What Is Dying Like?

— A Nurse Explains What Dying Bodies Do

It’s hard to ask your doctor what dying will be like. Death is a gut-wrenching reality for everyone. If you have an incurable illness, knowing what to expect as your body shuts down helps you prepare for as “good” of death as possible.

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  • If you have an incurable illness, knowing what to expect as your body shuts down helps you prepare for as “good” of death as possible.
  • There are similarities to every death, but each dying person’s journey is unique.
  • Normal signs and symptoms of dying are increased fatigue and weakness, social withdrawal, increased pain, loss of appetite and thirst, and altered mental status.
  • Changes in the bladder, bowel movements, breathing, and vital signs are also normal.
  • Facing these changes alone can increase suffering. Seek help earlier in your journey from your loved ones and a palliative care specialist.

A “good” death to most people is free of avoidable suffering and aligns with their cultural, spiritual, and relational wishes as much as possible. To achieve a more peaceful death, studies and experts say preparing helps.

As a hospital nurse, I cared for many dying people during their final hours and walked their families through the process. Every last breath was sacred and unique. The patients who learned about death and talked about what they wanted to develop a realistic plan for their comfort. They were more likely to avoid unnecessary suffering for themselves and their families.

At a point in the dying process, you’ll become unconscious and no longer able to express your wishes. Talking sooner than later about your end-of-life needs empowers your family and caregivers to care well for you when that time comes.

What it’s like to die: signs and symptoms of natural dying

A “natural” death refers to someone dying of a terminal illness or old age. More sudden death due to a traumatic injury will have some of these similar signs but at a more rapid pace depending on the injury. These signs and symptoms occur during the last few months to hours of a dying patient.

1. Weakness and fatigue

As the end nears, it’s normal to feel weak and sleepy, but the timeline differs for everyone. Some become weak quickly while others – often younger or healthier at diagnosis – take longer but then decline rapidly.

It’s okay to sleep as much as you need. Try to time your daily tasks and activities for when you’re more likely to have energy.

As you get weaker, a simple activity like sitting outside, going out to eat, or being with your children can cheer you up, even if it’s exhausting. But there may be a point where you simply can’t do it anymore.

Be honest with your loved ones and caregivers about how you’re feeling. Rather than push yourself too hard, be willing to ask for help when your muscles become too weak to move on their own.

2. Social withdrawal

As you progress toward death, you may feel less social. It can be hard to tell this to your loved ones, especially if you’re from a culture or community that many people want to visit. But it’s okay to let them know if you want fewer visitors. Try your best to explain how you feel, assuring them it’s not their fault.

At the end of life, some people want to be surrounded by friends and family instead of becoming less social. Let your loved ones know if you enjoy their visits.

As you feel more withdrawn and weaker, consider the remaining important things you wish to say and try to have the courage to say them before it’s too late.

3. Pain

Your pain may increase as your disease advances or your joints stiffen, but no one should suffer needlessly. Medications, hospice care, and alternative health treatments all help ease your discomfort.

It is difficult for your loved ones to see you hurt. Be sure you talk thoroughly with them about how you want to manage your pain. You may want enough medication to ease the pain while also staying awake with loved ones. Or, you may want the medicine to help you sleep painlessly for much of the day.

Take oral pain medications 45 minutes before the pain becomes intense or before you have an activity planned. Use consistent language to describe your pain so loved ones and caregivers understand when it changes. Make a list of questions about pain management to ask your hospice nurse during their next visit, such as when to call them about increasing pain and how best to take your pain medication. Consider alternative treatments like acupuncture, massage, music therapy, or Reiki.

As you near death and can no longer talk, your loved ones and medical providers will watch for nonverbal signs of pain like grimacing, moaning, stiffening, resistance when they try to move you, calling out, restlessness, or labored and uncomfortable breathing. They can give you medications for any signs of discomfort.

You can trust that with medical help like hospice, you’ll be more comfortable and peaceful.

4. Loss of appetite and thirst

Nearly all patients lose their appetite as they near the end. Your brain will not trigger hunger and thirst sensations during the final stage of death, so you may have no desire to eat or drink.

Eating and drinking less – or not at all – is a normal part of dying as the body stops using nutrients like it did when it was healthier. As a result, your hospice nurse won’t advise trips to the hospital for intravenous (I.V.) fluids or artificial nutrition.

Your loved ones might fear you’ll “starve to death” and plead with you to eat or drink, believing it will increase your comfort and strength. Remind them with kindness that you’re not uncomfortable. When your body is dying from an incurable illness, it will continue to shut down no matter how much you eat.

Eating or drinking less may make your mouth dry and uncomfortable, however. You or your loved ones can apply lip balm and mouth moisturizer. You can also lightly moisten oral sponges with water to moisten your mouth.

5. Dreams, visions, and hallucinations

In the final days and hours, you may become less alert, drifting in and out of consciousness. Many dying patients have dreams and visions of lost loved ones, God, or other spiritual realities. You may experience hallucinations or a surge of energy just before you die. Some feel an increased awareness of death as it gets closer.

