The Dying Process - What Happens as You Approach Death
The Dying Process
Not all cultures see death as negative or frightening; it is, after all, a natural process we all go through at some stage after our birth. Let's investigate the dying process.
When a person is nearing death, the body begins the process of shutting down. Care professionals recognize the signs of approaching death, and the focus of care will transition from pursuing tests and treatments toward maintaining the person's comfort. The person's family and/or caregivers may also receive support services.
Hospice and palliative care nurses are experts in the dying process. They can provide much-needed information, reassurances, and comfort to the person who is dying, as well as to the family.
Contemplating your final hours is never pleasant, and thinking about what will happen to you physically may be overwhelming. Please be assured that health professionals see death and dying every day, and they are well prepared to provide care to ease your burden. You are likely to be unaware of most of your final hours as the body finally shuts down, so please read the following information with that in mind.
As your disease progresses, you will become weaker and less interested in participating in daily activities. Eventually you will be unable to get out of bed unaided. Your body will not recover from treatment easily, and at this stage your health professionals may stop challenging treatments such as radiation.
You will become sleepier, and your social interactions with visitors and family will decrease as you become weaker.
You will lose interest in food and fluid as your body shuts down; this is because your body can no longer use the nutrients. Slowly, the disease overwhelms your heart and body systems, and they begin to shut down. You are likely to be unconscious at this time and unaware of what is happening. You will begin to dehydrate, but unlike healthy people who dehydrate, it will not be distressing. It is simply a natural part of the dying process.
As Things Progress...
As things progress you may appear confused or restless to your family. If this is distressing for them, palliative care nurses can give you medication to help you to relax. Please note that you are unlikely to be aware of the confusion or restlessness yourself; they are a result of advanced systems shut-down, which is a normal part of the dying process. This typically happens only when you are semi-conscious or unconscious.
You may lose control of bowel and bladder functions, but since you will not be eating and taking fluids, this will be minimal, or not present at all. Again, this is a normal part of the dying process, and something you are unlikely to be aware of.
Your circulation may slow as the heart struggles under the burden of illness, so your body may feel cold, particularly the hands and feet. The skin coloring may become white, or a mottled color.
In the final hours your breathing may change. It will slow, and may become deeper, as if you are sighing. Most, but not all, people develop what is known as the Cheyne-Stokes breathing pattern. This is characterized by clusters of rapid breathing that start with shallow breaths, which gradually become deeper, then fade off again, with a pause where no breath is taken for a period of time. This will progress until breathing becomes irregular with longer and longer pauses between breaths.
You may take a few reflex breaths after the heart has stopped beating.
You May Become (Briefly) Clear-Headed
During the last week or two you may suddenly—but briefly—become clear-headed after being very weak and sleepy. This is a common phenomenon that doctors have not been able to explain adequately. The improvement will be temporary, but will give you a chance to say final goodbyes before you slipping into a semi-conscious or unconscious state.
Health professionals know from studies that people who are semi-conscious, and even unconscious, can still hear conversations and feel the presence of loved ones, so nursing staff if present will encourage them to keep in close physical contact with you and talk to you, even if you are not responding.
Of course, no one can really know what the last hours of life will be like for you. Your experience will be a complicated result of your hopes, fears, beliefs, and the physical changes you are undergoing.
Many believe that the dying person spends much time “outside of their body,” preparing for their death. Many report seeing and communicating with those who have died before, particularly loved ones (e.g., deceased parents or a spouse who has passed on).
There are theories that these are hallucinations brought on by lack of oxygen, dehydration, etc., while others believe that they are indeed the spirits of our relatives who have come to help us in our final days.
Those who have experienced a near-death often report the presence of deceased loved ones, and again the argument for lack of oxygen is offered as an explanation. We cannot truly know until we die.
I have had the great privilege to nurse many patients in their final hours. What I have observed is that in their final hours they find great peace. They slip away quietly, surrounded by loved ones.