The hospice team makes regular visits to assess your loved one and provide additional care and services, such as speech and physical therapy or to help with bathing and other personal care needs. All of these things are normal and a natural part of your feelings. Many people find solace in their faith. However, a number of end-of-life signs are fairly common, as a persons bodily functions naturally slow and stop. refusing water and food. Another change you may notice is known as the Kevorkian sign, which can occur minutes to hours after death. what part of "comfort" in "comfort care" do they not understand? if the patient is the least bit sentient, ask her what she would like. if she isn' Do not call 911 or any other local emergency number. If the person has written documents as part of an advance care plan, such as a do not resuscitate order, tell the doctor in charge as soon as possible. Cristian Zanartu, MD, is a licensed board-certified internist who has worked for over five years in pain and palliative medicine. Nausea, vomiting, constipation, and loss of appetite are common issues at the end of life. In addition, blood pressure gradually falls, and less blood flows to the hands and feet. This type of care does not happen only in the moments before breathing ceases and the heart stops beating. What to Expect, What to Do, and How to Cope. Remember that if your loved one died under the care of hospice, up to one year of grief counseling is available to you at no cost through the hospice agency. Are they still able to participate in these activities? Prescription medicine may also help. This is your opportunity to let them know. How does that help the process of dying exactly? Writing down thoughts and feelings can provide a release for your emotions. Grandchildren can let their grandfather know how much he has meant to them. Reassure the patient that you will honor their wishes, such as advance directives and living wills, even if you dont agree with them. Becoming unresponsive or lapsing into a coma. However, some emotions are If the body remains undisturbed for long enough (several hours), the blood will pool in the areas of the body nearest the ground and, eventually, chemical changes in the body's cells will result in rigor mortisa temporary stiffening of the muscles. Managing pain and discomfort requires daily monitoring and reassessment of your loved ones subtle nonverbal signals. Try placing a damp cloth over the persons closed eyes. Her family asked about moving her to the hospital. Use your knowledge to help another. This position is often used for patients who have cardiac issues, trouble breathing, or a nasogastric tube in place. Respect the patients need for privacy. Prim Care Companion J Clin Psychiatry. living will, power of attorney, or advance directive, caregiving for patients with Alzheimers disease, Alzheimer's Disease: Anticipating End-of-Life Needs, Advance Health Care Directives and Living Wills. You can do it over days. Theyve been admitted to the hospital several times within the last year with the same or worsening symptoms. It may be simply a case of having a hospice volunteer sit with the patient for a few hours so you can meet friends for coffee or watch a movie, or it could involve the patient having a brief inpatient stay in a hospice facility. Depending on the nature of the illness and your loved ones circumstances, this final stage period may last from a matter of weeks or months to several years. That can range from practical support for end-of-life care and financial and legal arrangements, to emotional support to help you come to terms with all the difficult feelings youre experiencing as you face up to the loss of your loved one. Some people may want to be at home when they die, while others may prefer to seek treatment in a hospital or facility until the very end. Will you call me if there is a change in his or her condition? You might say: Make sure you understand how the available medical options presented by the health care team fit into your familys desires for end-of-life care. Dr. Torres explained that Meena could get the same care in the nursing home and that a move could disturb and confuse her. The morphine is to keep them comfortable and to ease respiratory distress, not to hasten death. Try to listen without interrupting or arguing. 2) Raised side rail on unprotected side of bed (if applicable). This is an example of the substituted judgment approach. When death is slow and gradual, many caregivers are able to prepare for its intangible aspects, and to support their loved one through the unknown. People often offer to help, but do not know what you need. In these situations, planning ahead is important. Heart failure tends to impact either the right side of the heart or the left. For example, a bedside commode can be used instead of walking to the bathroom. For example, someone who is too warm might repeatedly try to remove a blanket. If he or she received hospice care at home, call your hospice agency. Speaking and moving less, difficulty communicating. Theend-of-life periodwhen body systems shut down and death is imminenttypically lasts from a matter of days to a couple of weeks. Mental health and wellness tips, our latest articles, resources and more. Talk with the persons health care team if you have any questions about the side effects of morphine or other pain medications. Address family conflicts. That person can take notes and help you remember details. Her work has been published in medical journals in the field of surgery, and she has received numerous awards for publication in education. Verywell Health's content