For most people, this delirium or altered state of consciousness is peaceful and not distressing.

However, if you become agitated, medications like haloperidol can restore your comfort. Caregivers can also check for other problems like pain, constipation, bladder infections, or side effects of medication.

If you experience such symptoms when you are still awake and alert, it can be helpful to talk with loved ones or care providers like end-of-life doulas and hospice nurses, counselors, and chaplains.

6. Bladder and bowel changes

At different stages during the dying journey, you may notice bowel and bladder changes.

Your urine may change color due to organ failure, and you may urinate less. Depending on your disease process, you might lose control of your bladder – also called bladder incontinence.

Incontinence can cause skin breakdown for bedridden patients. If this happens, some medical providers recommend a urinary catheter if they increase patient comfort while protecting their skin. A catheter may also be recommended if your bladder is retaining urine.

Constipation is not uncommon at the end of life. Your medical providers should counsel you on taking stool softeners and laxatives for constipation. These should be stopped or decreased, however, if you stop eating.

It may feel awkward, but it’s always best, to be honest about these symptoms with your caregivers.

7. Skin changes

In the later stages of the dying process, your skin may change in temperature and color as it stops functioning. During your final days, your body will move blood away from your arms and legs while it shunts it to the vital organs. These changes can make you feel cold and make your skin look pale, gray, or blotchy.

Some people, however, feel warm and flushed or develop a slight fever. A cool cloth on one’s forehead may ease the heat.

Keep your loved ones informed when you get too cold or hot. This helps them understand your body’s trend to care for you when you’re unconscious. Heated blankets and heating pads can be helpful but can also burn your skin if ignored.

8. Breathing changes

When people are within days to hours of dying, their breathing changes. Sometimes it’s very slow and regular with only a few breaths each minute. For others, it’s slow and irregular where they may breathe three breaths and then wait 45 seconds to take another breath.

Some patients breathe very fast, then slow down, pause, breathe fast again, and so on. This is a normal end-of-life breathing pattern called Cheyne-Stokes respiration. It can occur when the brain forgets to trigger breathing.

When you reach your final breaths, agonal breathing is common. Agonal breaths look like the patient is trying to gulp for air and can be distressing to loved ones if they’re unfamiliar with it. Nurses sometimes nickname it “guppy” breathing because the mouth opens wide and the jaw and shoulders work to pull oxygen into the lungs.

When the diaphragm and other muscles weaken, phlegm builds up in a dying patient’s airways, making a rattling sound when they breathe. This is known as the “death rattle.” If this rattle occurs to you, it will not feel uncomfortable, but the sound can be distressing to loved ones. Your caregivers may reposition your body or your neck to reduce the rattle.

If a medication like atropine is given at the beginning of your final days, it may improve the death rattle later when it occurs in your final hours.

These breathing changes – even agonal breathing and the death rattle – rarely, if ever, cause discomfort. They are a normal part of dying and occur when you are in a relaxed and unconscious sleep.

If your breathing does look painful, very labored, or very rapid, your loved ones or nurses will give you a medication like oral or I.V. morphine, because the labored breathing may be a sign of pain. Morphine is typically the end-of-life pain medication of choice because it not only dulls the pain but also eases your breathing.

You may want to continue wearing oxygen as you reach the end. In most cases, it will not lengthen your life significantly during the final days, but some people find it comforting.

9. Heartbeat and blood pressure changes

Changes in your heartbeat and blood pressure will also occur. Your heart rate may become irregular and eventually weaker as your heart fails. These are normal changes and are not treated at the end of life. To de-medicalize the dying process for the patient and their loved ones, most medical providers will stop monitoring vital signs during a patient’s final days.

Facing death takes profound courage. If you have an incurable illness and know death approaches, gather your loved ones and your medical team around you. Consult with a palliative care specialist sooner than later to help you through the journey. Be sure to talk openly with them about tough topics such as what it’s like to die and how they can help make you comfortable.

Complete Article HERE!

Seven Common Requests From Dying Patients

Patients want comfort and peace at the end of life, but each one defines this differently. Death is a deeply personal journey, and more than anything when facing death, patients want medical providers and loved ones to hear and value their unique needs.

By Sharleen Lucas, RN

  • Dying patients want comfort and peace. Each patient defines this differently, but there are 7 common requests they make.
  • They want dignity and open talks about their illness and their treatment.
  • They want to be comfortable.
  • They want relief from burdens, time with loved ones, and a legacy that outlives them.
  • They may even want to die alone.

Death is a sacred journey, unique to each person. Knowing what a dying loved one wants is what matters.Patients with advanced illnesses may have a few days or years to live. The phrase “end-of-life” refers to the final stage of an incurable disease or injury. A time frame does not define this last stage of life because it’s a unique journey for each person.

“Every death journey follows along the same path in different ways,” explains Delta Waters, a death doula, and registered nurse. Like birth, each patient has unique symptoms and desires.

Patients, end-of-life specialists, and researchers agree on these seven common requests from dying patients.

