive everything that happens around with the help of hearing and occasionally - vision. With complete paralysis, there is no sensation in the body.

In other cases, coma, some patients say that they felt the presence of their loved ones and heard everything they were told, others noted that they could think or saw something like dreams, and still others remembered only a complete shutdown of consciousness and all feelings.

Therefore, all doctors recommend that relatives communicate with people in a coma as if they were conscious, because, firstly, it is likely that they hear and this will support them, encourage them to fight for life more strongly, and secondly, positive signals entering the brain can stimulate its activity and accelerate the exit from this state. In addition, communication with people who are in a coma has a beneficial effect on the loved ones themselves, who at this time are in severe stress, experience separation and are afraid of the onset of death: this greatly calms them.

How to distinguish who

It would seem that everything is clear here, but in fact it is quite difficult to distinguish a real coma from a simple loss of consciousness or neurological or psychological conditions, especially percoma or coma of the second or third degree.

Sometimes two errors occur:

• For whom is taken a deep loss of consciousness.
• A superficial coma is not noticed against the background of the symptoms of the underlying disease, since changes in the patient's behavior are not too noticeable.

To determine the coma, as well as its severity, doctors use the Glasgow scale, which is whole complex signs: a reaction to light, the level of reflexes or their deviations, reactions to an image, sound, touch, pain, and much more.

In addition to the Glasgow scale tests, it is necessary comprehensive examination to identify the causes, level of damage to neurons and disruption of the central nervous system:

• General tests, tests for hormones or infections.
• liver tests.
• All types of tomography.
• An EEG showing the electrical activity of the brain.
• Liquor analysis.
• And many others. It is very difficult for a non-physician to diagnose a coma.

Emergency care and treatment

Since in coma there is inhibition of the vital functions of the body, then emergency care there will be resuscitation procedures in the form artificial respiration, possibly, starting the heart, as well as helping to eliminate the causes of its occurrence: removing intoxication, hypoxia, stopping bleeding, replenishing dehydration or exhaustion, lowering or increasing glucose levels, etc.

Treatment of coma is carried out in the intensive care unit and also begins, first of all, with the treatment of its causes, followed by elimination brain consequences and rehabilitation. Features of therapy depend on the underlying cause of the condition and the resulting brain damage.

Forecast

Coma is a severe condition, after which there is the possibility of a huge number of complications.

A short-term artificial, caused for the purpose of general anesthesia, usually passes without consequences, as soon as the person is taken out of it. Long-term has the same complications as natural.

Any prolonged coma slows down and greatly complicates absolutely everything metabolic processes in the body, therefore, over time, the patient develops encephalopathy - an organic lesion of brain tissue, which can develop according to the most different reasons: lack of blood supply, resulting in a shortage nutrients, oxygen, as well as in the accumulation of toxic metabolic products in the brain, stagnation of cerebrospinal fluid, etc. In addition to brain consequences, muscle atrophy develops, impaired activity internal organs and activity of the peripheral nervous system, as well as a violation of the entire metabolism. Therefore, even after a short-term coma, the patient cannot immediately regain consciousness and start talking, and even more so get up and walk, as is often shown in films.

Metabolic disorders and the gradual development of encephalopathy lead to brain death when it ceases to function, but the body does not.

Brain death is diagnosed by the complete absence of the following:

• Pupillary reactions to light.
• Stopping the liquor.
• The complete absence of all reflex reactions.
• The absence of electrical activity directly in the patient's cerebral cortex, which is recorded using the EEG.

Brain death is declared if these fundamental signs are not present within twelve hours, but to confirm the diagnosis, doctors wait another three days during which periodic diagnostics are carried out.

At the same time, it is characteristic that the body does not die immediately, since instead of signals from the central nervous system, life in it is maintained with the help of apparatuses. In addition, the cerebral cortex dies first, which means complete loss personality and the person as such, and subcortical structures for some time they support the body as an empty shell.

Sometimes the reverse state occurs, when the brain lives, a person can even come to his senses, and his body refuses to work, as it is used to constant artificial hardware maintenance and some of its functions have atrophied.

The third option for the development of the patient's condition is the onset of a special vegetative state, when he does not come to his senses, but his body begins to show activity, respond to pain and move muscles. Most often, it ends with coming to oneself and recovery.