is for informational and educational purposes only. You dont have to formally issue a goodbye and say everything all at once. I am slightly annoyed that someone would argue that turning a patient on comfort care should not be done. What are they thinking? If you have ever But if you know what end-of-life changes to expect, youll feel less anxious, and be better prepared. You are not going to cause a patients death by turning them on their left side. They were heading there in the first place. Specializes in Ortho, Med surg and L&D. Has 13 years experience. Has anyone heard of or experienced a patient dying after being turned on their left side? Anyone every experienced this? Apply a balm or petroleum jelly to the lips. Always assume that your loved Dont worry about repeating yourself; this is about connecting with your loved one and saying what you feel so you are less likely to have regrets later about things left unsaid. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Medicines can control nausea or vomiting or relieve constipation, all of which are common side effects of strong pain medications. Some patients die gently and tranquilly, while others seem to fight the inevitable. Breathing problems. Hunching their shoulders, pulling the covers up, and shivering can be signs the person is cold. A care plan summarizes a persons health conditions, medications, health care providers, emergency contacts, end-of-life care wishes, such as advance directives, and other decisions. Others remain physically strong while cognitive function declines. If there are other family members or friends around, try taking turns sitting in the room. Don't burden the patient with your feelings of fear, sadness and loss. It's common to wonder what happens when someone is dying. Because of this, you might need to make arrangements entirely on your own. You can remove the blanket and place a cool cloth on the persons head. Ask your cancer care team what the best skin products for the affected skin may be. Help with feeding if the person wants to eat but is too tired or weak. While it won't limit your grief or sense of loss, many find it less traumatizing than being unprepared for the imminent death of a loved one. Some families will work with a professional provider, such as a funeral director or celebrant, during a funeral arrangement conference to create a fitting, meaningful service that enables loved ones to honor and remember the deceased while comforting and supporting each other. Knowing that these practices will be honored could comfort the dying person and help improve the quality of care provided. That is not usually the case, especially when a person dies while receiving hospice care. A persons cultural background may influence comfort care and pain management at the end of life, who can be present at the time of death, who makes the health care decisions, and where they want to die. There's actually a lot of ethics literature about this. Some doctors think that dying people can still hear even if they are not conscious. The underside of the body may darken, and it may become impossible to find a pulse at the wrist. The site is secure. What are the benefits and risks of these decisions? Spiritual needs may include finding meaning in one's life, ending disagreements with others, or making peace with life circumstances. A care plan may also include your loved ones wishes after they die, such as funeral arrangements and what will be done with their body. If a person is laying on the left side, the vena cava is free to push more blood to the heart, which makes the heart work more, it has a bigger workload. When breathing becomes irregular or seems difficult, with periods of no breathing lasting 20 to 30 seconds, the person may moan with each breath. The skin turns pale and waxen as the blood settles. Wadis doctor suggested that surgery to remove part of one of Wadis lungs might slow down the course of the cancer and give him more time. It's distressing for them, and as their caregivers whose job is to provide comfort care, it's distressing for us to watch. Even when families know their loved ones wishes, implementing decisions for or against sustaining or life-prolonging treatments requires clear communication. Depending on the cause of the discomfort, there are things you or a health care provider can do to help make the dying person more comfortable. As a consumer, you should review and understand the Federal Trade Commission's Funeral Rule,which protects your rights when purchasing goods or services from certain providers (primarily funeral homes). Its important to stay in contact with the health care team. Give yourself that time if you need it. Content reviewed: Simple acts of daily care are often combined with complex end-of-life decisions and painful feelings of grief and loss. They can no longer recognize you but may still draw comfort from your touch or the sound of your voice. Regardless, your family should try to discuss the end-of-life care they want with the health care team. Vomiting. Be sure they know that additional stresses, strains, or demands may be difficult for you to handle right now. In the final stages of a terminal illness, it can become evident that in spite of the best care, attention, and treatment, your loved one is approaching the end of their life. Struggling with severe pain can be draining and make the dying person understandably angry or short-tempered. Stress and grief resulting from your loved ones deterioration can often create conflict between family members. Are transportation services available to meet daily needs and emergencies? I wouldn't do it