1. Dignity

Dignity refers to a person’s inherent nobility and worth. Respecting a patient’s dignity is one of the most common values held by patients, loved ones, and medical providers alike.

But dignity is not an objective, one-size-fits-all concept. It means something different to each person.

“To most end-of-life patients, dignity means, ‘Until my dying breath, I feel like you treat me as if I’m alive and cared for,'” said Beth Patterson, a certified end-of-life doula, and veteran palliative care chaplain.

To one patient, feeling alive and cared for might mean staying on a life-saving machine until they die. To another, however, removing devices is more dignified. Some patients may want a family member to care for their bodily needs, while others may hire an objective caregiver.

Either way, honoring a patient’s wishes whenever possible is the best way to honor their dignity.

2. Open talks

When you’re well, you don’t care to talk about sickness. But when you’re sick, almost everyone wants to talk.

According to a 2011 study of Californian’s attitudes toward end-of-life, 79% of people would “probably” or “definitely” want to talk with a doctor about end-of-life treatment if diagnosed with a serious illness.

Most patients want frank discussions, but some don’t, asking doctors to give the hard truth to their loved ones instead. Many want to know how the medical team will treat their pain and symptoms. A few want to know what the end will be like. Sometimes patients want advice on talking with family or finding meaning in their final days.

Studies confirm that when medical providers talk openly with patients and their loved ones about their dying journey, it improves the quality of life for the patients and their families. It also decreases excessive treatment – which often causes greater patient suffering.

The 2011 study in California found that a quarter of Californians faced language issues with their medical providers, drastically reducing their quality of care. To prevent this, medical providers are required to provide interpreters.

But not all talking needs to be about a patient’s end-of-life treatment, Waters told me. A simple chat over a cup of coffee about whatever comes to their mind helps dying patients feel normal.

3. Comfort and symptom relief

It’s not surprising that dying patients want to be comfortable. Most importantly, comfort means symptom relief, but it also includes how and where they want to die. Most people prefer to die a natural death at home rather than in a hospital connected to machines.

Common end-of-life symptoms include pain, shortness of breath, increasing weakness, anxiety, nausea, loss of appetite, and thirst. Some patients want these symptoms controlled to the point where they mostly sleep. Others choose to endure some discomfort to be awake with loved ones.

Doctors and nurses provide many medical tools for managing symptoms. Patients may also find relief from complementary and alternative therapies.

The goal of symptom relief is comfort – as defined by the patient. Not clearly understanding a patient’s symptoms and desires for comfort can increase their suffering.

4. Relief from burdens

End-of-life patients worry about their families, their finances, and what the end is like. Most of all, dying patients want to know their loved ones will be okay.

One of the best ways to ease these burdens is hospice care. Hospice offers holistic care and counseling for patients facing their last six months of life. With care provided by nurses, aides, medical social workers, counselors, and volunteers, hospice is typically free of charge thanks to Medicare coverage and hospice fundraising.

Sadly, however, most patients wait too long to start hospice. Instead of using hospice for their last six months of life, about 50% of patients only use it for their final 18 days or less.

Contacting hospice sooner helps relieve patients and loved ones of their worries. At a time when every day counts, hospice may even lengthen patients’ lives for up to 29 days.

5. Time with loved ones

Most dying patients want to spend as much time as possible with loved ones. Many want to strengthen relationships, resolve old hurts, and pass on love, wisdom, and stories.

In his book, Dying Well, Dr. Ira Byock says there are five necessary statements to say to your loved ones at the end of life.

  1. Forgive me
  2. I forgive you
  3. Thank you
  4. I love you
  5. Good-bye

These statements help relieve the spiritual and relational burdens of both the dying and their loved ones.

6. A legacy

Loretta Bruening, Ph.D., founder of the Inner Mammal Institute, writes, “You are hard-wired to care about what you leave behind when you’re gone…The neurochemistry that drives animals to promote their genes is what drives you to care about your legacy. Understanding that is important to your happiness.”

Contributing to others and leaving a legacy is called generativity in psychology. It refers to the need of humans later in life to leave their mark. They want to create something that will live after they die.

End-of-life studies support this, saying dying patients show a need to contribute to their community to feel needed, significant, and remembered. Some patients create gifts, start projects, continue to work or make financial donations. Others offer time and knowledge to their community and loved ones.

After working with thousands of dying patients, Patterson knows the importance of a legacy unique to each person. She told me about one patient who left a legacy of “words and actions” by earnestly creating videos for his wife and the first responders he led as captain of the fire station. In contrast, Patterson also recalled a Buddhist coworker who felt no need to create a legacy because her “life was her legacy.”

7. Maybe to die alone

As Waters reminds us, “In the end, even though death is a universal human experience, it’s still a solitary journey for each person.” And some want it that way.

As an RN, I cared for a dying patient in the hospital who lived days longer than his family expected. At age 90, with a failing heart, we thought death would come quickly. His family sat with him each day, taking turns at night. They grew exhausted after several days but were grateful to be with him.

