Caregiver to Caregiver

Recently, Randy and I attended Memorial Day at South Fork Friends Church in Snow Camp, NC. My parents, baby brother, sister Rodema, and extended family members are buried in the picturesque cemetery located at this historic church that was founded in 1800. It was my mom’s childhood church and growing up, my family occasionally attended special services there. When I was in high school, the original building was replaced with a lovely, modern one. But some things never change – like the delicious and abundant food prepared by the ladies of the church for the covered-dish lunch following the service. An extensive buffet of perfectly prepared main dishes, veggies, salads and homemade yeast rolls was accompanied by a desert table laden with the tastiest of made-from-scratch layer cakes and pies. Yum!

Several nights ago I was making a batch of fudgie-oatmeal cookies when my four year old granddaughter Izabella ran in the kitchen, exclaimed, “Grammy, you’re making my favorite cookies!” and preceded to gift me with one of her scrumptious hugs.

Yes, in the South, food and love are often intertwined. And sometimes that is a good thing. But today, I would like to tell you about a time when the giving of food is not synonymous with providing good care. Of course, encouraging someone to overeat or consume foods deleterious to a medical condition such as diabetes would also fall into this category; but the subject I want to address today is attempting to force-feed a loved one when providing end-of-life care.

A caring nursing assistant who has often experienced this situation recently brought this problem to my attention: family members who erroneously believe that their loved one’s condition will improve if he/she will only take fluids and food. While it is true that hydration and nutrition are essential for life and recovery, this is not the case when someone is in the end stage of life. In fact, forcing hydration and nutrition during the dying process can cause discomfort that results as the body is no longer able to sustain the digestive process. Continuing to push spoonfuls of food into the mouth of a person who is clearly resisting also presents the risk of aspiration.

I understand that watching a loved one die is difficult. Unfortunately, some people believe that refraining from giving a dying person water and food or not providing artificial nutrition or hydration is being callous. It is not. According to “End Of Life, A Nurse’s Guide to Compassionate Care,” going without nutrition and hydration will cause “a change in metabolism in which the ketone level yields a mild form of euphoria.”

Please be assured, I am not advocating withholding fluids and foods from someone who is willingly taking them. As a family and professional caregiver, my personal motto has been, “Offer, encourage, but do not force.” I had the privilege of being with my father and sister during their last few days of earthly life. Both reached the place where they said, “No more.” My Dad had just taken one last spoonful of vanilla ice-cream on a Friday evening. He died peacefully and comfortably the next Monday night. Rodema took a tiny bite of a biscuit on Friday morning, shook her head, and drifted off into a tranquil sleep. She passed away Saturday afternoon.

Throughout our lives, being able to provide food and drink to loved ones is considered kind and fulfills physical and emotional needs. However, the effects of doing so at the end of life can produce uncomfortable side effects.

Instead, provide alternative comfort measures such as gentle oral care, application of water-based gel to lips, tender massage, reading scripture, soft music, loving words and tender embraces.

*Originally published in 2017