The dying process
Note: People may or may not want to know what happens when they or someone else dies, the below section goes into a fair amount of detail on the changes to the body in the final moments which may be upsetting for some readers.
There is a natural fear of death. Having the people we love leave this world is often filled with great sadness. But there is also fear of pain at death, which is unwarranted for the majority of deaths. Many healthcare professionals and researchers believe that dying itself is often not painful, but rather it is the symptoms and conditions leading up to death that can cause discomfort and pain. In her book With The End in Mind, Kathryn Mannix recounts the dying process of several people under palliative care with one key theme - between advances in pain management and the body naturally shutting down, often into a state of unconsciousness, the final moments are often peaceful for the person leaving this world. You can watch her TEDx talk as well.
Everyone’s dying process is unique and influenced by a variety of factors. For some, this process may take weeks; for others, only a few days or hours. Even doctors have a hard time prescribing exactly when a person will pass but there are some things to look for to give a sense of when someone is close to the end.
Physical changes may include:
Weakness and fatigue: As the body's systems begin to shut down, a person may experience weakness and fatigue. They may have difficulty moving around and may need assistance with daily activities.
Breathing changes: A person may experience changes in breathing such as shortness of breath or a change in breathing pattern.
Pain management: One may experience pain as the body's systems begin to shut down. Palliative or hospice care teams will work to manage the patient's pain and other symptoms.
Decreased appetite: A person may experience a decreased appetite and may not feel like eating or drinking.
Confusion and disorientation: One may experience confusion and disorientation as the body's systems begin to shut down.
Emotional changes may include:
Grief and mourning: A person may experience feelings of grief and mourning as they come to terms with their illness and impending death.
Fear and anxiety: One may experience fear, depression, or anxiety as they near the end of life.
Acceptance: They may find peace and a sense of acceptance of their illness and impending death.
Emotional and spiritual seeking: A person may develop emotional and spiritual needs as they near end of life and reflect back on their past while contemplating what they believe may come after death, if anything at all.
It can be common for a person to have a final burst of energy towards the end that may allow them to spend time with loved ones or be a part of a special activity. This ‘final rally’ can be mistaken for a loved one getting better but is often short-lived and hopefully the lucid time together should be taken advantage of in a meaningful way.
In the very final moments, people often slow right down, speaking and engaging less. They have little, if any, desire to eat or drink. You may notice that their hands feel cold as their body temperature and blood pressure decrease. At the end, breathing often changes from a normal rate and rhythm to a pattern of several rapid breaths followed by a period of no breathing - called “Cheyne-Stokes” breathing. You may also hear a little “rattle” as the body’s fluids begin to build up in the pharynx (this is painless). For some people, dying may include restlessness, but this and any other concerning symptoms can usually be treated by the care team. Their skin color may change from its normal tone to a duller, darker hue and fingernails may take on a bluish tint. Then often right before death, people will lapse into a coma or deep state of unconsciousness.
In his beautiful book, The Five Invitations, Frank Ostaseski shares what he has learned sitting at the deathbed of hundreds of people:
“In my experience and that if so many people I have accompanied, the encounter with muster is often marked by awe and wonder, as when our jaws drop open at the sight of unimaginable beauty. The usual activity of the mind stops and our consciousness rests. We become absorbed in tranquility and humbly bear witness. In such moments, time no longer devours our lives. We enter the eternal now. The future doesn’t exist; it hasn’t happened yet. The past doesn’t exist: it has already happened. Here in the place being the tyranny of time, there is no fear of death. And whenever there is an absence of fear, there is also a presence of love. Love is the lubricant that lets us skip out of the boundaries of the body. Love is the longing that calls us home.”
You can bring great comfort to a person dying, just by being there, sitting with them, holding their hand, or speaking in a calm and reassuring way. It can also be a meaningful experience to be witness to oneself.
For more understanding on what happens in and around death, The Beginners Guide to the End by BJ MIller goes through just about everything you might want to consider. And for a Canadian perspective, read 21 Days to Die by Linda Hochstetler. Both offer practical information and recommendations. And The Hospice Foundation has a guide for caregivers on what happens during the dying process and common symptoms to help manage end of life.
This article is not intended to be a substitute for professional medical advice or diagnosis. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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