They wondered why he held on so long. We discussed that perhaps he wanted to die alone, so the family decided to go to dinner together, leaving the patient with our staff for an hour.

Not long after they left, his breathing changed and slowed, eventually stopping before the family returned.

Patients who want to die alone are common, according to hospice staff and death doulas. It can be hard on loved ones, but letting patients die alone if they want to is another way to honor their wishes and dignity.

There’s no “right” way to die. Death is an individual’s sacred and one-of-a-kind moment. What matters is honoring each patient’s unique dignity and desires.

Complete Article HERE!

Dementia: How long can a person live without eating or drinking?

By Belinda Weber

Many people living with the later stages of dementia may not eat or drink. They may also develop dysphagia, which prevents them from swallowing effectively. How long a person can live without food and liquids varies, but doctors believe that sufficient end of life care may help improve their quality of life.

Dementia refers to a group of neurocognitive conditions that can permanently damage the brain. Alzheimer’s disease is the most common type, accounting for between 60% and 80% of dementia cases, according to the Alzheimer’s Association.

This article explains why someone living with dementia may stop eating and drinking. It also suggests ways carers can support them.

There are many reasons a person may stop eating and drinking. As a neurocognitive disorder progresses, most people become less active and do not need to consume as many calories.

According to the National Foundation of Swallowing Disorders, at least 45% of people living with dementia also experience dysphagia, which refers to difficulty swallowing. This can cause a person to be unable to consume adequate nutrition and liquids.

People living with dementia may also notTrusted Source be as diligent about their oral hygiene as they once were. This can cause them to have sore mouths, teeth with infections, or ill-fitting dentures.

Another reason may be that the damage in the brain has spread to the hypothalamus, the area that regulatesTrusted Source food intake. Alternatively, it could be that the person no longer recognizes things as food or forgets about eating.

Age can also play a part as the muscles involved in swallowing lose mass, resulting in a loss of strength and range of motion. The person may feel as if they are choking on food or cannot move it out of their mouth.

No one can say for sure how long someone can survive without eating or drinking, as it involves many factors. These include the person’s age, overall health, and how well their immune system can fight infections.

If someone has dysphagia, this can indicate that their neurocognitive disorder is progressing, as dysphagia usually occurs in the later stages. This increases the risk of a person inhaling food or liquid, leadingTrusted Source to chest infections.

While it is impossible to predict exactly how long someone can live without eating or drinking, having dysphagia can mark the beginning of end of life careTrusted Source.

People living with a neurocognitive disorder may benefit from end of life care for days, weeks, months, or years.

Artificial nutrition and hydration (ANH) is a procedure where doctors deliver nutrients and fluids intravenouslyTrusted Source into a person’s body via a tube. This tube runs into the stomach from the nose or a device fitted into the stomach.

However, these doctors need to administer these treatments in a medical setting, and many people with a neurocognitive disorder find the experience distressing. Some individuals may try to remove the tubes.

Doctors do not agree about recommending ANH for people living with late stage dementia as it is unclear whether it provides any overall benefits.

The American Speech-Language-Hearing Association notes that tube feeding does not improve the quality of life of a person with a diagnosis of dementia. Additionally, it states that tube feeding does not reduce their risk of developing a chest infection.

The Alzheimer’s Association recommends people living with a neurocognitive disorder plan their late stage care while they can still express themselves and make decisions. This can include whether or not they want ANH.

When someone living with dementia is nearing death, they tend to deteriorate more rapidly. They may develop incontinence and agitation.

According to the United Kingdom’s Alzheimer’s Society, signs that death is near for someone living with dementia include:

  • loss of consciousness
  • irregular breathing
  • restlessness
  • rattly sound in the chest
  • cold hands and feet

A 2019 study listed pneumonia as the cause of death for 50%Trusted Source of people who required hospital care due to dementia.

Doctors recommend helping someone eat and drink for as long as they can, even if they eat in small amounts. The Alzheimer’s Association suggests:

  • offering soft foods
  • thickening liquids with cornstarch or unflavored gelatin
  • alternating bites of food with sips of drink
  • offering sherbet or ice cream
  • serving finger food if someone has difficulties using cutlery
  • helping the person sit in an upright and comfortable position

Many people living with a neurocognitive disorder may stop eating and drinking. This may be due to infections, but it may also result from individuals experiencing swallowing difficulties.

Swallowing difficulties, or dysphagia, often indicates that the person’s neurocognitive disorder is progressing and may have reached the later stages.

Doctors believe that the person’s body adjusts to the reduced food and liquid intake and that people do not feel hunger or thirst.

Swallowing difficulties increase the risk of inhaling food particles or fluids, which can lead to chest infections, including pneumonia.

Complete Article HERE!

‘It’s a right over our own bodies’

— A remarkable documentary on medically assisted death

‘Getting to bring him home and put his bed right in the middle of the living room and then surround him with love was the greatest gift.’ Ondi Timoner and Eli Timoner in Last Flight Home.

