Withdrawal/Decreased Socialization

All death and dying experiences are unique and influenced by many factors, such as the particular illness and the types of medications being taken, but there are some physical changes that are fairly common. For some, this process may take months or weeks; for others, only a few days or hours.

Decreased socialization often occurs at this time, so patients may

become more quiet and withdrawn. This may be seen weeks or sometimes few months before death. Your patient may be trying to detach himself from his surroundings and those around him in order to “let go.” This progression of behavior is not exclusive to Vaishnavas and seems to occur in many patients no matter what spiritual or religious affiliation they adhere to. Your patient may indicate a desire to be alone more often or ask to see only a few people. Reassure family and friends that being one of the people he requests to see is, quite often, an indication of who he needs support from at this particular time and not necessarily a sign of who he loves or appreciates the most. It may also be someone the patient needs to see in order to reach an emotional closure.  (The Final Journey, pg 188)

A terminally ill patient who is feeling more withdrawn may not feel the need to verbalize her realizations and reasons for solitude. If this is the case, her silence can sometimes create, unintentionally, new dynamics within the family. Loved ones often perceive the patient as “pushing them away.” This can lead to anger and resentment on the part of the family, who may feel rejected after having given so much of themselves to the patient’s care. As a caregiver, you may be able to lessen existing tension by gently reminding loved ones that the patient’s withdrawal is a natural and necessary part of the dying process. It is not that the patient is ungrateful for the help she has received, but that she needs to separate herself from those around her in order to complete her journey. This is an internal passage in which the patient must travel alone.  (The Final Journey, pg 188)

Even though the patient may appear asleep or unresponsive or comatose, always be cognizant that they can hear even though they may not or choose not to respond. As hearing is one of the last things to go, always identify yourself and explain what you are about to do for their care before actually doing it.

In addition, periods of rest and sleep increase for the patient at this time. Even while awake, he may

lay for hours in silence with his eyes closed. Encourage those involved to respect the patient’s need for quiet and seclusion. Reassure them that nonverbal communication through a gentle touch on the hand can speak volumes. (The Final Journey, pg 188)

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