Category: The Dying Process

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What to expect when someone is in the last few days of life

The dying process is unique to each person, however there are a few common changes that happen to almost everyone when they are in the last days of life. Some of these might look distressing, but most of the time the person is not in any pain, and they are just a normal part of dying.

Loss of appetite

When someone is at the end of life they will typically have less appetite, as their need for food and drink reduces. If they stop drinking and their mouth looks dry, this does not necessarily mean they are dehydrated.

It might be too much effort to eat and drink. If this is the case you can offer sips or small bites, provided they are conscious and can still swallow. You can also help someone with a dry mouth by:

  • offering a drink through a straw (or from a teaspoon)
  • moistening the mouth with a damp sponge – special kinds of sponge are available for this purpose (the person may bite on this at first, but keep holding it, as they will let go)
  • placing ice chips in their mouth
  • applying lip balm

Changes to breathing

As a person becomes less active towards the end of their life, they need less oxygen. Breathing may become shallower and there may be long pauses between breaths. They might yawn frequently, as this is a natural response to draw more oxygen into the body.

Their breathing can make a noise because they are not able to properly re-absorb fluids in their chest or throat, which can cause a rattling sound. This may be upsetting to hear, but it doesn’t mean they are in distress or need oxygen. It can be a bit like snoring – it affects those who hear it more than the person who is making the sound.

If their breathing is very loud, it may be helpful to change their position so they are on their side, as long as this doesn’t disturb them. You can ask to be shown the best way to move them – ask about sliding sheets.

The doctor or nurse may also suggest medication to reduce the fluids in their chest or throat. This is not always needed, and it does not always make a difference.

Anxiety can cause their breath rate to increase a little. Breathlessness can be frightening but simply sitting with them so they know you are there can help.

Needing more sleep

They are likely to spend more time sleeping, and will often be drowsy even when they are awake.  They may also drift in and out of consciousness. Some people become completely unconscious for periods of time before they die – this could be for a short period or as long as several days.

They may seem less interested in what is going on around them, and have less energy to take part, but this does not mean they can’t hear you.

You can carry on speaking quietly to them. You could also try letting them know you are there in other ways, for instance by holding their hand, reading to them, or playing their favourite music.

Restlessness

Some people can become restless in the last few days of life. They will usually become calm again before they die.

They may appear confused and not recognise familiar faces, and even see or hear people or things that are not actually there – for instance, they may see pets or people who have died.

While this can be upsetting it is not a sign that they feel differently about you. This can be caused by medicines or changes in the chemical balance of the brain, or as a result of drifting in and out of sleep so they are unable to clearly distinguish between what is real and what is not.

If they are agitated, often just sitting with the person can help to calm them down. You can also help by:

  • speaking clearly and audibly
  • reminding them who you are (and being prepared to do so repeatedly)
  • keeping their surroundings calm with few changes in noise level
  • trying not to correct them if they say something wrong, or insist on them getting things right, as this may be upsetting for you and for them

Agitation could also be a sign of constipation or difficulty passing urine. Ask the medical team if you have any concerns so they can rule out any underlying causes and if necessary prescribe medicine.

Changes to skin

Changes to the metabolism of the dying person can cause their breath, skin and body fluids to have a distinctive smell similar to that of nail polish remover. If a person is dying from bowel or stomach cancer, this smell might be quite strong.

The person’s hands, feet, ears and nose may feel cold. Their skin may also become mottled and blue, or patchy and uneven in colour. Occasionally, a person’s hands or other body parts may swell a little.

This happens due to reduced circulation and is normal. As the body’s functions slow down, blood may coagulate or pool, particularly at the base of the spine, which can cause patches that look like dark purple bruising. This is not usually painful or uncomfortable. Gentle massage can help, ask the nurses to show you how to do this.

Losing control of bladder or bowels

When someone is in the last few days of life the muscles in their bladder and bowels relax, which can cause them to lose control of their movements. This may be distressing to see, and they might feel embarrassed.

You can ask a nurse to show you how to keep their bed clean and comfortable. You can also ask for incontinence pads or a catheter – a long thin tube that can be put into a person’s bladder to drain urine.

It is also common to have fewer bowel movements if they are eating less, and urine may get darker as they drink less.

Complete Article ↪HERE↩!

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Doctor Who Has Witnessed Hundreds Die Explains How It Feels For Person Dying

It’s one of life’s greatest mysteries – what happens when we die?

By Daisy Phillipson

Although science is yet to figure this out, a palliative care doctor who’s witnessed hundreds of people pass away has drawn on his experience to describe what the dying process looks like.

