Link back to index.html
Signs of the Death Process
All the passages below are taken from the book, “Leaving This Life With Hospice: Stories of Wonder and Hope” by Margaret Ledger. It was published in 2005.
If the dying person and her loved ones have made the decision to stay in her own home, and use the services of a hospice for in-home care, then the caretaker needs to understand what can be expected as that person nears the end of his life. Caring for a dying person at home, is one of the most difficult tasks that anyone has to face. Fear of the unknown is relieved a little by information, which will prepare the caretaker for what may transpire. Knowing that he can call the hospice nurse at any time is also very comforting.
Knowing what to expect, and how to respond, will give everyone a shared feeling of support, understanding, and comfort. Being honest and as straightforward as possible with each other enables the family to face their fears.
In general, though, two processes proceed at the same time. There are physical signs and symptoms of approaching death, as well as emotional, spiritual, and mental signs. Understanding them helps the caregivers respond appropriately. Each person is unique and will react in their own way, and not all signs and symptoms occur in every person, or in the same order. The two processes are closely interrelated and interdependent.
When the dying person enters the final stage before death, the body begins the final phase of shutting down. This process ends when all the body’s organs stop working and death occurs. Usually this process happens in an orderly and progressive series of physical changes, which are expected, and are the body’s way of preparing itself to stop. These changes are not medical emergencies and do not require intervention, except for checking the dying person is comfortable.
The hospice nurse will have a good idea, especially after consulting with the medical director, of the possible turns and effects this particular disease will have. She will be watching out for changes on her regular visits, and she will warn the family what is likely to happen, and what could possible happen, as the disease progresses. She will also be able to have the family prepared for how they will cope, including having the right medications in the house, so they wouldn’t have to wait for new doctors orders, and medication delivery.
The focus will be on keeping the dying person as comfortable as possible, and pain free. Initially the person may be quite mobile, but as his mobility decreases, aids, such as walkers, a hospital bed, commode, transfer mechanism from bed to commode, perhaps a catheter, will be introduced to support him. Again the hospice personnel will make suggestions and recommendations, but leave the dying person to make the choice.
As the body gradually shuts down the person will lose his appetite. Accepting this as normal may be hard for the caretaker, because nurturing and caring for someone is often associated with eating well. The appetite may fall off gradually, although the person may still enjoy special treats. As long as it does no harm, treats are a good way to lift the spirits. As he comes closer to death, the need for liquids gradually decreases. The demand on the body, to process intravenous fluids, is not helpful. The dying person will appreciate having their mouth moistened so it doesn’t become too dry, perhaps with crushed ice or juice chips or just with a small sponge applicator. Naturally as the body takes in less and less fluid the urine becomes concentrated and may become tea colored. It can also reduce because of a decrease in circulation through the kidneys. The dying person may become incontinent.
The person may spend more and more time sleeping and be more difficult to arouse or unresponsive. This is normal change is due in part to changes in the metabolism of the body. The dying person can appreciate the quiet companion who doesn’t need to talk much, but is there, maybe holding his hand. Speak to the person as you normally would, and don’t talk about them to others in the room. Hearing is the last of the senses to be lost.
The body’s ability to maintain a constant temperature weakens so the person’s hands and arms, legs and feet may feel increasingly cold to the touch. The color of the skin may change, with the underside of his body becoming darker and the skin may be mottled. This is just sign that the circulation of blood is slowing down to the body’s extremities and is being reserved for the more essential organs. The person just needs to be kept warm with a blanket.
Sometimes the person becomes disoriented and may be confused about the identity of people, the time, the place. It helps if the caretakers identify themselves gently, communicating clearly and simply. The dying person may make restless and repetitive motions such as pulling at bed linen or clothing. This can be due to less blood getting to the brain. Speaking in a calm natural way may be all that is needed to calm the person down.
