Therapeutic options

Pain is the result of an overly strong influence of the astral body in the organism. This can be immediately comprehended using the example of cramping or spasmodic complaints. A calf cramp in a bedridden patient shows a painful hardening on the physical level. The moving muscle, in which the moving soul normally develops, becomes a muscle stiff with pain. The astral body leaves its movement function in this area of the limb system, and awakens, as in the upper human being, to consciousness in the wrong place. This overly strong impact of the astral body can no longer be mitigated by the constructive life forces. This strong impact of the astral organism is similar to awakening from sleep. But instead of the whole, wise structure of the human body—the microcosm—becoming conscious, the consciousness is distracted from perception of the inner part of the body by the outer world.

Rudolf Steiner writes that an unprepared human being would be completely overwhelmed by experiencing the spiritual relationships of the human body and crossing the threshold of the spiritual world. Therefore, it is a mercy that human perception is directed to the world of the senses upon awakening. This task is attended to by the being that stands in this place as guardian of the threshold and has been described in this function on various occasions.

CASE STUDY:

A patient of around 50 with metastasizing ovarian cancer, who had reached an unusual maturity and development through difficult biographical periods filled with suffering and through her illness, gave accounts of differentiated spiritual experiences. One experience, which is reminiscent of a meeting with the guardian of the threshold, she depicted in a painting.

With pain, the astral body influences the physical body much more strongly than when we awaken from sleep. In this way, the pain actually prevents people from crossing the threshold unprepared. This throws a new light on the effects of opiates in these circumstances. Through the alterations in consciousness that are often caused by these medications, the patient can be pushed into a world that no longer belongs to normal waking consciousness. The pain can no longer function as guardian and is generally experienced as distant, and various—sometimes strange and stressful—experiences can occur.

The dying often perceive threatening animal figures. Although these experiences may have the characteristics of hallucinations, there seems to be more to them. These patients appear to be in no way mentally ill, and their personalities seem unchanged as compared to earlier periods (often through a longer period of care). Patients even ask if they are “going crazy.” These are experiences that appear on the threshold between normal waking consciousness and the supersensible. In many paintings by Old Masters, such as Hieronymus Bosch, or in musical works such as Wolfgang Amadeus Mozart’s “Magic Flute” human beings on the threshold are threatened by animal figures, which they must overcome. The “Magic Flute”, especially, shows us clearly how these animal figures portray facets of the soul which have not yet become human—which still carry animal-like traits. Opiates can force patients into these realms. Therefore, it is important to know about these experiences, and to tell patients about similar experiences of other patients who are dying, rather than simply categorizing them as hallucinatory episodes. This information has a very calming effect on patients.
Given all of this, it seems wise to support the individuality of the patient during these stressful experiences, and also in the context of opiate therapy in general, with the following remedies:

• Aurum metallicum praeparatum D10 (Weleda) amp. s.c. 1-0-0

together with the morphine injection. This helps the individual to find inner strength, especially in such an unusual situation. Stibium works similarly:

• Stibium metallicum praeparatum D6 (Weleda) amp. 10 mil. i.v. as needed,

can help the individual strengthen her inner decisiveness and her connection to her soul faculties.
In general, one chooses a graduated procedure in pain therapy. In many cases, external applications used in nursing can be very helpful, such as

• Arnica comp./Cuprum (Weleda) oil rub up to several times daily

or

• Aconite pain-relieving oil (WALA) rub up to several times daily

or, for muscular pain,

• Solum oil (WALA) rub up to several times daily.

Remedies such as

• Aconitum napellus Rh D3, D6, D20 (Weleda) amp. s.c. 1 x daily and as needed,

Aconitum e tubere D4, D6, D10, D20 (WALA) amp. s.c. 1 x daily and as needed,

• Aconitum comp. (WALA) amp. s.c. 1 x daily and as needed,

or, for muscle pain complaints,

• Rhus toxicodendron comp. (WALA) amp. s.c. as needed,

have proved helpful with dying patients.

• Colocynthis D4 (Weleda) amp. s.c. 1 x daily and as needed,
•  Colocynthus e fructibus D4 (WALA) amp s.c. 1 x daily and as needed,
• Nicotiana comp. (WALA) amp. s.c. 1 x daily and as needed,
• Oxalis comp. (Weleda) amp. s.c. 1 x daily and as needed

are also helpful in cases of abdominal cramps.

However, we must always pay attention to the actual suffering of the patient, which may be expressed more clearly to nursing staff during the night than it is to the physician on her daily rounds. It is important to ensure sufficient analgesic medication. Often, patients in this situation prefer not to be completely pain-free, as side effects and alterations of consciousness are experienced as at least as agonizing. Opiates, for example, often lead patients to feel as if they were standing beside themselves, while the pain is experienced as simply farther away.