Film-maker Ondi Timoner captures her family in a transitional phase, approaching death head-on in Last Flight Home, after her father requests the right to die

By

In late January 2021, Eli Timoner was hospitalized with difficulty breathing. It had been a long, slow physical decline. The 92-year-old entrepreneur and father of three had been paralyzed for 40 years after a stroke when he was 53; during the isolation of Covid, his mobility worsened, putting a great strain on his wife of 55 years, Elissa. Now, due to chronic obstructive pulmonary disease and congestive heart failure, he was permanently bedridden. Reached by phone in the hospital by his daughter, the documentary film-maker Ondi Timoner, Eli reports that he feels finished, is “just waiting to die”.

“Waiting to die?! I thought you were waiting to see me today,” a shocked Ondi responds. But Eli is adamant: “If they could give me goodbye powder, I’d take it.”

Last Flight Home, Ondi’s remarkable documentary on her father’s final days and medically assisted death, begins from this point of certainty. To be bedridden meant a transfer to a full-time care facility, which was a non-starter for Eli. He was in constant pain, tired, done. Cut to, less than five minutes into the film: a Zoom call between hospital-bound Eli, Elissa, Ondi and her siblings Rachel and David, discussing the possibility of medically assisted suicide. The conversation is the film in miniature: at once profound and practical, wry and devastating. A rare example of how to approach death collectively. How to do it legally, according to California’s End of Life Option Act. (There are 10 states that allow for medical aid in dying, in addition to Washington DC.) How to do it spiritually, as a family losing their patriarch, best friend, husband, father, grandfather. How to answer your loved one when, faced with terminal illness, they say: “I want it to end. Right away.”

The Timoners were supportive of Eli’s decision for medically assisted death, though confused on how to enact it, let alone live it for the state-mandated 15-day waiting period between evaluation by a physician and the administration of the lethal prescription. “I had no idea. It was like walking on the moon in my parents’ living room,” Ondi told the Guardian.

Last Flight Home captures a transitional phase – tasks to do, words to say, love to be honored and consecrated. There are final Zoom farewells, sentimental and largely upbeat, peppered with anecdotes from Eli’s time as founder and CEO of Air Florida in the 1970s and his lifetime as a friend. A follow-up appointment via Facetime with a different physician to confirm, in compliance with California law, the first doctor’s approval of the prescription. A meeting with a death doula, to whom Eli expressed his fear of being placed in a coffin while still alive. Practice drinking a smoothie with a straw, to ensure that Eli can, again in compliance with state law, take the medicine by his own hand. Conversations about life, about feelings of shame and gratitude, about funeral plans, old photos, monthly utility bills.

“There’s an unreality to it all,” Elissa, mostly camped on the living room couch, says in the film. “We’re just putting one foot in front of the other.”

The surreality, a mixture of familial candor and delicateness, was “a position that a lot of people find themselves in, and families find themselves in, because our culture doesn’t really set us up – we don’t talk about death,” Ondi said. “We’re really, really scared of it.”

Before her father’s decision, Ondi hadn’t really faced it, either. “I was panicking” at the beginning, she said, initially unaware of California’s End of Life Option Act. She began recording her father’s phone calls from the hospital. “I knew it was going to be imminent. I was just horrified at the concept that he would die as degraded as he felt. And he just felt like there was nothing for him here any more, and that no one cared besides the four of us, and that his life had really added up to a failure”, in large part due to material losses as a result of his disability. (Eli Timoner was forced out of his company following his stroke before the passage of the Americans With Disabilities Act in 1990.)

“Getting to bring him home and put his bed right in the middle of the living room and then surround him with love was the greatest gift,” Ondi said. “I don’t know where I’d be today if I didn’t have that chance. He was my best friend, my pal, and I was devastated, absolutely devastated.”

The cameras started rolling soon after, first as an archive rather than as a film. “I do a lot of recording, and my family is used to that, so no one knew that I was making a film, including me,” said Ondi. “I was desperate to bottle him up somehow.”

Filming such sensitive, raw moments was a family agreement. Eli, ever supportive of Ondi’s work, was on board with any future project to be made from the cameras installed throughout his living room. (Ondi also edited the film.) So were Elissa and David. Rachel, who has supported many people and their loved ones at the end of life as a senior rabbi with Congregation Beth Elohim in Brooklyn, was more wary.

Clockwise from top left: Elissa, Eli, Rachel, Ondi and David Timoner in an archival image taken at Boeing headquarters in Seattle on 30 October 1979.
Clockwise from top left: Elissa, Eli, Rachel, Ondi and David Timoner in an archival image taken at Boeing headquarters in Seattle on 30 October 1979.

“It felt so private,” she said. “Even though I don’t shy away from talking about death and having these conversations, it did feel like it was really just for us and not for anybody else’s eyes.