Answering a reader question on the subject for The Conversation, Seamus Coyle, honorary senior clinical lecturer at the University of Liverpool, said: “As an expert on palliative care, I think there is a process to dying that happens two weeks before we pass.

“During this time, people tend to become less well. They typically struggle to walk and become sleepier – managing to stay awake for shorter and shorter periods. 

“Towards the last days of life, the ability to swallow tablets or consume food and drinks eludes them.

Some people think our brains release a rush of chemicals in our final moments. Credit: Unsplash
Some people think our brains release a rush of chemicals in our final moments.

“It is around this time that we say people are ‘actively dying’, and we usually think this means they have two to three days to live.”

That being said, some people go through this process in just a day, while others continue on for nearly a week, which Coyle said is often distressing for the families.

He explained the actual moment of death is trickier to decipher, adding: “But a yet unpublished study suggests that, as people get closer to death, there is an increase in the body’s stress chemicals.

“For people with cancer, and maybe others, too, inflammatory markers go up. These are the chemicals that increase when the body is fighting an infection.”

One detail he was asked about is whether the last moments of life could be euphoric, perhaps triggered by a flood of endorphins.

Although Coyle couldn’t give a definitive answer as it hasn’t yet been explored, he did point to a 2011 study that showed the levels of the happy hormone serotonin tripled in the brains of six rats as they passed away.

“We can’t rule out the possibility that something similar could happen in humans,” he said.

As for the bit we’re all concerned about – pain – the doctor explained: “In general, it seems like people’s pain declines during the dying process.

“We don’t know why that is – it could be related to endorphins. Again, no research has yet been done on this.”

During his time in palliative care, Coyle has witnessed the full spectrum of deaths, from people who are anxious right up to the end to those who accept their fate early on.

“Ultimately, every death is different – and you can’t predict who is going to have a peaceful death,” he said.

“I think some of those I have seen die didn’t benefit from a rush of feel-good chemicals.

“I can think of a number of younger people in my care, for example, who found it difficult to accept that they were dying. They had young families and never settled during the dying process.

“Those I have seen who may have had an ecstatic experience towards the end of their lives were generally those who somehow embraced death and were at peace with the inevitability of it.”

Complete Article ↪HERE↩!

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1 in 2 older adults now die with a dementia diagnosis

by Kim Callinan

Nearly half of all older adults now die with a dementia diagnosis, up more than one-third (36%) in just the past two decades, according to a new study published in the Journal of the American Medical Association.

While these findings are disheartening, they also serve to underscore the importance of advance care planning for the care we want – and don’t want – should we get dementia. Thinking through these difficult decisions and having conversations with our loved ones and healthcare providers now, while we are still capable of making our healthcare decisions, will be a gift to our loved ones and to ourselves.

A good time to discuss your end-of-life care wishes with your family is when you are together, like Memorial Day weekend in May.

It’s important to keep in mind that dementia, as a public health crisis, came as a result of significant advancements in medicine.

As we have discovered cures or treatments for many diseases over the last century that used to be life-threatening, life expectancy has increased, and more people are dying with and from dementia. In short, medicine can prolong how long the body lasts, but not the mind.

However, the default mode within our medical system is to extend the patient’s life, regardless of the quality of life, even for people with advanced dementia. We even subject advanced dementia patients to aggressive end-of-life interventions that inflict needless suffering with little thought.

Dementia patients take comfort from their surroundings; transferring them to a hospital causes agitation, upset and in the most extreme situations, trauma. Yet, nearly six out of 10 nursing home residents with advanced dementia (57%) go to the emergency room at least once in the last month of life.

Furthermore, emergency room physicians are trained to extend life. This reality means you could be subjecting a patient with advanced dementia to cracked ribs as a result of cardiopulmonary resuscitation (CPR), an uncomfortable urinary catheter, or a breathing tube.

A small percentage of people may want these aggressive interventions. However, more than nine out of 10 Americans (92%) agree that a person should “have the legal right to put in writing in advance that they want their caregiver and medical team to stop medical treatments when they are at a specific stage of dementia,” according to a 2018 survey by NORC and the University of Chicago commissioned by my organization.

The way to solve this crisis is to balance our advances in medicine with empathy and respect for the voice and wishes of the individual; to be seen and heard as an individual and not just as a patient.

While every person does have a legal right to forgo treatments, operationalizing this desire is not clear-cut. Dementia is a progressive disease: it’s not always obvious to loved ones the point at which their loved one would want to forgo treatments. Is it when they no longer recognize you, even if they seem otherwise happy? Is it only if they get violent? Or perhaps it takes multiple factors (e.g., can no longer eat, speak, dress themselves or carry on a conversation)?