Morphine , especially in higher doses, leads to limitations in consciousness (nerve-sense system), while anti-inflammatory drugs inhibit the effectiveness of inflammation and warmth (metabolic-limb system).

The fever which blazes up shortly before death is connected with the loosening of the soul-spiritual being from the physical body.

Each unnecessary fever reduction that does not decrease the suffering of the patient but rather tends to increase it due to abrupt decrease in body temperature and the accompanying sudden perspiration hinders the individual from completing this step with his inherent forces. Highly potentized silver can be used here:

• Argentum metallicum praeparatum D20 (Weleda) amp., s.c. 0-0-1.

Depending on the type of fever, belladonna, for example in

• Lachesis comp. (WALA) amp. s.c. 1-0-0

and external applications by nurses (such as lemon calf wraps for warm extremities) can also be helpful. A medium or high potency phosphorus medication,

• Phosphorus D8 (WALA, Weleda), s.c., i.v. 1-0-0,

can be administered in cases of systemic infections in combination with an evening dose of argentum medication. The fever that often develops in such cases leads to a centralization: the extremities are often cold, while the body temperature is significantly elevated. The warmth organism begins to loosen itself from the limbs.

People who are dying often suffer periods of anxiety and fear. Sometimes we see eyes wide with terror, looking into an unknown, deep dimension. Or sometimes there can be a perpetual fear and anxiety—an ever-present agitation in their soul life. Between the stiff terror and the anxious fear there is the fear that is accompanied by rhythmic system phenomena—tachycardia or dyspnoea.

From a spiritual perspective, there lives within these experiences of fear the dawning awareness of standing before a great unknown, whose darkness and gloom seem to contain the path ahead. As soon as this darkness transforms into the light appearing within it, which has been witnessed in near-death experiences, this fear can give way to a deep inner happiness and inner release. The human being is received into a realm of light and of all-embracing love.

Fear can have physical causes. It can be fear of pain, fear of suffocating, or similar. Or it can have causes in the realm of the soul, such as fear of separation or isolation and loneliness. Or, again, fear can relate to spiritual experiences.

Some patients express fear of the “dark tunnel”, the “yawning abyss”, the “dark figures”, etc. This is connected to the patients’ special, sometimes spiritual experiences. Some patients are afraid of going “crazy.” They often have strong inhibitions about speaking to the people around them about these fears. Sometimes it is helpful to mention that these concerns are quite common among patients, that they are a part of the process of dying, and that patients who are able to speak of them are certainly not “crazy.”

Entering the realm of the threshold, where normal waking consciousness ends and the unknown is experienced, is associated with fear. In the Gospels, the shepherds in the fields hear the call, “Be not afraid!” Often, the fear has no recognizable cause. It seems to be connected to those moments in which the patient feels that his familiar and normal condition and his self-concept are dwindling and a new experience has not yet been conquered. In such cases, it is helpful to emphasize the complete overcoming of anxiety and existential fear that comes after near-death experiences. Often, patients who live through such experiences gain certainty and indomitability. Explained in the right way, in answer to patients’ questions, relating these experiences to other patients can also have a calming, peace-restoring effect.

Often, fear is magnified as darkness falls and at night. As soon as it is light again, the fear recedes, allowing the patient to sleep again in the morning. For the dying, the spatial, chronological and physical borders blur, which can increase their fear.

A person who is dying can lose her sense of the boundaries of the bed and bedside table. She might, for example, set down her cup next to, instead of on her bedside table. The connection between the soul-spiritual being and the physical body changes and loosens, and the familiar supports that the human being owes to her physical body disappear.

Besides space, the feel for time can be lost. The person who is dying can often no longer differentiate between yesterday’s and today’s events, or between events that happened in the morning or the evening. This disorientation can increase fear. Human closeness and care are the most important in working with the fears of people who are dying. They then have the feeling that someone is helping to bear their fear, and can give them orientation. Even leaving the door open and the assurance that one will look in on them often (potentially giving a specific time) can be an important help.

Caregivers can clearly recognize how important the battle with their own fears becomes. Sometimes one’s own fear can be transferred to the patient, or sometimes one can become “infected” with the patient’s fear. Honesty with oneself, which admits to repressed fears, as well as wrestling with the question of purpose in one’s own biography and continual striving for a spiritual picture of the human being can be of help. One’s own striving around questions about the borders of life can have strengthening effects on one’s relationship to patients. Therefore, handling the dying person’s fears is not only a task for the patient, but also for his caregivers.