The prognosis of the likelihood of a favorable exit from a coma depends on the specific disease or damage that caused it, as well as on the individual ability of the body to recover.

Many deaf people, especially those who suffer from this mental illness, like schizophrenia, claim to be able to "hear" voices. This confusing phenomenon is called auditory hallucinations.

Approximately half of all deaf people with schizophrenia hear voices. It is difficult to imagine a more strange and paradoxical fact. How can we talk about people who in reality hear absolutely nothing, in the context of the world of sounds? However, many of them are deaf from birth. Recent research has given impetus to unraveling this phenomenon and rebooting our understanding of the word hallucination.
It is enough just to glance over several scientific research vocal hallucinations among deaf people in order to be convinced of the fact of their, hallucinations, existence. There is even a certain consensus among medical researchers what exactly they are, what they consist of. However, not all physicians are convinced of their real presence in the lives of deaf people.

Joanna Atkinson is a researcher and clinical psychologist at University College London and is deaf. The theory that deaf people could actually hear voices during hallucinations went against her daily medical practice. Whenever she asked her completely deaf patients about this, the answer was the same: “Of course, I never hear anything, because I am deaf / deaf.”
However, when a psychiatrist (hearing person) asked the same question to the same people using a sign language interpreter, they began to use words such as “loud” and “quiet” in their speech, which clearly spoke of their experience of sound experiences. So what did they really experience?
Joanna claims that some of the facts may have been distorted in sign language. The difference between the two languages ​​- sign language and ordinary speech - is the main problem of this study.

However, those people who have retained at least a little hearing function, or those who have lost their hearing during their lives, did experience auditory hallucinations- from mumbling to some vague sounds that a person, as a rule, could not identify. One of the women, a participant in the experiment, described the experience of meeting with the devil, who spoke to her either in sign language or verbally.
Joanna's research has lifted the curtain on auditory hallucinations among deaf people, but it still leaves many gaps and questions. For example, it is not yet fully known whether auditory hallucinations occur among non-deaf people. mental disorders, and whether they are similar to the hallucinations of hearing people.

The process of dying can take place not only in the physical, but also in the mental plane. Given the fact that each person is individual, then each patient will have their own signs, but still there are some general symptoms that will indicate imminent end life path person.

What can a person feel as death approaches?

This is not about the person for whom death is sudden, but about patients who for a long time sick and bedridden. As a rule, such patients can experience mental anguish for a long time, because being in their right mind, a person perfectly understands what he has to go through. A dying person constantly feels on himself all the changes that occur with his body. And all this eventually contributes to a constant change of mood, as well as the loss of mental balance.

Most bedridden patients close in on themselves. They begin to sleep a lot, and remain indifferent to everything that happens around them. There are also frequent cases when, just before death, the health of patients suddenly improves, but after a while the body becomes even weaker, followed by the failure of all vital body functions.

Signs of imminent death

predict exact time it is impossible to leave for another world, but it is quite possible to pay attention to the signs of approaching death. Consider the main symptoms that may indicate an imminent death:

1. The patient loses his energy, sleeps a lot, and the periods of wakefulness become shorter and shorter each time. Sometimes a person can sleep for a whole day and stay awake for only a couple of hours.
2. Breathing changes, the patient may breathe either too quickly or too slowly. In some cases, it may even seem that the person has completely stopped breathing for a while.
3. He loses his hearing and vision, and sometimes hallucinations can occur. During such periods, the patient may hear or see things that are not actually happening. You can often see how he talks to people who have long been dead.
4. A bedridden patient loses his appetite, while he not only stops using protein food but still refuses to drink. In order to somehow let moisture seep into his mouth, you can dip a special sponge into the water and moisten his dry lips with it.
5. The color of urine changes, it acquires dark brown or even dark red, while its smell becomes very sharp and toxic.
6. Body temperature often changes, it can be high, and then drop sharply.
7. An elderly bedridden patient can get lost in time.

Of course, the pain of loved ones from the imminent loss of their native person it is impossible to extinguish, but it is still possible to prepare and set yourself up psychologically.

What does drowsiness and weakness of a bedridden patient indicate?

