Understanding the Process of Dying

The dying process usually begins well before death actually occurs. Death is a personal journey that each individual approaches in his or her own unique way. Nothing is concrete; nothing is set in stone. There are many paths one can take on this journey.

As one comes close to death, a process begins: a journey from the known life of this world to the unknown of what lies ahead. There are milestones along this journey. Because individuals experience death in their own unique way, not everyone will stop at each milestone. Some may take months to reach their destination, others will take only days.

One to Three Months Prior to Death

As one begins to accept their mortality and realizes that death is approaching, they may begin to withdraw from their surroundings. They are beginning the process of separating from the world and those in it. They may decline visits from friends, neighbors and even family. They are beginning to think through their life and revisit old memories. They may be evaluating how they lived their life and may be sorting through any regrets.

What we can do: Offer supportive listening. Do not judge or argue. Allow them to speak and share their feelings without interruptions. Sit with them quietly. Hold their hand. Make sure their environment is peaceful, neat and uncluttered.

Food becomes less appealing as the body begins to slow down. The body doesn’t need the energy from food that it once did. The dying person is sleeping more now and not engaging in activities they once enjoyed. They no longer need the nourishment from food they once did. The body does a wonderful thing during this time as altered levels of chemistry in the body produce a mild sense of euphoria or happiness. They are neither hungry nor thirsty and are not suffering in any way by not eating. It is an expected part of the journey they have begun.

What we can do: Keep their lips and mouth moist by offering glycerin mouth swabs and lip balm. Offer orally gratifying food and drink as desired. Do not pressure them.

One to Two Weeks Prior to Death

This is the time during the journey that one begins to sleep much of the time. Disorientation is common and altered senses of perception can be expected. One may experience delusions, sometimes thinking others are trying to hurt them. They may also experience hallucinations, sometimes seeing or speaking to people that have passed on before them. They may pick at the sheets and their clothing in a state of agitation. Their movements and actions may seem aimless and make no sense to others. They are moving further away from us on their journey.

Physical Changes

The body is having a more difficult time maintaining itself. There will be signs that the body may show during this time as well.

· The body temperature lowers by a degree or more

· The blood pressure lowers

· The pulse becomes irregular and may slow down or speed up

· There is increased perspiration

· Skin color changes as circulation becomes diminished. This is often more noticeable in the lips and nail beds as they become pale and bluish

· Breathing changes occur, often becoming more rapid and labored. Congestion may also occur causing a rattling sound and cough

· Speaking decreases and eventually stops altogether

Days or Hours Prior to Death

The person is moving closer to their destination. There may be a surge of energy as they get closer. They may want to get out of bed and talk to loved ones. They may ask for food when they haven’t eaten in days. This surge of energy may be less noticeable but is usually used as a final physical expression before moving on.

The surge of energy is usually short lived and then the previous signs become more pronounced as the end approaches. Breathing becomes more irregular and often slower. “Cheyne-Stokes” breathing (rapid breaths followed by periods of no breaths) may occur. Congestion can increase causing loud, rattled breathing.

Hands and feet may become blotchy and purplish (mottled). This mottling may slowly work its way up the arms and legs. Lips and nail beds are bluish or purple. The person usually becomes unresponsive and may have their eyes open or semi-open but not seeing their surroundings. It is widely accepted that hearing is the last sense to go so it is recommended that loved ones sit with and talk to the dying during this time. We can also make sure soothing music is available for the resident.

Eventually, breathing will cease altogether and the heart stops. Death has occurred. They have reached their final destination in their journey.

“I am standing on the seashore – A ship at my side opens her white sails to the morning breeze and sails away into the blue ocean. I stand and watch her until at length she is but a speck of white just where the sea meets the sky. Then quietly I say, “She is gone.”

…Gone from my sight – that is all – For just as I am saying “she is gone”, another - on another shore takes up the glad shout “Here she comes!” Barbara Karnes: From “Gone From My Sight”

Source: The Hospice Foundation of America – A Guide for Caregivers

6/09