I encourage all of us to give our loved ones the gift of clarity by filling out the free-of-charge Compassion & Choices dementia values and priorities online tool (values-tool.compassionandchoices.org); this tool helps you create a personalized care plan, based on your selected preferences, that your health care proxy can use to care for you should you get dementia.

While unfortunately there is no cure for dementia, we can take proactive steps to die naturally, potentially with less suffering, through advance care planning.

Complete Article ↪HERE↩!

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First ever recording of moment someone dies reveals what our last thoughts may be

Does your life really flash before your eyes when you die?

By

What happens when we die?

Scientists may finally be in a position to answer that question after they recorded the brain waves of a patient as her life ended.

Crucially, they didn’t set out to capture this data – instead it ocurred by happenstance.

Researchers in the United States were running an electroencephalogram (EEG) on an 87-year-old man who suffered from epilepsy.

An EEG measures the electrical activity of your brain and, in this case, was being used to detect the onset of seizures.

However, during the treatment, the patient had a heart attack and died.

As such, the scientists were able to record 15 minutes of brain activity around his death. And what they found was extremely interesting.

Focusing on the 30 seconds either side of the moment the patient’s heart stopped beating, they detected an increase in brain waves known as gamma oscillations.

These waves are also involved in activities such as meditation, memory retrieval and dreaming.

We can’t say for sure whether dying people really do see their life flash before their eyes, but this particualar study seems to support the idea.

And the scientists say the brain is capable of co-ordinated activity for a short period even after the blood stops flowing through it.

‘Through generating oscillations involved in memory retrieval, the brain may be playing a last recall of important life events just before we die, similar to the ones reported in near-death experiences,’ said Dr. Ajmal Zemmar, lead author of the study, which was published in the journal Frontiers in Ageing Neuroscience.

‘These findings challenge our understanding of when exactly life ends and generate important subsequent questions, such as those related to the timing of organ donation.’

In the study, the researchers point out that similar changes in brainwaves have been detected in rats at the time of death.

However, this is the first time it’s been seen in a human.

Dr. Zemmar and his team say that further research needs to be done before drawing any definite conclusions.

This study arises from data relating to just a single case study. And the patient’s brain had already been injured and was showing unusual activity related to epilepsy.

It’s not clear if the same results would occur in a different person’s brain at the time of death.

‘Something we may learn from this research is: although our loved ones have their eyes closed and are ready to leave us to rest, their brains may be replaying some of the nicest moments they experienced in their lives,’ Dr. Zemmar said.

Complete Article ↪HERE↩!

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A good death: Julie McFadden’s message

McFadden relates that the dying often call out to parents, and report seeing beloved relatives who’ve already passed away, waiting to lead them onward. She has no idea why.

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Have you ever witnessed someone peacefully die? Was it a trauma, a privilege, an intrusion, a wonder? A palliative nurse from Los Angeles has gone viral with her TikTok videos explaining the mysterious process. Julie McFadden’s message:Trust the body. It knows what it’s doing, just as it knows what it’s doing in childbirth. Do not be afraid of what’s unfurling before you so mysteriously and irreversibly – and predictably.

Her aim is to normalise a shielded process. She says death is not, normally, painful; it’s a “peaceful and natural” procedure. “Our bodies are truly built to survive birth, for the most part, and they’re built to die. When someone is in a hospice dying a natural death, the body knows.” She explains: “[It] will start kicking in its regular mechanisms that are built in when someone is getting near death. It will stop eating and drinking for the most part, and sleeping a lot more.”

McFadden believes the less intervention the better, and talks of “the rally” that often occurs near the end, when the patient suddenly seems much better hours or days before death. She says the less we mess with the process, the more peaceful the death usually is. She explains that changes in breathing and skin colour, terminal secretions and fevers are all normal. I could add that the patient’s face takes on the look of a death mask, as if the visage is rehearsing for the skull to come. I saw this with both my father and grandmother as they approached death.

With my father, I was in denial, refused to believe this could be happening. Because what I didn’t get from the hospice, for all their good intentions, was a bracing honesty. I needed the blunt truth, that dad had begun his journey upon the irreversible road into death. In hindsight the staff knew but the family didn’t. We didn’t trust the peaceful process, didn’t surrender to reality, but clung to the wild, stubborn hope of a miraculous turnaround. The head of the palliative unit had said that some people do actually leave their care alive, that it’s not always terminal, and that’s what we gripped on to. Foolishly.

The actual care couldn’t be faulted. The room was large and airy, sliding doors opened to a peaceful courtyard, the dog was allowed onto the bed, there was music and endless cups of tea, as a circuit breaker, in a spacious communal lounge area. So much thought had gone into this compassionate place – it felt like a gift at the end of life. The Australian way of a foreseen death, done very well.