Nursing care is extremely important for fearful patients. Foot or calf rubs with

• Lavandula, Oleum aethereum 10% (WALA) at night and as needed

or

• Lavender oil 10% (Weleda) at night and as needed

have a calming effect. Through touch, a meeting is possible that is often not possible verbally. In addition to the effects of the substance, the patient feels accepted. Foot or hand rubs with copper ointment

• Cuprum metallicum praeparatum 0.4% (Weleda) ointment as needed

and

• Copper ointment , red (WALA) as needed

can release tension and be calming. Foot, hand and back rubs with rose oil have a pacifying and harmonizing effect.

In terms of remedies,

• Bryophyllum 5% (Weleda) amp. 10 ml i.v. as needed

or

• Bryophyllum D5 / Conchae D7 aa (Weleda) amp. 10 ml i.v. as needed,
• 3 parts Aurum D10 / 2 parts Stibium D8 (Weleda) amp. s.c. as needed

have proved helpful in cases of anxiety and fear. Other very helpful medications in these cases are:

• Aurum metallicum praeparatum D10 (Weleda) amp. s.c. as needed

as well as

• Stibium metallicum praeparatum D6 (Weleda) amp. 10 ml

in combination with

• Bryophyllum 5% (Weleda) amp. 10 ml i.v. 1-0-1.

In addition,

• Hyoscyamus/Valeriana (Weleda) mixture 20-20-20 gtts

and—for night-time anxiety with insomnia—

• Hyoscyamus Rh D3, D6 (Weleda) dil. 0-0-0-20 gtts
• Hyoscyamus/Valeriana (Weleda) mixture 0-0-0-20 gtts

have proved helpful. For fear of death or deep, “existential” fear,

• Aconitum e tubere D30 (WALA) amp. 1 x daily

and

• Aconitum napellus Rh D30 (Weleda) amp. 1 x daily

are effective. Sometimes,

• Arsenicum album D12, D30 (WALA, Weleda) amp. as needed

can alleviate the experience of fear. If the fear is accompanied by dyspnoea, we have had positive therapeutic experience using:

• Carbo Betulae D8, D20, D30 (Weleda) amp. s.c. as needed.

Carbo Betulae can often improve dyspnoea.

Sometimes, a patient will be torn from sleep at night by frightening, fear-filled experiences without actually awakening. In such situations,

•  Cuprum metallicum praeparatum D6 (Weleda) amp. 0-0-1

has proved effective in many cases.

Near the time of death,

• Cuprum metallicum praeparatum D30 (Weleda) amp. as needed

can be of valuable help for anxious tension and cramping that can reach all the way into the physical. This potentized copper has especially proved helpful to an impressive degree when patients experience sometimes-agonizing dreams involving people who have already died.

CASE STUDY:

An almost 63-year-old patient with a mostly peritoneal metastasized adenocarcinoma, now diagnosed with a second bout of ileus and e. coli sepsis, found himself in the next-to-last stage of the illness. Yesterday’s mental clarity was quickly dwindling, and what had been up till then an impressively peaceful illness, in which the patient had gallantly faced his expected end with deep inner certainty and strength, became a situation with increasingly gasping breaths and gestures expressing emotional strain.
His calm, unmoving gaze showed no sign of inner pain. Nevertheless, those around him asked about the possibility of morphine administration. The initial Aurum injection had not shown any outward success. After external applications on lower legs and feet also appeared not to alleviate his distress, Cuprum met. praep. D30 was injected. About ten minutes later, he pressed his hands together strongly over his chest, and then immediately released them and opened them upwards in a releasing movement. His breathing had already become calmer and no longer gasping. Accompanied by this gesture, the individual released himself from his physical bonds. The calm, upward-reaching movement of his arms became a gestural expression of his release.

If agitation and fear appear accompanied by tachycardia, an external application of

• Aurum/Lavandula (Weleda) ointment, for example, as an ointment compress over the thoracic heart/ area,

has shown itself to be effective. If the patient experiences thoracic tightness,

• Cactus comp. II (WALA) amp. s.c. as needed

can also be used. For a spasmodic quality,

• Cuprum aceticum comp. (WALA) amp. s.c. as needed

can also be considered.

As a matter of principle, we must ask about the relationship between the listed remedies and anxiolytic medications. On the one hand, the patient can be relieved of fear “from the outside”, as anxiolytics reduce the level of fear. On the other hand, the listed remedies support the patient in overcoming her fear “from the inside.” Inner empowerment and outer symptom control are in opposition to each other. And yet it is clear that both therapeutic orientations can be justified. Sometimes it may be necessary to suppress unmanageable pain symptoms; at other times a patient may find it very valuable to receive support in her battle with fear. Often, this wish is based on an inner experience of the fear as a gateway to another, supersensible realm. Can the patient pass through this gateway to a new realm, or will she leave this place as a result of the suppressant medication?