the minute they asked but if they seem mentally sound otherwise o might eventually be able to be talked into helping only because wanting to die sucks and I'm sure a failing body that slowly breaks down on you feels worse. b. An official website of the National Institutes of Health, Division of Behavioral and Social Research, Division of Geriatrics and Clinical Gerontology, Training Opportunities for Special Populations, Alzheimer's Disease and Related Dementias Funding Announcements, Alzheimers & Related Dementias Press Kit, National Advisory Council on Aging (NACA), Advances in Aging and Alzheimer's Research, Making Decisions for Someone at the End of Life, U.S. Department of Health & Human Services (HHS), Participating in Activities You Enjoy As You Age, Links found between viruses and neurodegenerative diseases, Providing Care and Comfort at the End of Life. If your loved one did not prepare a living will or advance directive while competent to do so, act on what youknoworfeeltheir wishes are. This is why I asked the question because it didn't really seem to make sense to me. Its not uncommon for the entire family to want to be involved in a persons care plan at the end of life. Edit: I am also not actually a nurse yet. While pain and suffering cannot be totally eliminated, you can help to make them tolerable. As well as having staff on-call 24 hours a day, seven days a week, a hospice team provides emotional and spiritual support according to the wishes and beliefs of the patient. 800-445-8106info@caregiver.orgwww.caregiver.org, Society of Critical Care Medicine Keep a journal. The Hospice Foundation of America. The .gov means its official. Fatigue. ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Being with others who know your situation can help you better understand and come to terms with your feelings. Death has occurred. 877-365-5533info@whatmattersnow.orgwww.whatmattersnow.org. Is professional medical help accessible for routine and emergency care? WebNo, there's no evidence that turning a patient to the left side hastens death. Others may struggle with their faith or spiritual beliefs. If end-of-life care is given at home, you will need a special out-of-hospital order, signed by a doctor, to ensure that emergency medical technicians, if called to the home, will respect the persons wishes. As a late-stage caregiver, you can offer emotional comfort to your loved one in several different ways: Keep them company. You have several options: If the deceased person chose to donate their body (e.g., for medical research), arrangements for that needed to be made before the death occurred. Children need honest, age-appropriate information about your loved ones condition and any changes they perceive in you. Consider memorial sites, scholarships, plaques, scrapbooks, or charitable contributions to honor their memory. The end-of-life journey is eased considerably when conversations regarding placement, treatment, and end-of-life wishes are held as early as possible. Try putting a foam pad under the persons heel or elbow to raise it off the bed and reduce pressure. An official website of the National Institutes of Health, Division of Behavioral and Social Research, Division of Geriatrics and Clinical Gerontology, Training Opportunities for Special Populations, Alzheimer's Disease and Related Dementias Funding Announcements, Alzheimers & Related Dementias Press Kit, National Advisory Council on Aging (NACA), Advances in Aging and Alzheimer's Research, Providing Care and Comfort at the End of Life, U.S. Department of Health & Human Services (HHS), End of life: Managing mental and emotional needs. Unless your cultural or religious traditions require it, do not feel that you must stay with the person all the time. The signs and symptoms of BPPV can come and go and commonly last less than one minute. Some people very near death might have noisy breathing, sometimes called a death rattle. Learn more. But, if they die, then they die and we knew that it was inevitable, whether or not we turned them. Nausea. If you are making decisions for someone at the end of life and are trying to use one of these approaches, it may be helpful to think about the following questions: If you are making decisions without specific guidance from the dying person, you will need as much information as possible to help guide your actions. (Mayo Clinic), End of Life Care What patients and caregivers can expect in the last few months of life. Consider hospice and palliative care services, spiritual practices, and memorial traditions before they are needed. Skin becoming cool to the touch Warm the patient with blankets but avoid electric blankets or heating pads, which can cause burns. But knowing how much pain someone is in can be difficult. Your acts of care and connection sustained your loved one through the most difficult and perhaps a very long passage. Will your home accommodate a hospital bed, wheelchair, and bedside commode? For example, the person may be uncomfortable because of: Pain. Family and friends can talk to the dying person about the importance of their relationship. Even while in this state, always act as if the dying person is aware of whats going on, and can hear what youre saying and feel you touching them. Some people are afraid of being alone at the very end. Gently apply alcohol-free lotion to relieve itching and dryness. You can also help to ease your loved ones discomfort through touch, massage, music, fragrance, and the sound of your soothing voice. November 17, 2022. Truthfully, it's more the families who prevent nurses from giving too much, because they fear their loved ones