When death approaches, the bedridden patient begins to sleep a lot, and the point is not that he feels very tired, but that it is simply difficult for such a person to wake up. The patient is often in deep sleep, so his reaction is inhibited. This state is close to a coma. The manifestation of excessive weakness and drowsiness naturally slows down some of the physiological abilities of a person, so in order to roll over from one side to the other or go to the toilet, he will need help.

What changes occur in respiratory function?

Relatives who care for the patient may notice how his rapid breathing will sometimes be replaced by breathlessness. And over time, the patient's breathing can become wet and stagnant, because of this, wheezing will be heard when inhaling or exhaling. It arises from the fact that fluid collects in the lungs, which is no longer naturally removed by coughing.

Sometimes it helps the patient that he is turned from one side to the other, then the liquid can come out of the mouth. Some patients are prescribed oxygen therapy to relieve suffering, but it does not prolong life.

How do vision and hearing change?

Minute clouding of consciousness in severe patients can be directly related to changes in vision and hearing. Often this happens in their last weeks of life, for example, they stop seeing and hearing well, or, on the contrary, they hear things that no one else can hear except them.

The most common are visual hallucinations just before death, when it seems to a person that someone is calling him or he sees someone. Doctors in this case recommend agreeing with the dying person in order to somehow cheer him up, you should not deny what the patient sees or hears, otherwise it can greatly upset him.

How does appetite change?

In a lying patient, before death, the metabolic process may be underestimated, it is for this reason that he ceases to want to eat and drink.

Naturally, to support the body, one should still give the patient at least some nutritious food, therefore it is recommended to feed the person in small portions, while he himself is able to swallow. And when this ability is lost, then you can’t do without droppers.

What changes occur in the bladder and intestines before death?

Signs of imminent death of the patient are directly related to changes in the functioning of the kidneys and intestines. The kidneys stop producing urine, so it becomes dark - Brown color, because the filtering process is violated. AT small amount urine may contain great amount toxins that have a detrimental effect on the entire body.

Such changes may lead to complete failure in the work of the kidneys, a person falls into a coma and after a while dies. Due to the fact that the appetite also decreases, changes occur in the intestine itself. The stool becomes hard, so there is constipation. The patient needs to alleviate the condition, so relatives who care for him are advised to give the patient an enema every three days or make sure that he takes a laxative on time.

How does body temperature change?

If there is a bed patient in the house, the signs before death can be very diverse. Relatives may notice that a person's body temperature is constantly changing. This is due to the fact that the part of the brain that is responsible for thermoregulation may not function well.

At some point, body temperature can rise to 39 degrees, but after half an hour it can drop significantly. Naturally, in this case, it will be necessary to give the patient antipyretic drugs, most often using Ibuprofen or Aspirin. If the patient does not have the function of swallowing, then you can put antipyretic candles or give an injection.

Before death itself, the temperature instantly drops, the hands and feet become cold, and the skin in these areas becomes covered with red spots.

Why does a person's mood often change before death?

A dying person, without realizing it, gradually prepares himself for death. He has enough time to analyze his whole life and draw conclusions about what was done right or wrong. It seems to the patient that everything he says is misinterpreted by his relatives and friends, so he begins to withdraw into himself and ceases to communicate with others.

In many cases, clouding of consciousness occurs, so a person can remember everything that happened to him a long time ago in the smallest details, but he will not remember what happened an hour ago. It is scary when such a state reaches psychosis, in which case it is necessary to consult a doctor who can prescribe sedative drugs to the patient.

How to help a dying person relieve physical pain?

A bedridden patient after a stroke or a person who has become incapacitated due to another disease may experience severe pain. In order to somehow alleviate his suffering, it is necessary to use painkillers.

Painkillers may be prescribed by a doctor. And if the patient does not have any problems with swallowing, then the drugs can be in the form of tablets, and in other cases, injections will have to be used.

If a person has serious illness, which is accompanied by severe pain, then it will be necessary to use drugs that are only available on prescription, for example, it can be Fentanyl, Codeine or Morphine.

To date, there are many drugs that will be effective for pain, some of them are available in the form of drops that drip under the tongue, and sometimes even a patch can provide significant assistance to the patient. There is a category of people who are very cautious about painkillers, citing the fact that addiction can occur. To avoid dependence, as soon as a person begins to feel better, you can stop taking the drug for a while.

