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Hallucinations
  *  May, due to vision changes, see straight things such as walls wavering in
           a way that makes the patient feel unsafe in his or her surroundings

   *  Many patients, in their final weeks, see animals (rabbits, rats, penguins,
           and horses have all been reported), sometimes in great numbers, in the
           room; several patients have believed they saw insects all over their bed
           linens and moved their hands frequently to brush them away

   *  Some patients have "seen" things flying at them from around the room

   *  Hallucinations may also be auditory (as in voices heard)

   *  Many patients discuss their visions of deceased relatives, angels, or
           unknown but friendly strangers within the room (
See also End-of-Life/
           Travel References)
What the Patient May Be Feeling

   *  If still cognitively clear, may realize that the hallucinations are just that and
           may express thoughts like "I must be cracking up.
Of course my
           father wasn't here. My father's been gone for a long time now.
           What's
wrong with me?"

   *  If the hallucinations are believed to be real, may be fearful that he or she is
           in legitimate danger

   *  Eager for reassurance that the unusual things seen are tricks of failing
           vision and are perfectly harmless

   *  Comforted when the caregiver says he or she will keep watch and alert
           the patient of any real danger while sleeping

   *  Frustrated that the caregiver doesn't share the same concerns

   *  Agitated if the caregiver debates the veracity of the visions

   *  Reassured by the perceived presence of loved ones who have predeceased
           him or her

   *  Intrigued and curious about the fascinating "circus" of events occurring
           within the room

   *  Preoccupied and distractable as hallucinations occur during conversations
           with others

   *  Sometimes confused about whether he or she is dreaming or awake

   *  Overstimulated and agitated by the combination of fast-firing thoughts,
           visual and auditory hallucinations, and normal household background
           noise

   *  Difficulty in falling asleep if he or she is trying to remain vigilant over
           hallucinations perceived to be harmful (afraid to give in to sleep and
           lose control to these visions and "visitors")

   *  Decadron increases may compound the problem on two fronts: if
           steroid psychosis ensues, the patient may become more suspicious
           and fearful of the hallucinations; and if insomnia follows, increasing
           fatigue could make hallucinations more frequent

   *  May move in and out of reality and have a hard time figuring out whether
           family members saw the visions too or whether things that actually
           occurred (such as a morning visit from a neighbor) were just another
           hallucination---may look for frequent "reality checks" from the
           caregiver
What the Caregiver May Be Feeling

   *  Frustrated that frequent reassurances and explanations are not convincing
           to the patient

   *  Uncomfortable about references to unseen people in the room

   *  Anxious to allay the patient's fears in order to maximize comfort

   *  Aware that "normal" conversation may be becoming difficult as the
           patient dwells more and more often in a world of hallucination

   *  Overtired, if the patient wakes often in the night needing reassurance
Tips

Hallucinations that disturb or frighten the patient are best addressed by trying to convince him or her that they are unreal.

If simple verbal reassurance isn't enough, the caregiver may need to call upon the kinds of tactics used to comfort small children. For example, if the patient is afraid that a nearby wall is unsteady, one could run hands over it or knock on it a few times to "test" it or "fix" it and make sure everything is all right. (Let the patient observe this and say things like, "Nope. Seems just fine. You're all set now. I took care of it.") If the patient is seeing insects, it might help to "spray" the bed (by using a plant mister or while holding a can but not actually spraying anything) and tell the patient, "That ought to take care of the problem. Those bugs won't be coming back
now!" The tactic is similar to when a parent waves a "magic protection wand" over a child experiencing night terrors. (See also Childlike Behaviors.)

Hallucinations that comfort the patient---such as visions of a deceased parent---should not be debated. When the patient is not disturbed by what he or she sees, it is generally counterproductive to argue about the truth. In such cases, it is best for the caregiver to respond favorably and match the patient emotion for emotion, addressing only the most alarming images.

If hallucinations lead to an agitated state, seek the help of a hospice nurse or physician, who can prescribe medications that will slow the manic pace of the images and find the patient real peace and comfort and enable him or her to sleep far better. Know that some of these helpful agents can take up to several days to reach an effective blood level and bring about improvement, so if the problem has magnified and it has already been a day or two, don't hesitate to seek help because it might still be a few days away (spoken from experience!). (
See also Personality Changes/Agitation.)