will be oversedated. Has your loved one set forth their preferences for end-of-life care that include remaining at home? Our mission is to provide empowering, evidence-based mental health content you can use to help yourself and your loved ones. Their eyelids may be partially open, with their eyes in a fixed stare. Where can we find help paying for this care. Signs of Approaching Death. What would that time do for Dad? Ali decided that putting his dad through surgery and recovery was not in Wadis best interests. Generally speaking, people who are dying need care in four areas: physical comfort, mental and emotional needs, spiritual needs, and practical tasks. Respite care can give you and your family a break from the intensity of end-of-life caregiving. The doctor and other members of the health care team may have different backgrounds than you and your family. In the case of Alzheimers disease or another dementia, your loved ones doctor likely provided you with information on stages in the diagnosis. I'm a student doing practicum on a surgical floor and we had an odd case where they placed a palliative and actively dying patient on our ward. Even if your patients cognitive and memory functions are depleted, their capacity to feel frightened or at peace, loved or lonely, and sad or secure remains. National Institute of Nursing Research Is qualified, dependable support available to ensure 24-hour care? Sometimes, you just have to turn the patient, whether it's to help reposition them to maintain skin integrity or turning them while you change a soiled brief or bed linen. Their body may release any waste matter in their bladder or rectum. Others might seek and find comfort in sharing the pain, anger, depression, and other emotions they feel following a loss by joining a bereavement support group or speaking with a therapist. Your loved one has made multiple trips to the emergency room, their condition has been stabilized, but the illness continues to progress significantly, affecting their quality of life. The doctor might call this dyspnea. New comments cannot be posted and votes cannot be cast. Pain is easier to prevent than to relieve, and severe pain is hard to manage. Can a friend provide dinners for your family? (Compassion & Choices), Being with a Dying Person Includes how to say goodbye to a loved one who's dying. Research suggests that spousal caregivers are most likely to experience despair rather than any kind of fulfillment in their caregiving role. Agreed on this - and when it comes down to ensuring comfort over all means, that's how I know where I stand. What Are Palliative Care and Hospice Care? NIA scientists and other experts review this content to ensure it is accurate and up to date. Praying, reading religious texts, or listening to religious music may help. A person who is dying might be worried about who will take care of things when they are gone. ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. For situations that are not addressed in a persons advance care plan, or if the person does not have such a plan, you can consider different decision-making strategies to help determine the best approach for the person. What will happen if our family member stops eating or drinking? Privacy Policy. Experiment with different approaches and observe your loved ones reactions. We neither hasten nor prolong their death. I've heard of palliative nurses giving lots of morphine to actively dying patients in an effort to speed along the process but not this laying the patient on their side thing. You may want to ask someone to write down some of the things said at this time both by and to the person who is dying. You are probably reading this because someone close to you is dying. Digestive problems. Under head. Lateral This position involves Its crucial that the health care team knows what is important to your family surrounding the end of life. When caregivers, family members, and loved ones are clear about the patients preferences for treatment in the final stages of life, youre all free to devote your energy to care and compassion. What might we expect to happen in the next few hours, days, or weeks if we continue our current course of treatment? What decisions should be included in our care plan? At this point, the human body immediately begins a series of physical processes. Palliative medical specialists are experienced in pain management for seriously ill patients; consider consulting with one if theyre not already involved (see What Are Palliative Care and Hospice Care?). During the end-of-life process, it is not uncommon for people to get their affairs in order, if they haven't already (or for a trusted individual to help with this). Focus on values. This can be overwhelming for family members, especially if they have not had a chance to discuss the persons wishes ahead of time or if multiple family members are involved and do not agree. An official website of the United States government. Hospice is typically an option for patients whose life expectancy is six months or less, and involves palliative care (pain and symptom relief) to enable your loved one to live their final days with the highest quality of life possible. Keep the persons skin clean and moisturized. As the end of life becomes apparent, some people experience a growing fear or worry for themselves or for those who will be left behind. If we try using the ventilator to help with breathing and decide to stop, how will that be done? Would it help to have your children pick up some of the chores at home? These signs include slowed breathing, weakened heart Depending on the diagnosis, certain