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



Breathing Changes


Decreased Mobility/Muscle


Distancing Self from Others

    Increased Sleeping

Decreased Eating

Increased Confusion

   Childlike Behaviors  


    Speech/Conversation Problems

    Personality Changes/Agitation

    Increased Seizure Activity

Blindness/Vision Changes

End-of-Life/Travel References

Nausea and Vomiting

    Decreased Speaking

    Decreased Drinking