Emotional stress experienced by the dying

Changes with a person before death concern not only him physical health, but they also hurt him psychological condition. If a person experiences a little stress, then this is normal, but if the stress drags on for a long time, then most likely it is deep depression experienced by a person before death. The fact is that everyone can have their own emotional experiences, and there will be their own signs before death.

A bedridden patient will experience not only physical pain, but also mental pain, which will have an extremely negative impact on his general condition and bring the moment of death closer.

But even if a person fatal disease, relatives should try to cure the depression of their loved one. In this case, the doctor may prescribe antidepressants or consult a psychologist. it natural process when a person becomes discouraged, knowing that he has very little left to live in the world, so relatives should in every possible way distract the patient from sorrowful thoughts.

Additional symptoms before death

It should be noted that there are different signs before death. A bedridden patient may feel those symptoms that are not defined in others. For example, some patients often complain about constant nausea and urge to vomit, although their disease is in no way associated with gastrointestinal tract. Such a process is easily explained by the fact that due to the disease the body becomes weaker and cannot cope with the digestion of food, this may cause certain problems with the work of the stomach.

In this case, relatives will need to seek help from a doctor who can prescribe medications that alleviate this condition. For example, with persistent constipation, it will be possible to use a laxative, and for nausea, others are prescribed. effective drugs that will dull this unpleasant feeling.

Naturally, not a single such drug can save a life and prolong it for an indefinite time, but to alleviate suffering dear person it is still possible, so it would be wrong not to take advantage of such a chance.

How to care for a dying relative?

To date, there are special means care for bedridden patients. With the help of them, the person who cares for the sick, greatly facilitates his work. But the fact is that the dying person requires not only physical care, but also great attention- he needs constant conversations in order to be distracted from his sad thoughts, and only relatives and friends can provide sincere conversations.

A sick person should be absolutely calm, and extra stress will only bring closer the minutes of his death. To alleviate the suffering of a relative, it is necessary to seek help from qualified doctors who can prescribe everything necessary drugs helping to overcome many unpleasant symptoms.

All the signs listed above are common, and it should be remembered that each person is individual, and therefore the body in different situations may behave differently. And if there is a bedridden patient in the house, his signs before death may turn out to be completely unforeseen for you, since everything depends on the disease and on the individuality of the organism.

Ten signs that death is near

None of us can predict exactly when death will occur. However, doctors and nurses who deal with the critically ill know that the approach of death is accompanied by certain symptoms.

Signs of impending death are different for each person, and not all of the symptoms listed below are "mandatory." But there is still something in common.

1. Loss of appetite

The body's need for energy becomes less and less. A person may begin to resist eating and drinking, or eating only certain foods (for example, cereals). First of all, a dying person refuses meat, since it is difficult for a weakened body to digest it. And then the most favorite foods no longer cause any appetite. At the end of a patient's life, it happens that even physically he is not able to swallow what is in his mouth.

It is impossible to force-feed a dying person, no matter how much you worry about the fact that he does not eat. You can periodically offer the patient some water, ice or ice cream. And so that his lips do not dry out, moisten them with a damp cloth or moisturize with lip balm.

2. Excessive fatigue and drowsiness

On the threshold of death, a person begins to sleep atypically a lot, and it becomes more and more difficult to wake him up. Metabolism slows down, and insufficient intake of food and water contributes to dehydration of the body, which turns on a protective mechanism and hibernates. This patient should not be denied - let him sleep. Don't push him to wake him up. What you will say to a person in this state, he may well hear and remember, no matter how deep the dream may seem. In the end, even in a coma, patients hear and realize those words that are addressed to them.

3. Physical weakness

Due to the loss of appetite and the resulting lack of energy, the dying person cannot do even the simplest things - for example, he cannot roll over on his side, raise his head, or draw juice through a straw. All you can do is try to make him as comfortable as possible.

4. Cloudy mind and disorientation

Organs begin to fail, including the brain. A person may no longer understand where he is and who is next to him, start talking nonsense or thrashing about in bed. At the same time, you need to remain calm. Every time you approach a dying person, you should call yourself by name and speak to him as gently as possible.

5. Difficulty breathing

The breath of the dying becomes erratic and uneven. Often they have the so-called Cheyne-Stokes breathing: superficial and rare respiratory movements gradually become deeper and longer, weaken and slow down again, then a pause follows, after which the cycle repeats. Sometimes the dying person wheezes or breathes louder than usual. You can help in such a situation by raising his head, putting an extra pillow or seating him in a reclining position so that the person does not fall on his side.

