[Dying and death in an acute-care medical hospital]

Nowadays, more people seem to die in hospitals or other establishments than in their own homes. The following paper reports on 50 consecutive cases of death that occurred in a clinic of internal medicine. The analysis concentrated on the circumstances, the symptoms and the treatment of the patients during the 12 h. preceding and immediately before death as well as on the opinion of the relatives and the attending staff. A questionnaire registered the different opinions. Nearly a third of these deaths occurred after a fairly short hospitalization time. Death was not always the result of a long illness and it involved also young people. Most of the patients died in their hospital room, in the presence of their relatives and/or of the attending staff. They were mostly unconscious during the moments preceding their death. Terminal symptoms such as pain, anxiety, shortness of breath or thirst were largely kept under control. The relatives and concerned people were, as far as possible, informed about the grievance and the fatal issue of the patient's illness. Their reactions were diverse. Most relatives were satisfied with the treatment and care given to the hospitalized patient. The doctors and nursing staff considered their working together as being better than usually expected. Clear therapeutical concepts, appropriate palliative care as much as optimal communication are important requirements for a good treatment of the dying. The following results allow us to question many a prejudice concerning death in a hospital surrounding, but also show us possibilities of improvement. So we should sometimes question ourselves about the sense and the need of certain nursing interventions. We should spend more time during our medical training on the question of palliative care and on the problem of the relationship of doctors to death and to the dying. We feel that establishing a "science of death" or a segregation of the dying in specialized institutions makes no sense.