“The graves are full of ruined bones, of speechless death-rattles” (Pablo Neruda)
“You villain touch! What are you doing? My breath is tight in its throat” (Walt Whitman)
It is natural to die as to be born. (Francis Bacon) Death may be the greatest of all human blessings. (Socrates) How people die remains in the memory of those who live on. (Dame Cicely Saunders) Our dead are never dead to us, until we have forgotten them. (George Eliot)
Even if most of us may be regarding the subject somewhat unspeakable, you and I, one day will die from the same thing even as we may call it by different names: cancer, diabetes, heart failure, stroke, etc. One organ will fail, then another, then another and then yet another; or maybe all at once. We’ll become more similar to each other than to people who continue living with your original diagnosis or for that matter, mine.
Although many individuals shy away from contemplating the inevitability of death, most would agree that they would like to die well. A new review of existing literature, published in the American Journal of Geriatric Psychiatry, asks what makes a “good death” according to those involved in the process. Lay literature covers dying well almost thoroughly, but the scientific literature on the issue is rather sparse. What do the dying and the soon-to-be bereaved consider to be a good death?
Some believe that American culture, indeed Western culture at large, is becoming increasingly death-phobic. In sharp contrast to a century ago when seeing a dead body would be commonplace, nowadays, individuals outside of the relevant industries - health, funeral homes, cemeteries and crematoria, etc. - very rarely see a corpse. Consequently, death is less likely to be discussed and even considered.
All the same dying has its own biology and symptoms. It’s a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions. Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing to us out of empathy; but aren’t usually uncomfortable for the dying person. These symptoms are well-treated with medications and with hospice availability increasing worldwide, it is rare to die in pain. While few of us will experience all the symptoms of dying, most of us will have at least one, if not more. This is what we the caregivers should expect while handling our loved ones during the last hours of their sojourn on this Earth.
If an elderly has a terminal illness, knowing death may be near is often difficult to comprehend. Understanding what to expect may make things a little easier. It is important to recognize the signs that death may be near. Any person approaching death, becomes less active. This means the body needs lesser energy; he or she may stop eating or drinking as much, as his appetite gradually reduces. A person may completely stop eating a few days before his death. When this happens, it helps to keep their lips moistened with honey or a lip balm, so that they are not uncomfortable.
In the two or three months before his death, a person may spend less time awake. This lack of wakefulness is because the body’s metabolism is becoming weaker. Without metabolic energy, a person will sleep a lot more. In such a situation the dying loved one who is sleepy, should be made comfortable and let be asleep. When he will have energy, he should be encouraged to move or get out of bed to help avoid bedsores.
As a dying person’s energy levels are reduced, he may not want to spend as much time with other people as they once did. If such a person is becoming less social, coaxed into being social lest he should feel offended. It is not unusual for a person to feel uncomfortable letting others see them losing their strength. If this is the case, it is advisable to arrange visits when the person dying is up to seeing someone.
As a person approaches death, his vital signs may change in these ways: drop in blood pressure, breathing changes, heartbeat becoming irregular which may even be hard to detect, urine may be brown, tan, or rust-coloured. The urine colour changes because the kidneys are shutting down. Seeing this and the other changes in a loved one may be distressing. But these changes are not painful, so it may help to try not to focus overly on them.
Because a dying person is eating and drinking less, his bowel movements may reduce. He may pass less solid waste and that too less often. He may also urinate less frequently. When the person nearing death stops eating and drinking completely, he may no longer need to use the toilet. These changes can be distressing to witness in a loved one, but these are to be expected. The use of a catheter in such a situation may prove helpful.
In the days leading up to a person’s death, the muscles may become weak, which means that the individual may not be able to carry out the small tasks that he was able to do previously. Drinking from a cup or turning over in bed may no longer be tasks he can do. If and when this happens, the loved ones should help him orher lift things or turn over in bed.
A drop in body temperature may mean there is very little blood flowing to the limbs and hands. In the days before a person dies, his circulation reduces so that blood is focused on their internal organs. This means very little blood is still flowing to his hands, feet, or legs. Reduced circulation means a dying person’s skin will be cold to the touch. The skin may also look pale or mottled with blue and purple patches. The person who is dying may not feel cold himself; offering him a soft and light blanket is a good idea if a relative or friend thinks he may need one.
When a person is dying, his brain is still very active. However, he may become confused or incoherent at times. This may happen if he loses track of what is happening around him. A person caring for a loved one who is dying should make sure to keep talking to him. Explaining what is happening around him and introducing each visitor assumes importance to save him discomfort or, at times, even embarrassment.
A person who is dying may seem like he is having trouble breathing. The breathing may suddenly change speed, he might gasp for air, or he may pause between breaths. If it comes to notice, the caregiver need not to worry. This is not usually painful or bothersome when being experienced by the dying person. It is a good idea to speak to the doctor for advice if someone is concerned about this change in breathing pattern.
It may be difficult to come to terms with the unavoidable fact that a person’s pain levels may increase as they near death. Seeing a pained expression, or hearing a noise that sounds pained, is never easy. A person caring for a dying loved one should speak to the doctor about options for pain medication to be administered. The doctor can try to make the person who is dying as comfortable as possible.
It is not unusual for a person who is dying to experience some hallucinations or distorted visions. Although this may seem concerning, a person caring for a dying loved one should not be alarmed. It is best not to try to correct them about these visions, as doing so may cause additional distress.
Until death it is all life. (Miguel de Cervantes Saavedra) Sadly enough, the most painful goodbyes are the ones that are left unsaid and never explained. (Jonathan Harnisch) If the people we love are stolen from us, the way to have them live on is to never stop loving them. (James O’Barr)
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.