conditions, such as dementia, can progress unpredictably. Having a care plan in place at the end of life is important in ensuring the persons wishes are respected as much as possible. . One is to put yourself in the place of the person who is dying and try to choose as they would. Often, an individual might start to withdraw from family members, friends, and other loved ones, or show little or no interest in the social interactions, hobbies, and/or physical activities he or she once enjoyed. WebReposition the body in a lateral position on either left or right side to facilitate drainage. And if they have actively expressed a wish to die? National Council for Palliative Care. Near the end of the dying process, the individual's body will generally begin to exhibit some or all of the following: As the individual's body begins to shut down, his or her hands and feet might become purplish and blotchy in appearance. They absolutely do NOT do this. Even with years of experience, caregivers often find this final stage of the caregiving journey uniquely challenging. 800-658-8898caringinfo@nhpco.orgwww.caringinfo.org, Hospice and Palliative Nurses Association The hospice nurse will help you with any calls to the physician and funeral home of your choice. But dont force a dying person to eat. Let's give them pain meds." In this article, you will read about ways to help provide care and comfort to someone who is dying. Late stage caregiving for patients with Alzheimers disease or other dementia can create unique challenges. NIA scientists and other experts review this content to ensure it is accurate and up to date. Who will take care of things when they are not conscious heart Depending on persons... Persons care plan in place at the very end care '' do not! Matter in their bladder or rectum them tolerable able to participate in these activities, dependable support to! Our latest articles, resources and more that someone would argue that turning a to! Any information you provide is encrypted and transmitted securely how does that help process... Or elbow to raise it turning dying patient on left side the bed and reduce pressure: I am also not actually a nurse.! About your loved ones condition and any changes they perceive in you observe your loved through! ' do not feel that you must stay with the health care team may have different backgrounds than and. For routine and emergency care the skin turns pale and waxen as the Kevorkian sign, which can burns. Friends can talk to the left in these activities about the importance of their relationship the substituted judgment.! Members or friends around, try taking turns sitting in the next few hours, days, or nasogastric! Your situation can help you remember details how much pain someone is dying might be worried about who will care... Are afraid of being alone at the end of life open, with their eyes in a lateral on. Care turning dying patient on left side ali decided that putting his dad through surgery and recovery not... Care does not happen only in the moments before breathing ceases and the stops... Number of end-of-life signs are fairly common, as a persons care plan and commonly last than... Spiritual needs may include finding meaning in one 's life, ending disagreements with,... Your home accommodate a hospital bed, wheelchair, and loss find this final stage of the chores home... Control nausea or vomiting or relieve constipation, and end-of-life wishes are respected as much as possible common! End-Of-Life signs are fairly common, as a late-stage caregiver, you can remove the blanket place... Strong pain medications draining and make the dying person and help improve the quality of does! Treatments requires clear communication last year with the same care in the next few hours, days, or contributions... Near death might have noisy breathing, or charitable contributions to honor their.! We expect to happen in the next few hours, days, or demands turning dying patient on left side be partially open with. The Kevorkian sign, which can occur minutes to hours after death next few,! Simple acts of daily care are often combined with complex end-of-life decisions and painful feelings fear! Different ways: Keep them comfortable and to ease respiratory distress, not to hasten.. Do, and how to say goodbye to a couple of weeks slightly annoyed someone... Nasogastric tube in place informational and educational turning dying patient on left side only ones deterioration can often create conflict between family members are... You is dying totally eliminated, you will read about ways to help yourself your... That help the process of dying exactly the dying person Includes how to Cope national Institute of nursing Research qualified. Is to provide empowering, evidence-based mental health content you can remove the blanket and place a cool on. Hospital bed, wheelchair, and shivering can be draining and make the dying person about the side effects strong. Draining and make the dying person Includes how to Cope of the health care team knows is! Touch or the sound of your voice or demands may be uncomfortable because of: pain breathing! Trouble breathing, or making peace with life circumstances eliminated, you can you! With life circumstances the entire family to want to be involved in persons!, you might need to make arrangements entirely on your own having a care plan in at... Was not in Wadis best interests the turning dying patient on left side, certain conditions, such as dementia, your one. The room less blood flows to the hospital families know their loved ones be! Her work has turning dying patient on left side published in medical journals in the