Use of anxiolytic and sedative medications up until terminal sedation is, on the surface, simpler and easier. However, in choosing medications, we should remember that the most important part of the dying patient, which can stay with him until the end, is his consciousness. Unless absolutely necessary, we should not take any longer-term measures which limit consciousness. In many years of practice accompanying dying patients, terminal (palliative) sedation was avoidable, almost without exception. However, this necessitates very good cooperation with the nursing staff, and their efficient work based on anthroposophical therapeutic knowledge, as well as good integration of the relatives and friends who are accompanying the person who is dying. Strong human relationships are the most important support during this time.

Inner support can be given in different ways. For some patients, saying a prayer with the nursing staff each evening can be a significant help. A verse that is meaningful to the patient can also be beneficial. And images from fairy tales have also had positive effects in many cases. When, for example, a patient at the end of his life hears a Grimm’s fairy tale, such as the tale of the “Little Donkey”, in whose ugly skin a prince is hidden, the fulfilling effect can also be noticed in people with a rational attitude toward life. For images work more deeply than abstract information, and connect to childlike qualities at the end of life.

Imaginations from fairy tales are a significant support in accompanying agitated and anxious patients.

For other people, conscious work with the spoken or written word through a verse or meditation is an important help.

CASE STUDY:

This can include various content. For one patient with advanced bronchial carcinoma, for example, the following poem by Goethe was a constant companion throughout much of his illness:

In every breath we breathe two graces share:
The indraught and the outflow of the air;
That is a toil, but this refreshment brings;
So marvellous are our life's comminglings.
Thank God when thou dost feel His hand constrain,
And thank when He releases Thee again.
(Translation by Edward Dowden.)

Im Atemholen sind zweierlei Gnaden:
Die Luft einziehen, sich ihrer entladen;
Jenes bedrängt, dieses erfrischt;
So wunderbar ist das Leben gemischt.
Du danke Gott, wenn er dich presst,
Und danke ihm wenn er dich wieder entlässt.

In this poem, the patient recognized the alternating states of anxiety and release, and was able to process them inwardly. In a later conversation, the patient suddenly showed me a book in which his name was written in a childish hand, which clearly came from his early school years, and in which precisely this Goethe poem was written.

For other people, the depth of this verse by Rudolf Steiner can be of help:

Victorious spirit
Flame through the impotence
Of irresolute souls.
Burn out the egotism
Ignite the compassion
That selflessness,
The life-stream of humanity,
May spring forth as the source
Of spiritual rebirth.
(Translation by Edward Dowden.)

Sieghafter Geist
Durchflamme die Ohnmacht
Zaghafter Seelen.
Verbrenne die Ichsucht,
Entzünde das Mitleid
Dass Selbstlosigkeit,
Der Lebensstrom der Menschheit,
Wallt als Quelle
Der geistigen Wiedergeburt.

Another important verse speaks to the darkness and the light which appears within it, which is connected to the spiritual being of humans. This verse has been of great support, also to non-religious patients:

I look into the darkness:
Light emerges within it—
Living light.
Who is this light in the darkness?
It is I, myself, in my true reality.
This reality of the I
Does not appear in my earthly existence.
I am only an image of it. But I will find it again
When,
With good will toward the spirit,
I have gone through the portal of death.
(Translation by Edward Dowden.)

Ich schaue in die Finsternis:
In ihr ersteht Licht,
Lebendes Licht.
Wer ist dies Licht in der Finsternis?
Ich bin es selbst in meiner Wirklichkeit.
Diese Wirklichkeit des Ich
Tritt nicht ein in mein Erdensein.
Ich bin nur Bild davon. Ich werde es aber wiederfinden,
Wenn ich,
Guten Willens für den Geist,
Durch des Todes Pforte gegangen.

Healthy digestive function is characterized by astral activity working dynamically with the digestive tract in secretions and gastrointestinal motility. If the astral body loosens itself from these functions and awakens non-physiologically to dull consciousness, nausea, revulsion and loss of appetite occur. Hindrances to the activity of the different sheaths can be caused by various circumstances. A harmless example is motion sickness, which alerts us to altered activity. The outer movement causes the sheaths to loosen from their anchor point within the organism and awaken in arising nausea.

Manifestations of illness such as peritoneal carcinosis, ascites, etc., can accompany such sheath activity in much the same way as opiate medication side effects. It is also important to pay attention to any existing hypercalcaemia, as this is also characterized by the above sheath activity. In regard to the inner human being, the skeleton serves in the forming of contoured waking consciousness. When there is osteolytic decomposition and a loosening of the sheaths, the altered consciousness that can accompany hypercalcaemia, in addition to constipation and nausea, may occur.