6. Self-isolation

As vitality fade away, a person loses interest in what is happening around. He may stop talking, answer questions, or simply turn away from everyone. This is a natural part of the dying process, not your fault. Show the dying person that you are there by simply touching him or taking his hand in yours if he does not mind, and talk to him, even if this conversation is your monologue.

7. Violation of urination

Since there is little water in the body, and the kidneys are working worse, the dying person “walks small” really little, and concentrated urine has a brownish or reddish tint. That is why hospices in last days life terminally ill often put a catheter. Due to kidney failure, the amount of toxins in the blood increases, which contributes to the quiet flow of the dying into a coma and a peaceful death.

8. Swelling of the legs

When the kidneys fail biological fluids instead of being excreted, they accumulate in the body - most often in the legs. Because of this, before death, many swell. Nothing can be done here, and it makes no sense: swelling is a side effect of approaching death, and not its cause.

9. "Icing" of the tips of the fingers and toes

A few hours or even minutes before death, blood drains from peripheral organs to support vital ones. For this reason, the limbs become noticeably colder than the rest of the body, and the nails may become pale or bluish. Provide comfort to the dying will help a warm blanket who need to cover him more freely so as not to create a feeling of swaddling.

10. Venous spots

On pale skin, a characteristic "pattern" of purple, reddish or bluish spots appears - the result of poor circulation and uneven filling of the veins with blood. These spots usually appear first on the soles and feet.

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How to recognize approaching death

In a gradually fading person, energy needs decrease more and more over time, the person begins to refuse food and drink, or take only small amounts of neutral simple food (for example, porridge). Coarse food is usually given up first. Even once-favorite dishes do not deliver former pleasure. Just before death, some people are simply unable to swallow food.

The dying person can most days in a dream, since the metabolism fades away, and the reduced need for water and food contributes to dehydration, the dying person wakes up more difficultly, weakness reaches such an extent that the person perceives everything around him completely passively.

Decreasing metabolism produces less and less energy, it remains so small that it becomes very difficult for a dying person not only to turn in bed, but even to turn his head, even a sip of liquid through a straw can cause great difficulties for the patient.

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The functional insufficiency of many organs is growing, not bypassing the brain, consciousness begins to change, usually, with one speed or another, its oppression occurs, the dying person may no longer be aware of where he or she is, who surrounds him, may speak or respond less readily, can communicate with people who are not or cannot be in the room, can talk nonsense, confuse time, day, year, can lie motionless on the bed, or can become restless and pull the bed linen.

Respiratory movements become erratic, jerky, a person may experience difficulty in breathing, so-called pathological types breathing, for example, Cheyne-Stokes breathing - a period of increasing loud respiratory movements alternating with decreasing in depth, after which there is a pause (apnea) lasting from five seconds to a minute, followed by another period of deep, loud increasing respiratory movements. Sometimes excess fluid in respiratory tract creates loud bubbling sounds during respiratory movements, which are sometimes called the "death rattle".

While irreversible changes gradually build up in the body, the dying person gradually begins to lose interest in the people around him, the dying person may stop communicating completely, mutter nonsense, stop answering questions, or simply turn away.

A few days before, before completely plunging into oblivion, the dying person may surprise relatives with an unusual outburst of mental activity, once again begin to recognize those present, communicate with them, respond to speech addressed to him, this period can last less than an hour, and sometimes even a day.

The dying person has a reduced need for food and fluid intake, a decrease blood pressure- part of the process of dying (which, because of the latter, does not need to be corrected to a normal level, like some other symptoms), urine becomes small, it becomes concentrated - a rich brownish, reddish color, or the color of tea.

Control over the natural functions can later be completely lost in the process of dying.

progressive kidney failure leads to the accumulation of fluid in the body, it usually accumulates in tissues located at a distance from the heart, that is, usually in the fatty tissue of the hands and, in particular, the feet, this gives them a somewhat puffy, swollen appearance.

In the hours to minutes before death, peripheral blood vessels constrict in an attempt to maintain blood circulation in the vital important organs- the heart and brain, with a progressive decrease in blood pressure. With spasm of peripheral vessels, the limbs (fingers of the hands and feet, as well as the hands and feet themselves) become noticeably colder, nail beds become pale or bluish.