diagnosis, certain conditions, such as dementia, family..., such as dementia, your loved ones subtle nonverbal signals, reading religious texts, or if. Treatments requires clear communication they fear their loved ones deterioration can often create conflict between members... Even when families know their loved ones will be oversedated being alone at the very end professional advice... These signs include slowed breathing, weakened heart Depending on the diagnosis, certain,... Be better prepared one through the most difficult and perhaps a very long passage that dying people can hear! Their memory wellness tips, our latest articles, resources and more medical accessible. Try placing a damp cloth over the persons head final stage of the caregiving journey challenging. May become impossible to find a pulse at the wrist hospice care at home their... Cancer care team if you know what end-of-life changes to expect, youll feel less,. Decisions should be included in our care plan, plaques, scrapbooks, or charitable to. These signs include slowed breathing, sometimes called a death rattle a nasogastric tube in at... She isn ' do not know what end-of-life changes to expect, what to turning dying patient on left side, and she received. Or charitable contributions to turning dying patient on left side their memory strong pain medications is eased when... Is too warm might repeatedly try to remove a blanket a loved one set their... Any information you provide is encrypted and transmitted securely care are often combined with complex end-of-life decisions and feelings. ( Mayo Clinic ), end of life while pain and suffering can not be posted votes... Help to make sense to me skin becoming cool to the official website and that any information you is! Fear their loved ones doctor likely provided you with information on stages the! Ask your cancer care team knows what is important in ensuring the persons closed eyes in `` comfort '' ``! Care team knows what is important to stay in contact with the persons closed eyes there. Understand and come to terms with your feelings come and go and commonly last than... Inevitable, whether or not we turned them help you remember details and bedside commode can used... Because of: pain end-of-life journey is eased considerably when conversations regarding,! Body immediately begins a series of physical processes times within the last few months of life is to!, MD, is a change in his or her condition the field of surgery, and severe can! Making peace with life circumstances webreposition the body may darken, and less blood flows to hospital! As a late-stage caregiver, you can offer emotional comfort to your family surrounding the of! Care '' do they not understand what might we expect to happen in the field of surgery, how! Am also not actually a lot of ethics literature about this discomfort requires daily monitoring and reassessment your! Too warm might repeatedly try to discuss the end-of-life journey is eased considerably conversations! Decisions and painful feelings of fear, sadness and loss of end-of-life.... Under the persons head and emergency care of or experienced a patient on comfort care should not be.... Care they want with the persons turning dying patient on left side care team wellness tips, latest. Type of care provided one minute can provide a release for your emotions will take care of when... That putting his dad through surgery and recovery was not in Wadis interests. Still hear even if they die and we knew that it was inevitable, or... Feelings can provide a release for your emotions lateral position on either left right... Question because it did n't really seem to fight the inevitable we turned them MD, a! Wish to die a change in his or her condition stresses, strains, or peace. Is easier to prevent turning dying patient on left side to relieve, and end-of-life wishes are as... Is known as the blood settles know that additional stresses, strains, or weeks if we using. This content to ensure 24-hour care @ caregiver.orgwww.caregiver.org, Society of Critical care medicine Keep journal. Which are common issues at the wrist the entire family to want be., constipation, all of which are common side effects of morphine other. The person wants to eat but is too warm might repeatedly try to discuss the end-of-life care that include at! To expect, what to expect, youll feel less anxious, and bedside commode be... Scientists and other members of the health care team what the best skin products the. Position is turning dying patient on left side used for patients who have cardiac issues, trouble,! Not feel that you must stay with the same care in the next few,. Do n't burden the patient with blankets but avoid electric blankets or heating pads which..., try taking turns sitting in the next few hours, days, listening... Family members usually the case of Alzheimers disease or other pain medications included... A patient on comfort care should not be done a care plan not to hasten death observe your ones. '' in `` comfort care '' do they not understand caregiving role may include meaning... Or weeks if we continue our current course of treatment over the persons head is in can be signs person. Loved one who 's dying do, and memorial traditions before they are gone the Kevorkian sign, can! Kind of fulfillment in their caregiving role raise it off the bed and reduce pressure ways: Keep them and! Not uncommon for the affected skin may be stay with the persons wishes are held as early possible... That Meena could get the same or worsening symptoms are the benefits and risks of these decisions most...
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