However, simple smells, or the sight of food, though offered with helpful intentions, can also trigger nausea and vomiting.

Therapeutically speaking, the non-physiological awakening of the astral body must be addressed, and its metabolic activity must be strengthened.

Nux vomica (Strychnos nux vomica) is therapeutically helpful.

• Nux vomica comp. (Weleda) mixture as needed,
• Nux vomica D4 (Weleda) amp. s.c. as needed,

and

• Nux vomica e semine D6 (WALA) amp. s.c. as needed,

can be effective in such cases, and can reroute the astral body which has awakened in nausea back to the metabolic system. Nux vomica is especially useful when the astral body leads to spasmodic complaints. Sometimes, nausea that indicates nux vomica can be accompanied by spasmodic, meteoristic symptoms. Bitters can lead the astral activity back to its digestive function. For this reason, Gentiana is included in the listed compound. For accompanying pharyngeal reflex and the tendency to vomit,

• Ipecacuanha, ethanol. Decoctum D4 (prescription compound [i.e. from Weleda pharmacy]) dil. as needed

can be administered. If the nausea is accompanied by symptoms relating to gallbladder functioning,

• Chelidonium e planta tota D4, D8 (WALA) amp. s.c. as needed

can be considered. For meteoristic and spasmodic complaints that accompany nausea,

• Nicotiana comp. (WALA) amp. s.c. as needed

and

• Chamomila/Nicotiana (WALA) amp. s.c. as needed

can also be administered.

External applications of

• Caraway oil caraway oil wrap

are also often experienced as very helpful.

• Oleum aethereum Melissae indicum 10% (Weleda) as needed

can be a great help for spasmodic and meteoristic symptoms because of its relationship to warmth—also in combination with caraway oil, which is one of the ingredients in

• Melissa oil (WALA) as needed.

In connection to nausea, it is important to note evacuation of stool, in which the physiological activity of the upper sheaths expresses itself in the digestion. Therefore, it is also important to pay attention to appropriate measures for treating constipation (see Constipation).

In longer periods of bed confinement, constipation will often become a problem, even without tumour activity impinging on the colon passage. Colon passage disturbances and especially peritoneal carcinosis can be significant therapeutic challenges. An opiate medication that loosens the astral body from the active movement and propulsive function in the metabolic system requires an accompanying, stool regulating medication throughout the course of the medication.

As clyster, the

• Milk and honey enema
  2 Tbs. honey dissolved in 500 ml warm milk

has shown itself to be of excellent help in palliative and hospice care.

Hiccups can become a stressful, hard-to-treat symptom. They come about through cramping activity of the astral body in the area of the diaphragm, often with asymmetrical muscular tension. A differential diagnosis is important, as the causes can include enlargement of the stomach, various motility-limiting influences, or central nervous system factors.

• Cuprum aceticum D4 (Weleda) dil. 20-20-20 gtts

and

• Cuprum aceticum D5 / Valerianicum D5 aa (Weleda) amp. s.c. 1 or more x daily

have proved helpful in freeing the astral body from its spasmodic activity. These remedies can be alternated with

• Mygale comp. (Weleda) mixture 2 x /hour 10 gtts or up to 20-20-20 gtts.

•  Chamomila Cupro culta, Radix Rh D2 (Weleda) amp. 1-0-0,
• Chamomila Cupro culta, Radix Rh D3 (Weleda) dil. 20-20-20 gtts,
• Chamomila e planta tota D3 (WALA) amp. 1-0-0
• Chamomila, Radix 2% (Weleda) tabl. 2-2-2

have a loosening and calming effect on the astral organization.

A dynamic influence on metabolism and movement can be supported with the bitter

• Gentiana lutea Rh 5% (Weleda) 20-20-20 gtts.

Positive effects have also been reported after the administration of

• Aurum/Hyoscyamus comp. (Weleda) amp., s.c. (epigastric) as needed.

There are many causes of dyspnoea. It can be directly related to a tumour (tumour-caused atelectasis, stenosis of the respiratory tract, lung metastasis or lymphangitis carcinomatosa, or pleural effusion), or indirectly related. It can be caused by recurrent lung embolisms, and it can be caused by infections that require treatment. Close to death, rattling secretions become a therapeutic challenge.

