A comedian once told his mother he had only a short time to live.
Upon hearing the distressing news his mother said, “Sit down, and I’ll make you some chicken soup.” The man asked, “Do you really think that will help me now?”
His mother responded with a hopeful smile, “It couldn’t hurt.”
Many caregivers for terminally ill patients feel much the same way. Because food is symbolic of love and nurturing, it is extremely difficult for family members to see their loved one having no desire or ability to eat.
A common reaction is to want to begin using nutritional supplements, tube feedings or even I.V. nutrition with the idea, “It couldn’t hurt.” But published facts now indicate that the use of forced nutrition in terminally ill persons is of questionable benefit and may actually worsen a patient’s condition.
Findings recently published in several studies point out that intravenous nutrition or forced feedings can lead to several harmful effects in the terminally ill.
When caregivers see their family member eating less or eating nothing at all, it is often the first time they face the realization that their loved one is going to die soon. If they can keep the patient eating, “He will live longer, right?”
It is difficult for loving family members to understand that by pressuring or forcing a patient to eat, death won’t be put off and the suffering may be increased. But this does not mean there is nothing that can be done when the patient’s appetite begins to decrease.
It is helpful to offer small, frequent meals, and if any supplements are added, the homemade varieties are best tolerated. Puddings, gravies, soups and milkshakes can be made with whole milk, which has been fortified with powdered milk.
Hard candy helps to moisten a dry mouth and add calories at the same time. Medications to control nausea and vomiting may be helpful in allowing the patient who desires to eat, to do so as comfortable as possible.
However, in spite of all the interventions, there will come a time in most terminal illnesses when a patient no longer feels any desire to eat, and, in fact, may be repulsed by food. When this occurs, no matter how upsetting to the family, the patient should not be pressured or forced into eating.
Caregivers should understand they are doing the right thing for their loved one by not insisting on artificial nutrition. Caregivers also should realize their loved one is not becoming too depressed to eat, nor is the patient trying to commit suicide; this decrease in appetite is part of the terminal process.
The issue of nutrition is probably one of the most guilt-inducing, frustrating and emotionally charged issues with which terminally ill patients and their families must deal. But with the help of hospice, both the family and the patient can make informed decisions based on what is best for the patient, allowing the patient to live and die as comfortably as possible.
What is best sometimes means to HOLD THE CHICKEN SOUP and substitute LOVE.
By Synthia Cathcart, R.N., B.S.N.
Synthia Cathcart is vice president for Clinical Education and Development at Compassus.