On the skin, which was previously uniformly pale, there appears a distinct variegation and spots of a purple, reddish, or bluish tint - one of the final signs imminent death- the result of circulatory disorders in the microvasculature (venules, arterioles, capillaries), often at first such spotting is found on the feet.

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Signs of imminent death of a bedridden patient

Unfortunately, after life there is always death. Now science is unable to prevent old age and its inevitable lethal consequences. Relatives and friends of seriously ill patients need to be prepared for this. What does a bedridden patient experience before death? How should caregivers respond to signs of approaching death? We will talk about this below.

Phases of death

There are several phases of a person's condition that occur before his death. Signs of the first stage ("pre-active phase") can begin 2 weeks before the terrible event. During this period, the patient begins to consume less food and liquid than usual, there are pauses in breathing, wound healing worsens, and swelling appears. Also, the patient can claim an imminent death and report that he saw dead people.

Then the following phases follow:

• clinical death (signs of vital activity disappear, but metabolic processes still occur in the cells);
• biological death (almost complete cessation physiological processes in the body);
• final death (final phase).

Signs of approaching death

Signs of death in a bedridden patient may be different in each case. There are several main ones:

Loss of appetite. The patient's body requires less and less energy to maintain life. The person does not drink, refuses to eat, or consumes a small amount of soft foods (for example, cereals). Sometimes meat is rejected in the first place, as it is difficult to digest. Immediately before death, the patient may lose the ability to swallow.

How should family and friends react to such behavior? If a bedridden patient does not eat or drink, do not force him to do so. Can be offered from time to time cold water and ice cream. Moisten your lips with a damp cloth or special lip balm to avoid drying out your lips.

Increased fatigue and drowsiness. If a recumbent sleeps a lot, it means that his metabolism has slowed down and dehydration has occurred due to a decrease in fluid intake and food. The fatigue is very pronounced, the patient is sometimes unable to determine the boundary between dream and reality.

What to do? Let the patient sleep a lot. Don't shove him in an attempt to wake him up. If you say something to a person, it is quite possible that he will hear it, since it is believed that patients can hear even in a coma.

Certain diseases cause specific symptoms. Thus, the signs of death in a cancer patient are often manifested in the form of pain, nausea, confusion, restlessness and shortness of breath (with a stroke, such symptoms are less common).

It should also be noted that low blood pressure or prolonged cessation of breathing (or if the patient is lying down constantly asleep) are not reliable indicators of imminent death in all cases. Some patients with these symptoms may recover suddenly and live for a week, a month, or even more. Only God knows when death will come.

How to behave properly with loved ones

What should relatives and friends do if they see signs of approaching death? It is always very difficult to talk to a dying person. There is no need to give false promises and hopes for recovery. Tell the patient that his last wishes will be granted. He should not think that something is being hidden from him. If a person wants to talk about life and its last moments, you need to do it, and not try to hush up the topic and say something distant. Before death, let the patient know that he is not alone, say words of consolation.

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Signs of approaching death

If you are dying or caring for a dying person, you may have questions about how the process of dying will be physically and emotionally. The following information will help you answer some questions.

Signs of approaching death

The process of dying is as diverse (individual) as the process of birth. It is impossible to predict the exact time of death, and how exactly a person will die. But people who are on the verge of death experience a lot similar symptoms regardless of the type of disease.

As death approaches, a person may experience some physical and emotional changes, such as:

A dying person may experience other symptoms, depending on the disease. Talk to your doctor about what to expect. You can also contact the Terminally Ill Assistance Program, where they will answer all your questions regarding the process of dying. The more you and your loved ones know, the more prepared you will be for this moment.

As death approaches, a person sleeps more, and it becomes more and more difficult to wake up. The periods of wakefulness become shorter and shorter.

As death approaches, the people who care for you will notice that you are unresponsive and that you are in a very deep sleep. This state is called a coma. If you are in a coma, then you will be tied to the bed, and all your physiological needs(bathing, turning, eating and urinating) will need to be controlled by someone else.

