She keeps on saying that she wants to go home, but we couldn’t cope with her at home.

She’s too unwell to go anywhere, I think that she could die at any time. I fully support your decision to keep her here in our inpatient unit. We’re going to get you all through this. She can’t go home for Christmas but maybe we could bring more of home in to this room?

Yes, we’ve put up the first of the Christmas decorations.

Please bring in more.

There’s something else that we need to talk about.

Okay.

We previously had a conversation with our Oncologist about ACP (Advance Care Planning,) and we talked about resuscitation, CPR. It was a bit tense as our Oncologist felt that it would not be in her best interests. We did not agree, and wrote in the ACP that we wanted full resuscitation.

Right.

Things are different now, and we’d like to reverse the decision.

You want her to be not for resuscitation?

Yes, not for resuscitation, as we don’t want our final memory of her to be of people attempting resuscitation.

I totally support the decision that you have made. To speak frankly, resuscitation would not work. We’d be doing something that would cause harm, but for no benefit. I would not be able to justify providing a treatment that does not work, but would cause harm. It would go against the first thing that they teach us in Med School. First do no harm. Not For Resuscitation, we will Allow Natural Death.

She made up her mind, and that’s what she wants, to go peacefully, with no dramas. What will happen as she gets closer to death?

She’s going to become more sleepy and less clear in her thinking, like is already happening. That’s Nature or a higher power protecting her from having to experience the full 3D/HD experience of the dying process, as it might not be so pleasant. We do not want her to suffer, and her comfort is our top priority. We will never stop trying to make her as comfortable as possible.

That’s all that we want.

There will be changes in her breathing pattern as things worsen, breathing will go faster, then it will slow down, and then there will be pauses. As things deteriorate the pauses will get longer, until the breathing doesn’t start up again. Her hands and feet will become cooler to the touch. It’s like a light with a dimmer switch, her light will fade away, as the body shuts down.

Can she still hear us?

She may become less able to respond to what you say to her, but she can still hear you. Keep on telling her what you need to, keep on loving her. Hearing your voices will provide her more comfort than any medications can provide. Hold her hands and be with her.

Okay thanks. You and your team have been really good with her.

Hey, that’s what we’re here for. This is what we do, all of the time here. You have done so well looking after your wife, I heard that you hadn’t even missed one appointment. Please get some rest when you get a chance, otherwise she’ll worry about you as well.

Hey thanks again.

Our pleasure, really. Holding the patient’s hand, Go well. Looking at the husband, I’ll see you later, take care.