“Part of what’s important about the dying process is that it be unmediated,” she added. “That it could be just private.” She came around slowly first to the filming, then to its public distribution. Her father was supportive, first of all, as was her mother, who found comfort in the footage after Eli’s death, watching it nightly for months. “If my mother is getting solace from this, then that’s by far the most important thing,” said Rachel. And then there was the effect on audiences. Viewers of the film left the theater “in awe about life, about love, about that if we are courageous enough to turn toward death, we turn toward life,” she said. “That to me feels like a really holy purpose. And I relinquished any concerns I had.”

Plus, she said, it could help influence other states to adopt compassionate choice laws. The film is adamantly for compassionate choice, which is still working through the New York legislature – “If you’re terminally ill, you should have the right to terminate your life if you don’t want to suffer any more. It’s a right over our own bodies,” said Ondi.

But the film does not shy away from discomfort with the process as it currently exists. The administration of the medicine is an ordeal of choreography and solemnity, trying to balance saying the last goodbye with specific, critical instructions; the final mixture must be consumed in full in under two minutes. That countdown, in which Eli, held by children and grandchildren, struggles to swallow the bitter poison against the clock and says “I can’t” is edited down but still feels 10 minutes long, a stressful race against time.

“It felt like an obstacle course,” said Ondi. “There’s got to be a more humane way to do this … We were surrounding him and it was going to be this really peaceful journey out, and to see him saying ‘I can’t stand it’” – referring to the taste of the final medicine – “that that was his last experience on earth was really sad to me.”

But in the end, peace. Eli died shortly after finishing the medicine, on 3 March 2021. Until then, he comes across as compassionate, generous, funny. “This film is exactly who he was,” said Rachel. “He just paid attention to everybody else, and rooted everybody else on,” said Ondi. “And I just aspire to have one-tenth of that generosity and grace.”

A final act of generosity: the willingness to speak openly about death, to offer a model of how one could embrace the end. “I hope people get inspired to face the fact that they and everyone they love is going to die,” said Rachel of the film. “And if they have the courage to talk about it, and to plan for it a little bit, that they have a real chance to have a beautiful, good death. And that that is a way for them to seize their lives. It is a way for them to embrace their living.”

  • Last Flight Home is released in US cinemas on 7 October and UK cinemas on 25 November

Complete Article HERE!

Final moments of life have one thing in common

— Three professionals who work with death and dying have described the one thing they all have in common.

By Bek Day

Woody Allen famously said “I’m not afraid of death, I just don’t want to be there when it happens,” and whatever you think of the scandal-plagued filmmaker’s behaviour in life, it’s a sentiment many can agree with.

“We live in a death-denying culture,” says Dr Merran Cooper, who is also trained as an end-of-life doula and physiotherapist. “By denying the possibility we might die, and having conversations about it, we deny ourselves the opportunity to have the most important conversations of our lives with the most important people.”

But just what are those all-important final moments like for people? Is death really as frightening as we think?

News.com.au spoke to three professionals who work with death and dying and their descriptions all had one major thing in common: it’s usually more peaceful than you might expect.

Camilla Rowland, CEO of Palliative Care Australia

“My experience has been that usually as the different organs start to shut down, people come in and out of a semiconscious state, and it is usually very peaceful,” Camilla explains, adding that the feeling of someone’s ‘spirit’ ‘energy’ filling the room is also common.

“I’ve had that experience, and also many other members of my palliative care team have said that as well, that they felt the spirit of the person around them. And that’s not necessarily a religious thing, it’s just a feeling that occurs. I’ve had people from all walks of life and all different belief systems say the same thing.”

Patsy Bingham, Death Doula

“Peace, calm, relief, hysteria – there could be any one of these feelings depending on who died, how they died and whether they were too young to die,” explains Patsy.

“But for everyone, it is a defined moment in time, and I have a habit of looking at the clock when someone takes their last breath, as family members don’t, and then ask later.”

Dr Merran Cooper, CEO of Touchstone Life Care

“Everyone dies differently but most commonly, when death is expected, a person begins to sleep more, and breath more shallowly until it is very hard to tell whether they are breathing or not,” Dr Cooper explains.

“It can be a peaceful thing to watch. There are noises that worry the person watching, and even bleeding which is distressing to watch, but for the person dying, they slowly move to a place of deeper and deeper unconsciousness until they do not take the next breath.”

Complete Article HERE!

‘A Last Act of Intimate Kindness’

I had barely seen my brother in decades, but when time was short, he let me in.

By Michelle Friedman

The message I had dreaded for years appeared on my phone: “Looking to find the sister of my patient, Jay Friedman.”

My ensuing phone conversation with the doctor brought ominous news. My 65-year-old brother, Jay, had advanced pancreatic cancer. He and I grew up together in Divine Corners, N.Y., a hamlet in the Catskills, raised by secular Holocaust survivor parents who stumbled into raising chickens. Their histories, coupled with the isolation and poverty of the farm, rendered my father brutal, especially to his only son.

I am the only family member with whom Jay maintained contact for the last three decades. Over that time, we communicated exclusively through email and cards I sent to a post office box. Despite working a quarter century in I.T. for the local school system, my brother did not own a cellphone. His doctor found my number via Google.

