Communicating with the Patient
My friend who’s ill says he’s nearing the end, but he seems to be doing well. Is this normal?

It’s sometimes hard to know why people respond the way they do to their illness. There could be a lot going on inside your friend that can’t be seen on the outside.

He may not seem to be declining rapidly, but may feel inside that things are changing. These changes can include pain, fatigue or lack of appetite, which aren’t necessarily visible to others. He may have a sense that something is going to happen, and that there isn’t a lot of time left. This sense may be prompted by feelings, symptoms or the urge to discuss difficult issues while there’s still a chance.

He may be doing well, considering the diagnosis, but something can happen suddenly to change is situation. This could include an infection, blood clot in the lungs, problems with organs such as the kidneys, or other complication. He may choose not to treat the setback, knowing full well that it’s likely to speed up his decline.

Perhaps your friend has had information from the health care team that leads him to realize that there isn’t much time left. He may not want to share the details, so he talks of dying as a way to help prepare you for the change he’s expecting.

You may want to ask your friend why he thinks he’s nearing the end. He may be willing to tell you his reasons. Even if he’s not, it doesn’t hurt to ask. This lets him know what you’re seeing, and that it doesn’t seem to match what he’s saying. When someone has a terminal illness, it’s reasonable to be prepared for the worst, even while hoping for the best.

There’s a guideline used in palliative care, called the momentum of change, which can give a sense of how an illness is progressing. When someone shows changes from one month to the next, the person likely has months of life left. When changes happen from week to week, there are usually weeks left in life. When changes occur daily, there are usually days of life left. When there are hourly changes, there are usually hours of life left. This is a general guide only; there’s always the possibility of unexpected changes in a person’s health.