“Do you have any ice cream?” My new patient Mrs. V., had nodded her head yes when I asked her if she wanted a massage, but clearly she had another form of comfort on her mind. I looked over on her tray and saw, among many items of untouched food, an open cup of melted chocolate ice cream. “It’s melted,” I replied. “Is that okay?” She nodded again, and I went to retrieve her treat.
Before I left her bedside to get the ice cream, I took a look at her wristband to make sure I was with the right patient. When the nurse gave me the referral, she told me that she was surprised that the patient was still alive: yet here was Mrs. V., not only alive, but asking me for ice cream.
In end-stage disease, many patients enter a final phase that we refer to in hospice as “actively dying.” In this state, we see common signs of imminent death: peripheral circulation slows, leading to discoloration of the hands and feet (known as “mottling”); breath becomes irregular, then shallow; the eyes become glassy and unfocused; the patient loses consciousness.
Actively dying patients do not usually eat or drink. The body no longer wants nutrition or hydration as it prepares to shut down; this is a natural component of the dying process. I was concerned that, even though she was asking for ice cream, perhaps her body would reject any attempt to feed her. But who was I to deny a dying woman what could be her last request? I picked up the spoon, dipped it into the melted ice cream, and brought it to her mouth.
Her lips parted, and closed around the spoon as she took in the ice cream. Then the corners of her mouth began to curl upward into a teeny smile. “Is that good?” I asked. Again she nodded. I gave her another spoonful, and then another. “Is chocolate the only flavor you have?” she asked. I looked again at her food tray and saw no other ice cream options, but spotted some vanilla pudding. When I offered her this option, she requested that I mix them together.
I dipped the spoon first into the custard, then into the ice cream. Again came the smile. A few bites later and she’d had enough. I put away the food and began to massage her left hand, then moved up to gently place my hands on her head. She drifted off into sleep and my work was done.
Mrs. V. died twelve hours later.