End-Stage Landmarks

THE END-STAGE LANDMARKS are signs that the brain tumor patient is moving through the natural end-time process.       Not every patient will experience every sign. The signs may not occur in the order listed here, although generally, those listed earlier do       occur sooner than those toward the end of the list.       It is too difficult to guess how much longer a patient may have at each stage, because some people will move through several steps over       a period of days, while others will linger at one point for months without change. For most, very generally speaking, the period from the       first serious changes through to death takes 1-4 months, but everyone is different.       Two end-stage landmarks that signal the remaining amount of time with a high degree of accuracy are:       *   when the last water intake occurs (with death following usually within 3-5 days)       *   when the patient's breathing changes, becoming fainter, louder and more mucousy, or more labored (with death following usually within            4 hours, but sometimes as long as half a day later)       Information about each listed change can be found by clicking on it. On these other pages, I've included a discussion of what to expect as well as       how each change might make both the patient and the caregiver feel emotionally.       My goals in compiling this list of signs are these:       *   that the caregiver will have maximum support all the way through the unfolding process       *   that the list will serve as a reality check for times when one isn't certain what is happening but knows that things are changing       *   that the information will enable caregivers to make the patient as comfortable as possible       *   that others in the periphery of care---family members who may not have been involved in the daily journey, for instance---will have a            source for understanding what to expect from here       *   and that understanding the general sequence of the stages will help family and friends to draw together and be present at the end, if that is            their wish

Swallowing Problems/Choking     Urinary/Bowel Changes     Difficulty Keeping Eyes Open     Low-Grade Fever     Nonspecific Pain/Restless Legs     Serenity     Coma     Breathing Changes     Death

Decreased Mobility/Muscle     Wasting     Incontinence     Preoccupation/Staring/     Distancing Self from Others       Headaches     Increased Sleeping     Decreased Eating     Increased Confusion    Childlike Behaviors

Hallucinations     Speech/Conversation Problems     Personality Changes/Agitation     Increased Seizure Activity     Blindness/Vision Changes     End-of-Life/Travel References     Nausea and Vomiting     Decreased Speaking     Decreased Drinking