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Adelani Temiloluwa
School Of Nursing Ondo
Nursing Student
300Level, Nigeria.

This is to be in a position where life and death are equally likely. This idiom is fairly straightforward. If someone is between life and death, he is currently alive but very sick or near to dying.

Life and death are the two sides of a same coin. Life is the part which exists between birth and death of a human being. Death is the beginning of the new end and between these two ends what exist is known as life. Life itself is a tragedy full of joy because people finally die.

However, life itself means that we have the certain value and meaning of the life to continue. Therefore, by just containing the value of our life, people can enjoy their joy. Sure, life is a sine curve, with its ups and downs and with values, people can continue their lives. Everyone will actually die, biologically. Life is as evanescent as morning dew so it may be compared to a voyage. In a voyage it is apparent that there will be the end of the voyage. However before arrival toward the real endpoint, we shouldn’t lose our value so that we would face the psychological death.

What is death all about?
Death is the permanent cessation of all biological functions that sustain a living thing. Phenomena which commonly bring about death include:
Aging,
Predation,
Malnutrition,
Disease,
Suicide,
Homicide,
Starvation,
Dehydration,
Accidents or major trauma resulting in terminal injury.

Can someone know when they are dying?
When a person is dying, they experiencing confusion, their brain is still very active. However, they may become incoherent at times. This may happen if they lose track of what is happening around them.

Though it has been scientifically proven to be almost impossible in the legendary ways, there are modern counterparts of coming back to life after death. One common example is the tense moment during cardio pulmonary resuscitation (CPR) or electrically shocking the patient’s heart in the hospital or incident scene when a person's cardiograph goes flat and a monotonic sound fills the silence, but suddenly beeps again while the cardiograph finally starts going up and down, securing the safety of his or her life. These dramatic scenes are not exactly untrue – several people have “come back from the dead” in this way. The situations above are only on the basis that the line of death is the cessation of blood circulation and breathing, or in other words, clinic death.

Nowadays, the point of death has fallen into three major categories; the point when all electric activity in a person’s brain ceases, the “irreversible cessation of circulatory functions or the irreversible cessation of the entire brain including the brain stem” (Uniform Determination of Death Act)

Every Nurse has an obligation to facilitate their patient’s wishes regarding their care preferences at the end of life. As Nurses, we cannot with 100% certainty ensure that each of our patient’s dying process will go smoothly without any problems. Advanced illnesses and diseases that are terminal differ in the way they progress from person to person. An intervention that works well for one person dying of cancer might not work for another person. What we can do is to be armed with the best knowledge about management of symptoms during the dying process and utilize them appropriately as needed.

A Nurse should facilitate a “good death” for our patients, remembering that a good death means ensuring that patients’ preferences are met and symptoms are managed through the use of open communication.

One of the most important things we can do for patients who are dying is to provide the best possible care for them and their families during the last phase of life through death. This is particularly important during the “imminent” phase.

This is the phase that precedes the actual death, and is also the time when the patient typically loses consciousness. The care the nurse provides during this phase will affect the family’s memories of their loved one’s final days and hours on earth. It is vital that the nurse performs thorough assessments, rapid response to changes in status, rapid titration of medications, and timely discontinuation and introduction of interventions aimed to promote comfort.

There are two ways that death can be classified: clinical death and biological death.

Clinical death comes first and is when a person’s heart stops beating. Circulation of the blood and respiration also stops once there is a cessation of heart beat. It is during this time that individuals can be revived by way of CPR. Oxygen can be given, the blood can be kept circulated and the heart beat could be potentially restored. Some patients who are at the end of life opt for a do-not-resuscitate order, and therefore CPR is rarely given.

Research has found that CPR is ineffective at restoring heartbeat in patients who are living with terminal illness (ELNEC, 2010). There is a 4 to 6 minute window in which patients can be revived with CPR. Without CPR, in approximately 4-6 minutes after clinical death (the cessation of heart beat), brain cells will begin to die from lack of oxygen. This is called biological death and is called the point of no return, meaning that once the brain dies, CPR will not be able to bring that person back. It is at this time that the cells in other organs, such as kidneys or eyes, will also begin to die.

Conclusively, being in the line between life and death is a critical period that requires the attention/care of the Nurse and family members. It is important that we maintain this line in a way that will please health care providers, the patients and the family members.

The period which the patient is under our care should be a memorable one for them...We should make the line between life and death great.

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