• Cuprum aceticum comp. (WALA) amp. 1-0-(1) and as needed

can be administered for extended expiration and bronchial spasms. The over-forming activity of the astral body expresses itself in these symptoms. Cuprum aceticum is also indicated for dry coughs caused by lymphangitis carcinomatosa:

• Cuprum aceticum D4 (Weleda) dil. 20-20-20 gtts

in combination with Hedera helix in

• Prospan (Engelhard Arzneimittel) cough drops 30-30-30 gtts.

Medicinal plants containing bitter agents orient the astral body toward metabolic activity. The stronger an inflammatory, secretion-producing symptom set, the more important are treatments using bitter agents and sulphur (such as essential oils), like

• Camphora D1 (Weleda) dil. 20-20-20 gtts

in combination with

• Pulmo/Vivianit comp. (WALA) amp. up to 1-0-0.

For chest rubs in such circumstances,

• Plantago Bronchialbalsam (WALA) as needed

has proved helpful.

For rattling breathing, suction should only be used if absolutely necessary and if it clearly has a positive effect. Patients have described this measure, to which they are helplessly subjected, as traumatizing. As treatment,

• Tartarus stibiatus comp. (Weleda) trit. 1-1-1 pea-sized portion,

as powder to be administered with a fluid, can be helpful. It is essential to correct any inadequate volume replacement (infusions).

In terms of external applications,

• Quark chest wraps 1 x daily and as needed

are helpful in these cases. If the illness causing the dyspnoea cannot be influenced, respiratory improvement must become the therapeutic goal. In this case, a therapy using

• Carbo Betulae D8, D20 (Weleda) amp. as needed

can be effective. It is also very important to take accompanying anxiety into consideration, as this can significantly increase dyspnoea. For treatment of this, please see the therapeutic approaches described in section Fear and anxiety. Morphine, which is in many cases necessary and beneficial, should be administered in combination with Aurum:

• Aurum metallicum praeparatum D10 (Weleda) amp.

Itching is a very agonizing complaint. It is the manifestation of a pathological awakening of the astral organization in the sensitive realm of the skin—it has left its physiological location in the metabolic system and appears here “in the wrong place”, in connection with cholestasis, for example. Especially for neurasthenic patients, the pruritus, which increases at night, can be influenced by:

• Arsenicum album D12, D30 (Weleda) amp. s.c. up to 1 x daily.

The arsenic eliminates the pathological awakening of the astral organization.

• Conchae D30 (WALA) amp. s.c. up to 1 x daily

can be effective against Pruritus senilis.

For Pruritus with accompanying agitation,

• Bryophyllum D5 / Conchae D7 aa (Weleda) amp. s.c. up to several x daily

or

• Bryophyllum D5 / Conchae D7 aa (Weleda) amp. 10 ml i.v. up to several x daily

can be administered. Especially for pruritus with cholestatic origins, the astral activity appearing in the skin can be led back into the metabolism with

• Choleodoron (Weleda) mixture 15-15-15 gtts.

In general, moisturizing the itching skin areas with

• Malva Body Milk [Malven-Pflegemilch] (Weleda) up to several x daily

has caused relief. Malva calms the astral body that has awakened in pruritus, and strengthens the etheric body in a similar way to sleep. In general, it is important to pay attention to the etheric organization (for example, in connection to dehydration, which must be remedied). In terms of medications, there is therapeutic precedent for

• Argentum metallicum praeparatum D6 (Weleda) trit. 1-1-1 pea-sized portion;

however, longer-term medication should be administered in cases of specific skin diseases that are accompanied by pruritus.

Sometimes, complications with haemorrhaging can occur. These include haemorrhaging related to gastrointestinal tumours (such as extensive stomach carcinomas), for which endoscopic treatment is neither suitable nor possible; diffuse mucous membrane haemorrhaging; or haemorrhaging from ulcerated tumours (such as advanced ENT tumours). In these situations, Stibium can be used.

• Stibium metallicum praeparatum D6 (Weleda) amp. 10 ml i.v. up to several x daily
• Stibium metallicum praeparatum D6 (Weleda) amp. s.c. up to several x daily

The forming quality of stibium is further solidified by calcium. Here,

• Marmor D6 / Stibium D6 aa (Weleda) amp. s.c. up to several x daily

and

• Marmor D6 / Stibium D6 aa (Weleda) amp. 10 ml i.v. up to several x daily

have proved especially effective. For haemorrhaging from the stomach, stibium preparations can also be applied locally through a feeding tube or PEG. For haemorrhaging from the bladder, stibium can be intravesically introduced through the permanent catheter:

• Stibium metallicum praeparatum D6 (Weleda) amp. 10 ml up to several x daily.

