Doctors don’t save lives, they just prolong them. Eventually, the process by which life renews – death – takes over. On the way there, many people start having more symptoms.
You or a loved one have recently been diagnosed with a terminal illness. Let’s call your loved one Bill, and let’s call his particular terminal illness lung cancer. Or, you or someone you know might actually have a terminal condition (i.e., something that cannot be cured – like a habit of listening to country music) but not realize it. This may be a structural problem with your heart (“heart failure”), lungs (severe COPD from smoking), or some other similarly stealthy illness. Eventually, Bill starts feeling worse. Naturally, Bill wants to know what changes he can expect in the last months of life.
There is a range of problems that Bill’s doctor and medical team will probably ask him about. Typically, these are:
- anxiety
- poor appetite
- depression
- drowsiness
- nausea
- pain
- shortness of breath
- tiredness
- general sense of well-being
Symptoms that Usually Do Not Change as Death Approaches
Some of these symptoms are remarkably unfazed by death. These are depression, anxiety, pain, and nausea. This makes sense. Many people that have a tendency towards depression or anxiety have had this tendency for most of their life. My best friend growing up, Jim, was anxious. When we were in grade four, he worried that he wouldn’t pass his spelling tests (he did). In grade seven, he would show up to the bus stop 10 minutes early because he worried about missing the bus. In high school, he couldn’t sleep the night before football tryouts because he was worried he wouldn’t make the team. When he got married, he worried that his wife would cheat on him (he wasn’t too far off on this one). Whenever Jim’s number comes up – do you think there is a good chance he will be worried about his death and all of the uncertainty that surrounds it? Very likely.
I don’t know why nausea and pain remain stable, but there is a good chance that this is because there are many good treatments available for these symptoms.
Symptoms that Usually Get Worse in the Months Before Death
Some things do tend to get worse in the months before death:
- Shortness of breath
- Drowsiness
- Sense of well-being
- Lack of appetite
- Tiredness
Many of these symptoms tend to really get worse in the last month of life. Bill might go from walking across the room to change the music, to relying on his remote. He might even get so tired that he can’t turn it on (“not the worst thing” – Bill’s wife).
Why would these particular symptoms get worse? You’ll notice that many of these changes are vague – like having the flu. Having a terminal illness is actually a lot like having the flu because of all of the chemicals that your body releases when it’s unwell. Some of these are chemicals intended to fight cancer, or heart disease, or whatever, and they end up causing collateral damage to healthy tissue. If you’ve had the flu, you probably slept more, and felt generally unwell. In between naps on the couch, you probably weren’t making reservations for a steak dinner that night. It’s the same with a terminal illness.
Most of this applies to people that remain at home for most of their illness. There are some unique symptoms that tend to come up more in hospitalized patients. A common one is delirium. Read about it here and what it might mean for life expectancy.