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End-Stage Landmarks
Decreased Mobility/Muscle Wasting

Incontinence

Preoccupation/Staring/Distancing
Self From Others

Headaches

Increased Sleeping

Decreased Eating

Increased Confusion

Childlike Behaviors

Hallucinations

Speech/Conversation Problems

Personality Changes/Agitation

Increased Seizure Activity

Blindness/Vision Changes

End-of-Life/Travel References

Nausea and Vomiting

Decreased Speaking

Decreased Drinking

Swallowing Problems/Choking

Urinary Changes/Bowel Changes

Difficulty Keeping Eyes Open

Low-Grade Fever

Nonspecific Pain/Restless Legs

Serenity

Coma

Breathing Changes
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 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 under-
    standing 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