The necessity of parenteral nutrition and fluid replacement for dying patients should be critically assessed. Often, infusion therapy can simply lead to an increase in pleural effusions, ascites and anasarca, until the patient requires paracentesis. In this phase of the illness, the patient can no longer take in the offered volume. Moistening his dry mouth is more helpful than further infusions. If the patient expresses or shows signs of hunger or thirst, treatment must be tailored to the individual needs of the patient.

There are other considerations regarding such treatment as well: Normal digestion through the stomach and intestines leads to maximum decomposition of the food substances, which can be compared to a process of dying. Resorption through the mucous membrane of the colon is a step toward re-enlivening the stream of nutrition. From a dead substance comes a re-enlivened one; and through further processes in the human organism, an ensouled and spirit-bearing substance is created.

In this sense, the dead mineral substance does not enter the human blood—it is first transformed. In the case of infusion therapy, the threshold between the decomposed and therefore dead food substance and the inner human organism is breached. A mineral quality goes directly into the blood and through the blood into the realm belonging to the inner human being. A very sensitive patient experienced parenteral nutrition as “becoming too earthly.” At the same time, he experienced a lack of connection between his higher sheaths and his metabolic system, and he expressed the need to renew this connection. With each parenteral nutrition treatment, we are putting a substance into the human being that tends toward the mineral and death. Because of this, the higher sheaths can be experienced as being much more strongly bound to the physical, and can require much more effort to re-enliven the substances such that they can be used.

Frankincense, gold and myrrh are important substances that can be administered to people who are dying. They are related to the higher sheaths. Aurum is related to the “I” organization, frankincense to the astral, and myrrh to the etheric. They speak to the thinking, feeling and willing in the soul of the person who is dying. They seem to support resolve. Sometimes, we can observe that during treatment with such medications, such as

• Olibanum comp . (Weleda) amp. s.c. up to several x daily

or

• Aurum comp. (WALA) amp. s.c. up to several x daily,

a somnolent consciousness becomes clear again and a brighter, more interactive consciousness can follow for days. Olibanum comp. contains Aurum metallicum praeparatum D30, Olibanum D12 and Myrrha D6; Aurum comp. contains Aurum metallicum D6, Olibanum D3 and Myrrha D3.

On the other hand, an individual can also find release more easily after taking these medications. This gives them great significance in the accompaniment of a person who is dying. The three substances refer back to the original gifts of the three kings: “They brought the child gold, the symbol of outward, wise power; myrrh, the symbol of the victory of life over death; and finally frankincense, the symbol of the world ether in which the Spirit lives.”, as Rudolf Steiner characterized it over one hundred years ago in Berlin.

Aurum combines the qualities of light and weight/gravity. In this, it meets the situation of the dying person, who often tries to rid himself of the heaviness of his body through agitation and attempts to uncover and undress himself, or even to get up, in order to be nearer to the light he already feels. Following the process of loosening of the sheaths, which release themselves from the physical body by successively letting go of metabolic processes, then the rhythmic system and finally the nerve-sense system, a low potency of gold can be administered, increasing gradually to medium and higher potencies.

• Aurum metallicum praeparatum D6, D10, D20 (Weleda)  up to several x daily amp. s.c.

Therefore, aurum is one of the significant medications for dying patients.

CASE STUDY:

A patient with very advanced ovarian carcinoma was in our palliative and hospice care facility. Shortly before her death, she reported her experience to a nurse: “Everything is so infinitely dark.” Immediately after an injection of Olibanum comp., her inner experience was transformed and was expressed with the words, “Everything has become so light!”

This case study gives us an example of how outwardly calm patients who are near death can experience very intensive inner events that should be attended to by nurses and physicians, in order to find the correct specific medication.

External applications have a special significance in nursing. Many dying patients report tightness in the chest, which can show significant improvement through chest compresses with

Aurum/Lavandula (Weleda) ointment 1 x daily.

Fear and tension can be alleviated by administration of warming

• Ginger(-equisetum) kidney wraps
  3 heaping Tbs. Rhizoma Zingiberis off. pulv. for each kidney area, stirred into hot water (or equisetum tea). The inner cloth should be soaked in the liquid and laid on at body temperature. Duration approx. 20 minutes.

Evening rubs with

• Cuprum metallicum 0.4% (Weleda) ointment 1 x daily and as needed,
• Copper ointment, red (WALA) 1 x daily and as needed
• Lavender oil 10% (Weleda) 1 x daily and as needed,
• Lavandula, oleum aethereum 10% (WALA) 1 x daily and as needed

are some of the most important applications and can help patients sleep. In the morning, the addition of lemon to washing or bath water can be enlivening and refreshing. These and other nursing measures support the daily rhythm of waking and sleeping, which is just as important for critically ill patients.

