Reading about dying of stomach cancer may seem an awkward subject, and it is, but death is part of the normal cycle of life.
From the moment we are conceived there is only one sure thing in life and that is our passing, it is a natural event that we must all go through and is meant to be, no exceptions.
I thought long and hard about whether it was right to have a page on death, but I think there are some important points to discuss, and leaving it out would be wrong.
A lot of them are probably more appropriate for your loved ones and anyone else that is likely to be with you at your journeys end, particularly as you are unlikely to know what is happening to you at this time.
In view of this, I will still write as if I am addressing you, but will assume that you have passed the page over to your loved ones once the information enters the final moment, and write for them instead.
I will discuss about the signs your journey is nearing its conclusion, the hours leading up to dying of stomach cancer, Imminent death and what happens after the event.
When dying of stomach cancer, in the final stages of your illness, you are likely to be completely go off your food to the point that you really don’t wish to eat.
You will feel progressively weaker and won’t be able to get out of bed in the final stages.
You may feel confused, particularly if you develop a secondary infection, a not uncommon scenario.
Cancer weakens immunity and infections such as pneumonia and septicaemia are some of the most common infections that can hasten death.
You may feel more breathless from the infection, from the cancer and from anemia. Cancer increases your risk of VTE or venous thromboembolism too which can lead on to pulmonary embolism.
This is where a clot forms in your veins, travels to your lungs and then lodges in a blood vessel. A big one will kill instantly, but smaller ones may just make you feel more breathless and can also cause some pain in your chest.
Bleeding in to your gut is another common scenario, partly due to the tumor itself, but also due to the reduction in the ability of your blood to clot.
This may have already happened to you and have likely to been treated with a blood transfusion, but a large bleed is usually unstoppable in this situation.
The tumor in your stomach can erode a blood vessel and cause an acute bleed to happen internally.
If the tumor invades your pancreas, you can become jaundiced and confused. The tumor can also invade through you diaphragm and in to your heart.
As a result, it can create a hole in your heart muscle or myocardium which will cause bleeding into the sac that surrounds your heart.
If this happens, the blood will squash your heart muscle and this will cause sudden death.
Whilst death can be a sudden event e.g. from an embolism to the lung or from bleeding, dying of stomach cancer can be, and usually is, more prolonged.
Taking to your bed, unable to get out with a continuous decline is the most common scenario.
As you near the end, you may not want to have anything, including water and if you don’t, then that’s okay.
It’s a time when you are likely be surrounded by the ones you love and cherish the most. If you have asked for someone from your religion to be present, this will be the time.
If there is any issue of distress, pain or breathlessness, you will be offered pain relief usually in the form of a ‘syringe driver’ administered by palliative care nurses at home or by doctors and nurses if you are in hospital.
A syringe driver is a ‘syringe and pump device’ that delivers drugs via a needle inserted in to a vein or more commonly just under your skin.
Common drugs administered are morphine, diamorphine, anti-sickness medications and sometimes hyoscine which all serve to reduce any distress, breathlessness, sickness or pain issues and make you comfortable.
As your loved ones body shuts down, skin becomes very pale and cold. At this point it is unlikely that they will be aware as confusion and subsequent coma develops.
Blood pressure, if measured will be low or un-recordable.
Breathing can be noisy and ‘bubbly’ to listen to. Drugs can reduce this through the use of a syringe driver.
Cheyne-Stokes breathing ensues, when breathing becomes deeper and faster, with periods where breathing stops when it is referred to as apnoea.
Cheyne-Stokes breathing usually herald’s the final moments before dying of stomach cancer.
Death occurs when your loved ones breathing stops, your heart stops, there is no pulse and no longer any response to any form of stimulus.
At this point, blood can sometimes come up from the stomach and this is something quite normal in this situation as everything relaxes.
After dying of stomach cancer, the eyes and mouth are often open, bowel and bladder function lost and this is all due to muscle relaxation.
If your loved one’s death has occurred at home, there is no rush to do anything as you may wish to spend some time with your loved one and It is not necessary to call for an ambulance.
In the USA, laws vary with different states and you family physician or cancer nurse will be able to advise you on reporting death and handling your loved one’s body.
In the UK, if the death has occurred at home, the family doctor or GP will need to be called. They will need to come and confirm the death, determine the time of death and who has died.
You will be issued a death certificate and information about how to register your loved ones death with the appropriate authority. In the UK, this is the registrar of births, marriages and deaths.
If there are any concerns, your doctor has a legal obligation to inform the coroner’s office, although in the case of stomach cancer, this is rare unless your GP hasn’t seen your loved one in the previous 2 weeks.
In the UK, after dying of stomach cancer, your loved ones death needs to be registered within 5 days although Scotland is slightly longer.
They will give you a certificate which allows you to bury or cremate your loved one’s body and this can be passed to the funeral directors.
It is worthwhile having several copies of the death certificate, as certain institutions such as insurers and banks may wish to have a copy.
Once your loved one’s death has been confirmed, by your doctor or trained nurse, the funeral director can be contacted.
They will come and collect your loved one’s body, whether this is at home or in hospital. Hospitals have bereavement officers who will guide you in this matter too.
The funeral directors will guide you through the process from collection to the funeral itself. They will look after your loved one’s body until the service is completed.
You can inform the funeral directors of any wishes you have.