Jay was admitted to a fancy Seattle hospital where I called him via the landline next to his bed. His voice sounded weak, plaintive.

“Jay, I’ll come,” I said. “Let me be with you.”

“I don’t know,” he said. “My house is a mess.”

“I can stay in a hotel.”

“I’ll let you know.”

I panicked. I knew the prognosis was dire, but my brother’s lonely life cast an even darker shadow.

The hospital discharged Jay with a bag hanging from his chest to drain bile from his tumor-blocked liver. A few days later the doctor called again. Jay wanted my help.

I caught a flight to Seattle, picked up a rental car and drove around Puget Sound to a town in Kitsap County. Before entering Jay’s house, I muttered an ad hoc prayer for strength. Following the sounds of his weak voice through the maze of papers, boxes and computer parts, I found my brother lying on the couch. The disease had consumed him, leaving his body whittled, skeletal. Only Jay’s voice sounded familiar, a gravelly baritone.

“Thank you for coming,” he said. “I’m sorry I was snappy over the phone.”

The blanket wrapping my brother was full of holes. A brown crust covered his kitchen floor and counters. Jay drank tea with lemon in the one glass he possessed. Not owning a kettle, he boiled water in an old pot.

I brewed tea and baked a piece of chicken. After a few sips of liquid and child-size bites of food, Jay felt full. He slowly climbed the stairs to the single bed in his bedroom. The sheets hadn’t been changed in months. All I found in the closet was a cotton duvet cover that I recognized from the farm where we grew up. The faint smell of the detergent and crisp lines from our mother’s iron told me Jay had never used it.

Retreating to a Best Western hotel two miles away gave me guilty relief. It was no palace, but it was clean and orderly.

In the morning, the doctor outlined my brother’s stark medical options. Surgery was out. Jay could pursue radiation or chemotherapy, but neither was likely to yield much in terms of quantity or quality of life.

Jay made his choice in seconds — no aggressive medical intervention. The focus shifted to palliative care at home.

He didn’t have much time, weeks. How was I to start a conversation with him about his death? I knew he took pride in his money management and had saved a lot (though I had no idea then how surprisingly much), so that’s where I started.

“Jay, have you thought about what you want to do with your money?”

“Yes, I’ve thought about this a lot. I want to give it to Planned Parenthood.”

“All of it?”

“Yes.”

His calm answer startled and pleased me. Throughout our decades of sparse contact, Jay stayed vague when it came to his personal opinions.

“Jay, that’s amazing! How did you come to this decision?”

“There are too many people in the world, and I believe that people should have autonomy over their own bodies.”

I sat in silence thinking about my brother’s autonomy, the little boy overwhelmed by our rageful father, the awkward teenager who wanted to join the Navy to get away but lacked nerve. My practical mind kicked in. “Jay, do you know a lawyer?”

Once again, he surprised me. “Yeah. One of the teachers I know went to law school at night. He’s a good guy.”

Jay had no contact information for the lawyer, but I found him through the school. He answered my text within minutes and got to work preparing the necessary papers.

By the next day, Jay could no longer crawl up and down the stairs and spent most of his time in his bedroom. We moved the mattress to the floor in case he rolled off during the night. I pleaded with hospice to fast-track Jay onto their service, and soon a nurse arrived and taught me how to dose the medication: morphine for pain, Haldol for nausea and Lorazepam for anxiety. Each floated in a medicine-dropper-topped bottle so that liquid relief could be applied to the inside of the patient’s cheek.

Jay’s condition deteriorated quickly, and I no longer retreated to the Best Western. My first night in Jay’s house, I slept downstairs on the sofa. The next night, I worried that I wouldn’t hear his whimpers, so I moved to the floor next to his mattress. My younger brother’s vulnerability pierced me; he was the innocent little boy on the farm who trusted me. I cried, silently.

When he no longer ate or drank, I repurposed a medicine dropper to drip orange juice and seltzer onto his parched lips.

The lawyer met privately with Jay and later told me of his firm wish to be cremated.

A clutch grabbed my heart. Jewish law, which I follow, prohibits cremation. “Can I at least get Jay’s ashes so that I can bury them according to our faith?”

“Yes. I think that will be OK.”

“We haven’t talked about this, but I’m wondering if you are part of a religious tradition?”

“I am. The Church of Jesus Christ of Latter-day Saints.”

His answer bolstered me, given what I was about to request.

“Can I ask you one more favor?”

“Sure.”

“When the time comes, I want to do a Jewish ritual washing for Jay. It’s called a tahara. It means purification. I’ll need help; it’s too hard to do alone.”

“Of course. Call me when you need me.”

The days passed in a kind of waking dream. Jay talked on and off, disclosing struggles of all kinds. He liked hearing stories about Divine Corners, how we played in the snow and explored the brook behind the coops. I emptied his drainage bag and changed his adult diapers.

“This is disgusting,” he said.

“I’m fine,” I said. “I’m here for you. There’s nothing else I want to do.”

