Coma Care

In the last few days of a patient’s life, it is very common for him to slip into a semi-coma or deep sleep, where he cannot be aroused. You may notice some moaning or grimacing with positioning, or a pause in breathing when you talk to him, but for the most part the patient is unresponsive. This is all normal. It is all part of the body slowly and naturally shutting down. Even though your loved one is unresponsive it’s very important to continue offering pain relief and comfort care. Here are a few tips:

  • Continue to medicate for pain and other symptoms, as the patient will not be able to express if he is in pain, though your doctor or nurse may adjust the meds as the patient nears death.
  • Be sure to continue giving good mouth care, cleaning gently with moist swabs or “toothettes.” You can moisten the mouth with small amounts of coconut or olive oil and use lip balm to keep lips moist. If the patient is able to swallow, you can dribble a little water or ice chips in his mouth. Some patients clamp down and don’t allow anything to be put in their mouths, so do the best you can, moistening the gums around the teeth. It’s a good idea to remove dentures at this time.
  • To prevent bedsores, gently turn the patient every 2–4 hours, from side to back, to other side, etc. Place pillows behind the back and between the legs when the patient is on his side.
  • Urine output will be decreasing but it’s important to keep the patient clean and dry using Depends as most patients become incontinent at this time. A catheter may be inserted by the nurse if the patient cannot urinate on his own or it is too difficult to change him.
  • Unless the room is cold, a light blanket or sheet is usually sufficient cover, as patients often become very warm or feverish. Place a cool washcloth on his forehead if the patient feels hot.
  • The lighting should be soft and shades drawn partway if sun is bright. Try to keep the atmosphere in the room quiet and peaceful.
  • Avoid loud conversations (and no arguing!) around the patient. They can often still hear you so tell them what you are doing. This is the time to tell him whatever you need to express. You can hold the phone to his ear and let others who cannot be present say a few last words.
  • These final days and hours are what is called holding vigil. Create an atmosphere of peace: put on soft music, read a favorite poem or scripture, light candles…gently reassure your loved one that you will be alright and she can go.
  • Some people may “rally” for a few moments or hours and may open their eyes or say a few words, but many do not.