We will all die differently. For each of us the circumstances of our death – the surroundings, the timing and the people with us when we die – will be unique. The process of dying is often quite predictable. Understanding this process is important because it may help to reduce our natural fear and anxiety about dying.
Many of us have similar fears about dying. Common questions include:
“Will it hurt?”
“Will I suffocate?”
“Will I lose my dignity? “
Those who die instantly, in an accident or following a sudden critical event, don’t get to ask these questions. Similarly, those who suffer a catastrophic major illness or injury are possibly so caught up in the fierce battle for life that they don’t have the opportunity to consider these questions. For these people, death arrives abruptly and unannounced.
For many of us, however, dying is something that happens over time. We will be aware of the fact that we are dying and we will have time to reflect on uncertainties and ponder questions about what will happen to us when we die.
Death is a natural event
What we need to keep in mind is that dying is a perfectly natural process. In this way, birth and death are remarkably similar.
The process of birth
Birth is not instant. It takes forty weeks to progress from conception to birth. Initially, there are no clues as to the secret little life in the womb. The pregnant mother is a lone witness to the first clues: morning sickness or the absence of her period.
As the pregnancy progresses, the signs of new life become more apparent and visible for all to see. As the baby grows in the womb, the expectant mother’s abdomen swells. Little movements turn into vibrant, vigorous kicks. The final few weeks are a waiting game as the baby’s impending birth is both eagerly and fearfully anticipated. Labour, when it begins, is irreversible and inevitably traumatic for both mother and baby. Birth has an uncertain beginning and a definite end.
The process of dying
Dying is much the same process as leading up to birth. First there are the subtle changes in the body signifying that something has changed, which may only be apparent to the person experiencing them. Energy levels may decrease and appetites reduce. The body becomes leaner and wasted as the signs of dying become more apparent. Life becomes wearisome, and pain and discomfort associated with illness increase.
As energy saps away, more and more time is spent in bed or in a chair resting. Everyday tasks become difficult. Everything is an effort. As with advanced pregnancy and impending labour, the body prepares for the final process of dying.
Signs of life ending
These are a number of signs that death is near:
Increasing fatigue and weariness
Illness uses up energy, and as this energy is depleted everyday activities become impossible. Even getting up out of bed is exhausting and no longer possible. Assistance is required with all activities and even the simple act of swallowing may become difficult.
Lack of interest in surroundings
The excitement of life is lost and hobbies or activities once enjoyed are no longer appealing. Watching football on television or reading a favourite novel is not worth the effort. Assets worth millions of dollars are no longer important. Everyday things that used to be important no longer have value. Visitors are a burden. Most of the time is spent asleep or resting. Sleep is a friend.
Loss of appetite
Eating is too much effort, and even the thought of food is distressing. That “favourite apple pie” loses its appeal. Cigarettes are not needed and alcohol is unwanted.
Increased confusion and restlessness
Like wearing a pair of ill-fitting shoes or a scratchy woollen garment, it is as if the body no longer fits. The result is restlessness and fidgeting as the “discomfort of illness” increases. In addition, the brain, subject to the chemical changes associated with dying, becomes confused. Hallucinations are common. Dying is associated with decreased consciousness.
Breathing becomes irregular as death approaches. Deep breaths are followed by shorter episodes of breathing and there are times, long times, when no breathing occurs. The breathing also becomes noisy as secretions in the back of the throat gurgle away. This abnormal breathing does not cause the dying person distress, but it can be distressing to witness
Unexplained dramatic improvement in health
For unknown reasons, some people who are obviously dying paradoxically dramatically improve in health a few days or hours before they die. They go from a state of impending death to being the life of the party. They sit up and chat and feel well enough to eat. Their energy levels increase, and it seems as if the prospect of dying has been a false alarm. This unexplained episode of revitalisation is bonus time to enjoy with family and friends. It is an ominous sign that death is at hand.
The final stages of dying
The signs of approaching death are not absolute or definitive, but should rather be viewed as a signal that death is near. As with labour, dying cannot be rushed or avoided. Some people may take days to die, others require hours. And, as with labour, death is something for which the body is prepared
There is no denying that in dying our body struggles with the limitations placed on it as life draws to an end. The role of the palliative care team cannot be overemphasised during this turbulent time. These people are the “saints of medicine”, providing compassionate medical care to minimise the pain or other symptoms associated with dying. It is often the case, however, that some kind of compensatory mechanism is at work, which diminishes the distress associated with dying. Dying people are not aware of their bowel functions or thirst or need for air. The whole event is often a blur, a foggy confused process.
As with the travails of birth, dying is also like a storm which rages for a while and then passes by. Somewhere in the battle between life and death, it becomes quiet and peaceful. The body is at rest. What was our greatest fear is to be feared no more. Death brings an end to a life, but not necessarily a “life” to an end.
Death is a common event, an everyday event and one that we are all destined to experience. Each person experiences death and dying in a unique way. If you have a story to share, we would love to hear it.