As our mother did when we had fevers as children, I gave Jay a sponge bath and changed his worn pajamas to a clean set.

Jay quietly slipped away. He told me that his dream was to buy a house on a lake with a few acres of land.

“That’s such a nice idea, Jay,” I said. “I love you.”

“I love you too.”

And then I made a plea I knew people have uttered for millenniums. “Send me a sign, Jay. Please send me a sign from the other side.”

Early Thursday morning I woke up inches from my brother to find him gone. No labored breathing, no death rattle. His skin had cooled, his limbs stiffened.

When the sky was fully lit, I called his friend, and we performed the tahara. We removed Jay’s pajamas, removed the drain and bag, all the while using a clean sheet to keep his frame covered and dignified. I repurposed the battered teapot to pour water over his body, starting with his head and moving to his feet. We toweled him dry, dressed him in long underwear and wrapped him in the duvet cover from our childhood farm. The work felt tender, holy, a last act of intimate kindness.

The mortuary people came and removed Jay’s body. At 6 o’clock I boarded the van for the airport. Only one other person got on, a white-haired woman in a sweater set. I saw that she bid a sorrowful farewell to the man seeing her off. She sat a few rows behind me. Drizzle and traffic caused delays, but our elfin driver navigated the trip and asked us which terminals we needed.

“American,” she said, turning mournfully in my direction. “It’s a sad trip. My brother is dying of brain cancer in Florida.”

“United,” I said, and to her: “I just left after taking care of my brother, who died this morning. I hope you get there in time.”

We reached across the aisle and held hands. Jay had made good on his sign.

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‘I’m a Death Doula and This Is the Top Way Most People Prefer to Be Comforted at End of Life’

By Jessica Estrada

Death doulas or end-of-life doulas, if you’re not familiar, are trained professionals who help people who are dying and their loved ones. These doulas provide emotional and practical support such as sitting vigil, helping plan funeral and memorial services, communicating with the medical support team, and assisting families with processing grief. Ensuring the person nearing the end of their life is comfortable is another big element of the job. While every death and situation is different, there are many practices and rituals that death doulas do—and teach and encourage the person’s loved ones to do—to bring comfort to the dying.

Below, Ashley Johnson, the founder of Loyal Hands, a team of millennial death doulas, shares five rituals, including the top way most people prefer to be comforted at the end of their life. Interestingly, many of these practices are universally comforting, even for those who are not actively dying, and can be incorporated now to help cultivate comfort in your everyday life.

Create a comforting ambiance

Setting the mood and creating a comfortable ambiance is important. Many people prefer to die at home, Johnson says, but wherever they may be, there are things you can do to make the environment as comfortable, familiar, and soothing as possible for them. To do this, she suggests asking the person what their ideal last day would consist of. Some ideas she recommends include playing their favorite music, having soft lighting, filling the room with soothing scents, and having their pets around.

Rub their feet or hands

Rubbing a person’s hands and feet can also provide comfort. “The last senses to go are usually touch, followed by hearing,” Johnson says. “Gently rubbing hands and feet will help the family and the dying process the labor of death. The comfort of massage helps relax tense moments. That sense of touch reminds the dying that they are loved and not alone.”

Sit vigil

Sitting vigil with someone nearing the end of their life also provides great comfort. Johnson says this involves sitting bedside with them, actively listening, and ensuring they are as comfortable as possible during their final hours. Sitting vigil also includes relaying any sign of pain to the hospice team.

Perform deathbed rituals

Deathbed rituals are a way to honor the dying person and their loved ones, Johnson says. Rituals can be done before, during, or after death and can be religious, cultural, or simply personal things the person finds comforting. For instance, Johnson recalls one client requesting that his family wash his body with warm water and lavender.

Shift their perspective on death

Death doulas also support the dying and their loved ones to adopt a death-positive mindset. They do this by having conversations about death, dying, and grief and encouraging them to view death as a normal part of life that everyone experiences. That can help reduce fears and anxiety around death.

Share and preserve memories

Another way death doulas help grieving families is by encouraging them to share memories and stories about their loved one. “This can help provide the family with a sense of purpose and also help significantly with coping and healing,” she says. You can get as creative as you’d like with this. Some ideas Johnson shares include capturing voice memos and videos, creating a family cookbook, planting trees in their honor, stitching a memory blanket together, donating to a charity they support, and keeping trinkets and mementos around that remind you of them.

Help get their affairs in order

According to Johnson, the top thing that makes people nearing the end of their life feel the most comforted is ensuring that their affairs are in order before they pass. Not only will this cause less stress to their loved ones, it also helps them achieve a sense of completion and peace before they pass.

“While legal documents are important, complete end-of-life care also includes helping the dying person spiritually, mentally, and emotionally in alignment as well,” Johnson says. “People ideally would like to transition with a sense of completion, a sense of satisfying their purpose here [in] this realm.” Examples of things that can provide that sense of fulfillment include extending forgiveness or requesting forgiveness from others, releasing things beyond their control, and addressing any fears or concerns around death.

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