End of life AML - how to support

Hi all,

A loved one was told 6 weeks ago that treatment was no longer an option for Acute myeloid leukaemia (AML) (diagnosed at the end of 2022, remission in 2024 after stem cell transplant).

I’ve heard of the “rally” or “terminal lucidity”, thought it’s noted it’s not massively common with Acute myeloid leukaemia (AML) and usually short lived. He has been feeling great for the last 3 days, despite being close to death for the last 6 weeks. Eating, drinking, chatting, moving around. He’s only in his early 50’s and has worked throughout his treatment.

I guess I’m wondering what the signs are at end of life (a few days until death). I have no clue what to expect. Based on how he was last week, I prepared for the end. Now I feel like I’ve been hit with a second wave of grief when the symptoms haven’t even come yet.

I am prepared for a horrible end but I would really appreciate knowledge of any real life experiences and what to expect.

Thank you.

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Hi there, I’m so sorry to read this and I’m sending you strength at this time. Though it was a different cancer, I supported my dad as he was dying 2 years ago and found it required some preparation and thought as it approached. Please know that this was only my experience and I fully appreciate how individual this may be. We did have some Marie Curie support (district/palliative care nurses can make referrals, I imagine a GP can as well). Someone could call Marie Curie to check the process. I asked them to tell me what would happen as my dad deteriorated, what would it look like, what was needed. I was acutely aware that I would be the one responsible for knowing when to call family.

I wondered how I’d know when to stop him trying to get out of bed, or how that deterioration might present. I wondered about losing his swallow, about breathing changes, knowing whether a sleep was just that or something deeper, when I’d know to give, or stop, food and water etc. I just wanted to do the very best I could for a man I idolised.

As it progressed, each stage fell into place in a way that wasn’t scary and was actually really clear. One day my dad tried to get up, I placed a hand on him and suggested we rest that day. He looked right into me and I said that it was just for today and we’d see what tomo would bring. He had a tiny bit of breakfast that day, then his morphine via mouth. Within 2 hrs he needed more which I dispensed via mouth syringe again and knew straight away that, in those 2 hrs, he had lost the ability to swallow. He never ate or drank after that. I immediately spoke to district nurse and asked straight out for a syringe driver. This was inserted within 3 hrs and took most of the pain relief responsibility away from me.

My dad then drifted in and out of sleep for 2 days. It then was clear it was no longer sleep but something deeper. I had called my sisters home the previous day and he knew we were all there. I’ll be honest and tell you he didn’t die for another 6 days. I was repeatedly told that length of time for active dying is not common. For most of it, my dad was peaceful. There were times it was clear that pain was reaching even the deep place he was in and I never hesitated to get help. He deserved that.

We continued to keep my dad clean, I did mouth care, we talked to him, we made sure each of us had time with him, we tried to be kind to each other while we negotiated the bedside and the caring. There were moments we all, silently, begged for that last breath to come. Moments we felt utterly alone, detached, like it wasn’t happening. It was also the greatest privilege of my life.

The breathing changes came a day before he died. It became very mechanical sounding, and later became quieter. His colour changed, he was colder, he was less there. Thr change was clear. We then shared the last mins of his life and watched his breathing lessen, not loudly nor dramatically. There was one last deep breath, his chest inflated, deflated and laid flat. No drama, no mistaking it. He was gone and visibly at peace. There was nothing scary in the moment.

I wish your loved one, you and all those else going through this, peace, moments of calm, strength and comfort. May they know they are loved

Please forgive me for the length of reply, for the detail. I know back then I could have used the reassurance that we all do our best at this time and it’s enough.

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This is a beautiful message, and I can’t tell you how much I appreciate it - thank you.

Your experience is in line with my expectations, I can only hope his transition is as peaceful as your dad’s. Google is a scary place and can give many traumatic ideas on what to expect. Whilst I know not all deaths are like this? it’s refreshing to hear of a calm passing.

I hope you are coping well x

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Hello 1998,

I am so sorry to hear about your relative’s diagnosis and that treatment is no longer an option for them. I can only imagine that this must be a very difficult time for you and them.

Judesadventures has shared a very detailed personal experience as a relative to someone at end of life, and whilst I am lucky enough to have never experienced this with a family member, I have nursed many people in their last days and hours.

End of Life discussions are so important, but this subject barely gets mentioned due to it being so difficult for everyone to talk about as it often provokes many deep emotions. I do hope you don’t mind that I am contributing to this thread, as a nurse and not a peer.
My experiences of caring for those that are at the end of life be it weeks, days or hours made me feel very humble and appreciate the privileged position of being involved at that time.
I’ve worked both as a district nurse, so I assisted with medications to ease symptoms, liaising with GPs etc, and then several years later worked as a community hospice nurse - which involved much more of a holistic approach to end of life, for example sitting with family, making care plans, giving medications, assessment of symptoms, or whatever was needed until the end.
Reflecting on all of this now, what I really wanted to say was that the more prepared the patient and their family/support network are the more peaceful the last days and moments can be. If someone has support and guidance from their GP or a community nursing team (palliative care team, Marie Curie or Hospice) this can make a huge difference in feeling less alone and knowing what may happen or what to expect and what to do. All of the deaths in the community that I have seen were calm due to the planning and support involved. Sadly, having also been an A&E nurse for many years prior to cancer nursing, the experience there was often very different usually because it was unexpected and not planned.

Whilst not everyone wants or needs help, just knowing there is support to call upon can take some pressure off family at a time when often they may not have experienced anything similar before, so feel unsure and anxious.
It might be useful to know that Marie Curie offer services in many parts of the UK, so I would encourage everyone to get in touch with them. They also have some very good information on their website too: MarieCurie/EndOfLife which can be helpful to read through. They may be able to offer guidance on when to call for help or offer reassurance when someone is unsure of processes to access care and support.

Our support line nurses can also offer a listening ear and guidance on any concerns or questions around end of life care if needed, we’re here if you need us.
It’s also important to care for yourself when caring for others, so please make sure to reach out for support for you too.
Take care, Heidi.

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Hi Heidi,

Thanks so much for your advice. He is remaining in hospital where we have a palliative nurse on call to assist. I have to say, we didn’t realise how much a palliative doctor could help - whilst he’s exhausted, his pain and sickness are minimal now . We are a very open and honest bunch, which I feel is really helping us to accept the situation and have the difficult conversations.

I think we’re as prepared as we can be. Whilst I know it’s going to be heartbreaking, it really is an honour to be one of the people he wants with him at this time.

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Oh @1998 I certainly cannot follow @judesadventures and @Heidi_BloodCancerUK.
Yes, a palliative doctor, nurse and team are priceless.
I also think that you are a very open and honest bunch is a great advantage.
Around here we have a brilliant hospice and social services which enable patients to stay in their own home, if they wish too.
Spend quality time together and talk and ask questions, when appropriate..
Perhaps it helps if you can ask for and receive help.
Look after yourself as well as you are looking after your much loved one.
We are here for you to be able to say how it really is for you.
Sending you all virtual hugs

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