Wednesday, September 22, 2004

Symptomatology of Dying 2: Fixed Stare

In my last symptomatology post on the death rattle, Mari had asked what other symptoms suggest impending death, so I thought I'd write about another symptom.

First, let's review a couple of vague references to symptoms from prior posts. So far, I've mentioned:

EARLY SYMPTOM: 1-3 MONTHS PRIOR TO DEATH
-detachment from others (or withdrawal from the world & people)

MIDDLE: 1-2 WEEKS
-confusion (aka altered mental status)

LATE SYMPTOM: 24 HOURS OR LESS
-death rattle

I would also like to mention that symptoms with death are as individual as the people are themselves. Obviously the symptoms I am referring to apply to people who are dying of a disease that is taking their life over a relatively slow period of time. These symptoms may not be the same for all diseases. And the symptoms even vary among people dying from the same disease.

The next symptom I will address is the fixed, glassy stare. This usually occurs within the last few days of life. Of course, not all patient's eyes are open. Some are closed. Some may be part-way to fully open. However, for the fixed stare, eye care is important to ensure comfort. The eyes of these patients may tear on their own; however, frequently the eyes become dry and blood shot. In this case, artificial tears are applied around the clock to maintain moisture.

Sometimes, I have attempted to close the patient's eyes manually with my fingers. I explain to them that their eyes are dry and sore and it would probably be best to keep their eyes closed (at this point, the patients are never able to speak nor show any evidence of a response). Sometimes the eyes simply will not remain shut. Other times, they are able to keep their eyes closed, despite their complete absence of blinking prior to my manually closing their eyes for them. I have some inner struggle over whether or not to close their eyes. A part of me worries that they wish to see until the very end. However, I also worry about their ability to shut their eyes despite discomfort. For the purposes of their daily bed bath (as an additional incentive), it is easier to wash their face with their eyes closed.

What would you want if it were you? Eyes closed or eyes open?

6 comments:

Tammy said...

Mia, thank you for the kind comments you left me.

You have a beautiful blog. Thank you for sharing these very human experiences. I'll definitely be back.

Anonymous said...

I have been unfortunate enough to have heard the "death rattle" a couple of times.

By the way, is this your nickname or a common phrase used in your industry?

Nurse Mia said...

No one I know uses the term "death maiden" seriously. I was jokingly given this nickname at work. I have a reputation for preferring to work with this population. One night, when I had two patients die at the very beginning of my shift, a co-worker laughingly said, "You're like a death maiden! Can you NOT go into my patients' rooms? I'd kind of like to keep them around for the rest of this shift." And "Death Maiden" kind of stuck with me ever since.

Jennynyc said...

I interpreted "Annonymous"'s question as asking: In your industry is the term "death rattle" a clinical term or a nickname that you in the field use.

This post is very interesting. It is fascinating...things I would never know otherwise. It applies to everyone (everyone who will die and who have or will lose loved ones). Useful.

Nurse Mia said...

"Death rattle," although not a particularly science-based term, is used ocassionally in the medical setting. "Fixed stare" is not commonly used on our floor. My unit is a combination general medicine/palliative care unit. So we don't necessarily use the same palliative care lingo that units that focus on that care exclusively might. As my Master's will be in end of life, I expect to become more acquainted with common vocabulary over time.

Anonymous said...

Dec 2, 2011 11:05 I lost my grandfather

I witnessed my grandfather pass away and just heartbroken. I heard the "death rattle" and I will unfourtantely never forget the sound as long as I live. My passion has always to be a nurse but feel my callling may be hospice. My grandfather's hospice was not "hired" help to us she was family. She will always be a part of our life. I have never lost a loved one and struggling deeply. It dosent even seem real yet.