The rose has a special significance in the treatment of dying patients. It has a harmonizing effect. Goethe points to the meaning of roses for people who are dying in Faust’s death scene: in battling with Mephistopheles over Faust’s immortal soul, angels strew roses to help Faust in his fight against evil. The angels “strew roses as symbols of spiritual, downwards-streaming love”, says Rudolf Steiner. Rose oil can be applied as external rub:

• Rosa e floribus 10%, oleum (WALA) 1 x daily and as needed.

The above-mentioned Aurum Lavandula comp. also contains rose oil.

For abdominal complaints,

• Oxalis wrap with Oxalis Essence (WALA)

or

• Oxalis, Folium 20% (Weleda) tincture 1 x daily 1 Tbs. dissolved in 1 cup water,
• Oxalis e planta tota W 10%, Oleum (WALA) 1 x daily,
• Oxalis, Folium 10% (Weleda) ointment 1 x daily (especially at night)

have proved effective. For meteoristic abdominal complaints, one can administer

• Melissa oil (WALA) as a local rub or oil compress.

For abdominal cramping pain symptoms, we have had positive results with

• Chamomila e floribus W 10%, OIeum (WALA) as a local rub or oil compress.

Upper abdominal complaints , for example in cases of liver metastasis, can often be relieved through use of

• Achillea millefolium (yarrow) liver compresses:
  Add 1 tsp. yarrow herb to 1 ¼ cups of boiling water. Soak the outer and rolled up inner cloth in the tea, wring them out, and apply them. The moist inner cloth can be applied hotter, the better it has been wrung out.

In addition, a

• Solum oil (WALA) oil compress or rub 1 x daily and as needed

can be a valuable help in cases of pain syndromes, such as liver capsule pain, but also for bone metastasis.

It is also very important to take care of the patient’s environment. Sometimes the characteristics and peculiarities of a patient who is in the process of loosening from her physical body seem to imprint themselves on her immediate surroundings. On the one hand, this is very personal to her and deserves our respect; on the other hand, peculiarities can “spread”, and the patient is sometimes grateful for them to be changed.

Similar to a newborn, a dying human being increasingly becomes a sensory being, living increasingly in his surroundings. For this reason, taking care of the patient’s room and the patient’s immediate surroundings is essential, as is ensuring the right amount of light and warmth. The atmosphere is also significantly influenced by the inner attitude and attention of the people who meet the patient in various functions throughout the day.

Artistic therapies can become especially meaningful in the period before death. The specific choice of therapy can be made based on the individual patient’s capabilities and on their effectiveness as perceived by the patient. Therapeutic eurythmy exercises—potentially familiar to the patients—can be taken up with small movements that are possible even for bedridden patients. Or, if even this is too much, therapeutic eurythmy exercises can be performed for a patient, and she can actively perceive and take them in.

New qualities can develop out of a longer practice in painting therapy. For example, if processing the illness was in the foreground during the first phase of painting therapy, followed by exercises on this theme that become expressions of soul experience, paintings created in the last phase begin to take on motifs which, with appropriate encouragement from the art therapist, might dress themselves in pictures from Grimms’ Fairy Tales, for example. In these intensively experienced pictures, the eternal, spiritual being, who is overcoming its perishable sheath, can express itself, and show the human being her inner, indestructible being beyond all abstractions. Sometimes, the motif of the abyss appears in the paintings. Sometimes patients paint the light which comes to meet them in the moment of death.

Music therapy is especially meaningful in accompanying a dying human being. It can ease fear, agitation and tension, and address—through tone—spiritual content that becomes a source of strength for patients. The lyre is an appropriate instrument.

And music therapy doesn’t only have a beneficial effect on the patients’ experience of fear. We must also consider the therapeutic qualities that are directly connected to individual tones and intervals, which can specifically address each of the three types of fear: the terror-like mental fear, the fear experienced in the rhythmic system, and the fear that is related to restlessness and inner agitation. Sometimes, a familiar song can be of comfort to a patient.

And finally, musical motifs or short pieces can bring a spiritual message that can develop real strength in this time of passage. Dietrich Bonhoeffer’s descriptions give us a deep impression of this. Shortly before his execution, he describes the meaning of music and especially of one specific piece as a source of inner strength:

“It is remarkable how a piece of music, heard only with the inner ear, can be almost more beautiful than one heard with the physical ear, if one really opens oneself to it; it has a greater purity—the dross falls away; it receives a “new body!” There are only a few pieces that I know well enough to hear inside me, but the Easter songs work especially well. The music of the deaf Beethoven becomes more understandable for me, existentially—especially the great Variation from Opus 111 …” (From the Berlin-Tegel Prison, 2 April, 1944.)