The breathing pattern becomes slower and more erratic. Close to the end, breathing can stop for as much as forty five seconds before resuming again. Congestion can also be very loud. Oral secretions may increase and collect in the back of the throat. This is sometimes referred to as the death rattle.
Emotional, spiritual and mental signs
When the person’s body is ready and wanting to stop, but the person has some important issue or relationship that is unresolved or not yet reconciled, they may tend to linger even if they are uncomfortable or debilitated, in order to finish whatever needs finishing. On the other hand, when a person is emotionally, spiritually and mentally resolved and ready for release, but his body had not completed its final physical process, the person will continue to live until the physical shut down is completed.
As the dying person prepares to release himself from this life he completes his business with some people, effectively saying goodbye, and focusing on a smaller group of close family or even just one person, and spending more and more time withdrawn. This appearance of an unresponsive, or comatose state is a preparation for a release from surroundings and relationships. Sometimes the caregiver needs to protect the dying person from too many visitors and respectfully ask them to say their goodbyes quietly and leave.
Restless behavior can be a physical sign or an emotional one indicating that something is still unresolved or unfinished. The hospice nurse or social worker will help the caretaker try to identify any issues that may be holding the person here, and try to find ways of releasing them from tension or fear.
Again, the greatest gift the immediate family can give to the dying person is permission to die and leave them. A dying person may hold onto life as long as possible, even though the body is ready to leave, because he is so concerned that his loved one cannot cope without him. The family needs to say everything that completes their life with the dying person, including, “I love you” and “Goodbye,” which aids his peaceful passing enormously.
The dying person may also have vision like experiences or unusual dreams in the last week or two. They may claim to have seen or spoken to people who are already dead, or seen places not presently accessible to others. The surrounding family may see and hear the dying person, listen to something they alone can hear or speaking to people they alone can see. These experiences are very real to the dying person, and quite normal and common. The caregiver can just accept them as real, even if she can’t confirm their presence. The dying person might need reassurance that these experiences are normal. This is very common in the last week or two before death. It would appear that loved ones who have already died, come back with the purpose of accompanying the dying person over from this life.
Close to the end the person may make statements that seem to come from out of the blue. This indicates he is ready to say goodbye and is testing whether the loved one is ready to say goodbye, too.
Everyone is unique, so all these symptoms will not occur in all people and the timing of events can vary dramatically. In sudden death there is no warning; events have a life of their own. Some people may have only hours or a few days, from knowing the severity of their illness to their death. Some people may be dying over a ten-year period. As a person reconciles the issues and relationships of a lifetime, he seems more able to release himself from this world peacefully.
Some dying people seem to know ahead of time when they will die, and some seem to be able to choose the best moment to do so.
The experience we call death occurs when the body completes the natural process of both physically shutting down, and completing the emotional, spiritual, and mental aspects. These two processes need to happen in a way that is appropriate and unique to the values, beliefs and life style of the dying person.
The signs of death are: no breathing, no heartbeat, loss of bowel and bladder control, no response to shaking or shouting, eyelids slightly open, eyes fixed on a certain spot, and jaw relaxed and mouth slightly open.
Signs of spirit
Sometimes a survivor describes the body of his loved one some time later, maybe within an hour of his death, and say it looked totally different, that it was clear that the essence of the person was no longer there. Some people describe seeing some matter or essence leave the body at the moment breathing ceases or shortly thereafter.
A dying person may struggle in their process, and then suddenly come to peace a few days before she dies. Often people, who come to this place of peace, are described as having a look of wonder, a beautiful smile, as if they have seen what is to come and are very happy about it. Some dying people seem to glow from within for the last days or even weeks.
Many witnesses of a dying person observe light and energy around the person, and feel a difference in the level of love surrounding them. Some people describe the dying person as the source of that love and sometimes, they describe beings of light in attendance around the person dying. I certainly saw beings of light around my mother as she was dying.
This is life’s final mystery.
Link back to index.html