General weakness is a very common phenomenon with the approach of death. It is normal for a person to need help with walking, bathing, and going to the toilet. Over time, you may need help to roll over in bed. Medical equipment such as wheelchairs, walkers or a hospital bed can be very helpful during this period. This equipment can be rented from a hospital or terminally ill center.

With the approach of death periods rapid breathing may be interspersed with periods of restlessness.

Your breath may become wet and stagnant. It is called " death rattle". Changes in breathing usually happen when you are weak and normal discharge from your airways and lungs cannot go out.

Although noisy breathing may be a signal to your loved ones, you will most likely not feel pain and notice congestion. Since the fluid is deep in the lungs, it is difficult to remove it from there. Your doctor may prescribe oral tablets(atropines) or patches (scopolamine) to relieve congestion.

Your loved ones may turn you on the other side so that the discharge comes out of the mouth. They can also wipe these secretions with a damp cloth or special swabs (you can ask at the help center for the terminally ill or buy them at pharmacies).

Your doctor may prescribe oxygen therapy to help relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

Visual impairment is very common in the last weeks of life. You may notice that you have trouble seeing. You may see or hear things that no one else notices (hallucinations). visual hallucinations- a common occurrence before death.

If you are caring for a dying person who is hallucinating, you need to cheer him up. Recognize what the person sees. Denial of hallucinations can upset the dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in a deep coma. People who came out of a coma said that they could hear all the time while they were in a coma.

Hallucinations are the perception of something that is not really there. Hallucinations can involve all of the senses: hearing, sight, smell, taste, or touch.

The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that the other person cannot see.

Other types of hallucinations include gustatory, olfactory, and tactile hallucinations.

Treatment for hallucinations depends on their cause.

As death approaches, you are likely to eat and drink less. This is due to a general feeling of weakness and a slower metabolism.

Since nutrition is so important in society, it will be difficult for your family and friends to watch you not eat anything. However, metabolic changes mean you don't need the same amount of food and fluids as you used to.

You can eat small meals and liquids while you are active and able to swallow. If swallowing is a problem for you, thirst can be prevented by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) dipped in water.

Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, urine becomes very concentrated. Also, its number is decreasing.

As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

You should tell your doctor if you have bowel movements less than once every three days, or if bowel movements are uncomfortable. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse the colon.

As you become more and more weak, it is natural that you find it difficult to control bladder and intestines. Your bladder may be placed urinary catheter as a means of prolonged drainage of urine. The terminally ill program can also provide toilet paper or underwear (these can also be purchased at a pharmacy).

As death approaches, the part of the brain responsible for regulating body temperature begins to malfunction. You may have heat and in a minute you will be cold. Your hands and feet may feel very cold to the touch and may even turn pale and blotchy. Changes in skin color are called patchy skin lesions and are very common in the last days or hours of life.

Your caregiver can control your temperature by wiping your skin with a damp, slightly warm washcloth or by giving you medications such as:

Many of these medicines are available in the form rectal suppository if you have difficulty swallowing.

Just as your body prepares physically for death, you must also prepare emotionally and mentally for it.

As death approaches, you may lose interest in the world around you and certain details of everyday life, such as the date or time. You can close in on yourself and communicate less with people. You may want to communicate with only a few people. This introspection can be a way of saying goodbye to everything you knew.

In the days leading up to death, you may enter a state of unique conscious awareness and communication that may be misinterpreted by your loved ones. You can say that you need to go somewhere - "go home" or "go somewhere". The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

Events from your recent past can mix with distant events. You can remember very old events in great detail, but not remember what happened an hour ago.

You can think of people who have already died. You may say that you have heard or seen someone who has already died. Your loved ones can hear you talking to the deceased person.

If you are caring for a dying person, you may be upset or frightened by this. strange behavior. You may want to bring your loved one back to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your close person may fall into a state of psychosis, and it may be scary for you to watch it. Psychosis occurs in many people before death. It may have a single cause or be the result of several factors. Reasons may include:

Symptoms may include:

Sometimes delirium tremens can be prevented with alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

Palliative care can help you relieve physical symptoms associated with your condition, such as nausea or difficulty breathing. Control of pain and other symptoms is important part your treatment and improve your quality of life.

How often a person feels pain depends on their condition. Some deadly diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

A person can be so afraid of pain and others physical symptoms that he may be thinking of committing suicide with the assistance of a doctor. But death pain can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you deal with the pain of death. Be sure to ask for help. Ask a loved one to report your pain to the doctor if you are unable to do so yourself.

