Tuesday, January 24, 2012

The Stages of Dying

I have spent many moments at the bedside of people passing from the living to the non living. While there are unique aspects that accompany each individual’s journey, there are far more similarities.

Plenty have said to me, “No human knows the exact time of a person’s death”. That is an absolute truth. However, like a weatherman trained to look at data, also watching the sky for signs and then predicting when the rain will come, I too look at data and watch my patients, and predict when their time will come.

The first signs, weeks and months before, are very gradual. Tiredness and sleeping begin to increase. What used to be one nap a day turns into multiple naps; time asleep becomes more than time awake. Digestion slows, so inevitably someone begins to eat less. At first just smaller quantities, then ultimately, whole meals are skipped. Most people at this stage begin to turn inward. Outward conversations and relationships become less important. The person wants to be left alone and can be inpatient. All these signs can be confused with depression. But close examination or even a trial of anti-depressants will show this isn’t depression, but the way we humans prepare for death.

As we get closer to days and weeks, time itself becomes skewed. Days and nights get reversed, and a person jumps from memories, to dreams, to reality all in a matter of minutes.  This is the time that restlessness occurs. There is a feeling of needing to go somewhere or do something, but the person is unsure what that is. There are moments when the eyes are open, but seem to be looking through everyone in the room. This mixture of distorted time and delirium can be very tough for families. We refer to this time as the transition, as the body moves from shutting down to active dying.

Once the transition is complete, now with only hours to days remaining, the physical body declares itself. Usually the person is no longer able to respond; blood pressure drops and the kidneys fail, skin is cool and sometimes a blotchy purple blue color.  The body can no longer control temperature, so innately the temperature spikes into the 100’s. Because the person isn’t able to swallow, and yet the body still makes saliva, a moist breathing sound is heard. Long pauses in breathing initially noticed days before change to very shallow, rapid breaths.

The actual moment when physical life stops comes quickly; like an engine running out of gasoline the breathing pattern rate begins to stutter. Finally there are empty breaths, like sighs, as the flicker of life goes out.

I write this for three reasons. First, to say what death is not. It is not suffocation and it is not sudden pain. Second, as a reminder that there are those, like me, who have knowledge and tools to help.  Finally, I want to empower you.  At some point there will be someone in your life in these stages. While each human experience is unique, there are far more similarities.

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