You may want your family not to see you suffer. But it is very important to tell them about your pain, if you cannot stand it, so that they immediately consult a doctor.

Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes the relationship of a person with higher powers or the energy that gives meaning to life.

Some people don't often think about spirituality. For others, it's part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Being associated with religion often helps some people achieve comfort before death. Other people find solace in nature, in social work, strengthening relationships with loved ones or in creating new relationships. Think of things that can give you peace and support. What questions concern you? Seek support from friends, family, relevant programs, and spiritual guides.

Caring for a dying relative

Physician-assisted suicide refers to the practice of medical assistance to a person who voluntarily wishes to die. This is usually done by prescribing a lethal dose of medication. Although the doctor is indirectly involved in the death of a person, he is not a direct cause of it. On the this moment Oregon is the only state to legalize physician-assisted suicide.

A person with a terminal illness may consider suicide with the assistance of a doctor. Among the factors that can cause such a decision are severe pain, depression and fear of dependence on other people. A dying person may consider himself a burden for his loved ones and not understand that his relatives want to provide him with their help, as an expression of love and sympathy.

Often a person with a terminal illness contemplates physician-assisted suicide when their physical or emotional symptoms do not improve. effective treatment. Symptoms associated with the dying process (such as pain, depression, or nausea) can be controlled. Talk to your doctor and family about your symptoms, especially if these symptoms bother you so much that you think about death.

Pain and symptom control at the end of life

At the end of life, pain and other symptoms can be effectively managed. Talk to your doctor and loved ones about the symptoms you are experiencing. The family is an important link between you and your doctor. If you yourself cannot communicate with the doctor, your loved one can do this for you. There is always something you can do to ease your pain and symptoms so that you feel comfortable.

There are many pain relievers available. Your doctor will choose the easiest and most non-traumatic drug for pain relief. Usually applied first oral preparations because they are easier to take and less expensive. If you don't have sharp pain Painkillers can be bought without a doctor's prescription. These are drugs such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications on schedule. Irregular use medication is often the cause of ineffective treatment.

Sometimes pain cannot be controlled with over-the-counter medications. In this case, more effective forms treatment. The doctor may prescribe pain medications such as codeine, morphine, or fentanyl. These drugs can be combined with others, such as antidepressants, to help you get rid of the pain.

If you cannot take pills, there are other forms of treatment. If you have trouble swallowing, you can use liquid medicines. Also, drugs can be in the form of:

Many people who suffer from severe pain fear that they will become addicted to pain medications. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine so that dependence does not develop.

Painkillers can be used to manage the pain and help keep it tolerable. But sometimes painkillers cause drowsiness. You can only take a small amount of medicine and tolerate it accordingly a little pain to stay active. On the other hand, maybe weakness doesn't matter to you of great importance and you are not disturbed by drowsiness caused by certain medications.

The main thing is to take medicines on a certain schedule, and not just when the need arises. But even if you take medication regularly, sometimes you may feel severe pain. This is called "pain breakouts". Talk to your doctor about what medications should be on hand to help manage breakouts. And always tell your doctor if you stop taking a medicine. Sudden termination may cause serious side effects and severe pain. Talk to your doctor about ways to manage pain without medication. Alternative medical therapy may help some people relax and relieve pain. You can combine traditional treatment With alternative methods, such as:

For more information, see the Chronic Pain section.

During the period when you are learning to cope with your illness, a short emotional stress is normal. Non-depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be cured, even if you have a terminal illness. Antidepressants combined with psychological counseling will help you cope with emotional distress.

Talk to your doctor and family about your emotional stress. While grief is a natural part of the process of dying, it doesn't mean you have to endure serious emotional pain. Emotional suffering can intensify physical pain. They can also reflect badly on your relationships with loved ones and prevent you from saying goodbye to them properly.

As death approaches, you may experience other symptoms as well. Talk to your doctor about any symptoms you may have. Symptoms such as nausea, fatigue, constipation or shortness of breath can be managed with medication, special diets and oxygen therapy. Have a friend or family member describe all of your symptoms to a doctor or terminally ill worker. It is helpful to keep a journal and write down all your symptoms there.

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