As Ursula Le Guin wrote once, “Let the dying spirit go”. Dad was ready, the staff were ready, but we the family were not. Perhaps it’s just too difficult sometimes to broach the subject; to announce the brutal words “look, they’re dying now, it’s not far off” to a desperately grieving family. I felt like something of a hostage within a death-hesitant culture; needed the truth but hope is easier, a polite and powerful drug.

There are grumblings that our palliative system isn’t good enough, particularly in the fraught arena of arguments around Voluntary Assisted Dying. Yet we felt cradled by support; there was a profound compassion for the dying as well as the living. I just wish there’d been a bit more brutal honesty – it would have lessened the shock. Because we weren’t prepared, mentally, for the process.

McFadden’s TikToks have helped with an understanding of the mysterious state a body succumbs to along its path into death. My relatives were irreversibly lost to us, as a family, yet seemed responsive to love as they underwent a leave-taking that felt beautiful and harrowing all at once. It didn’t feel claustrophobic, but a natural end to things; a slide over days into stillness. McFadden relates that the dying often call out to parents, and report seeing beloved relatives who’ve already passed away, waiting to lead them onward. She has no idea why.

Complete Article ↪HERE↩!

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My dad’s final days

By Ken Dychtwald, Ph.D.

I grew up in the 1950s and ’60s in a mostly blue-collar community in Newark, New Jersey. My father, Seymour, was a fiercely hardworking guy who wanted to be successful. For him, work wasn’t about “finding his bliss,” it was about being a responsible husband and father. His dad had skipped out on him, his siblings and mother for almost 10 years during the Depression. In contrast, my dad was a reliable family man and wanted our family to live the American dream.

Ultimately, Dad rose from selling clothing and home furnishings out of the back of his truck to owning and operating a successful chain of women’s clothing stores. In their mid-60s, my folks retired and relocated to Florida.

Throughout my life, Dad and I had a loving but feisty relationship. He was very opinionated (I guess I am, too) and was skeptical of many of my lifestyle and career moves—from moving to California, from studying physics to the field of psychology and then to gerontology. But he had great love for my family and he eventually developed a deep respect for what I made of myself.

In the 1990s, my father started to lose his vision and with it, control over much of his life. Sadly, Alzheimer’s was also chiseling away at my mother’s mind. Dad loved Mom so much that he railed against the dissolution of her memory and her mind. He got depressed and angry.

“If I die before Mom, she’ll struggle terribly, and if she dies before me, I’ll go crazy. Just as we’ve lived together, we want to die together,” he said. That was quite a lot for me to digest.

One night, he asked me, “If I take my own life and Mom’s, would that be brave or cowardly?”

I said, “I don’t know, Dad. If I was in your situation, I can’t imagine what I’d think or do.”

So, for almost a year, every night I’d go to sleep not knowing if my parents would be alive in the morning.

In 2013, my brother Alan called me in a state of distress to report that our dad’s blood sugar was going haywire. And to make things worse, he’d lost his balance and fallen on his face, giving himself a big gash on his forehead. Alan was already on his way to Florida. I packed my bags and headed east.

Dad’s doctor admitted him to intensive care. He had internal bleeding and had suffered a heart attack. When he realized that his boys were there for him, he called out to us: “What’s going on? Get me out of here!”

Dad settled down a bit, and Alan and I went to see our mom. Later that night, the phone rang. It was Dad pleading with us to rescue him. 

We shot back to the hospital and went into our anguished father’s room. His arms, chest, face and hair were covered with blood because he kept pulling out his IV lines. In the morning, after a torturous night for both my dad and brother, and a sad night for me and for my confused mother, I returned to the hospital. Alan and I asked: “Dad, what do you want?”

“I’m scared,” he said, “but I know this: I’ve lived my whole life on my own two feet, and I’m not going out on my hands and knees. Please help me bring this to an end.”

Shortly after, Alan and I met with Dad’s physician. He was a kind and decent man who asked us if we wanted our dad to remain in intensive care or if we preferred to shift him to hospice car
Were we going to battle to keep Dad alive for a few more days, albeit in a ghastly, ghoulish fashion? Or were we prepared to make him comfortable and allow him to die a good death? 

What would he want us to do?

We had Dad transferred to the hospice floor, where the nurses and aides removed all the wires and tubes, lovingly sponged all of the blood off him and even gave him a shave and combed his hair. They asked him what his favorite music was and then put on Frank Sinatra.

Next, they began a low dose of morphine to ease his anxiety. My wife and kids all dropped what they were doing to fly to Florida and be with him.

As I contemplated the end of my father’s life, I reflected that even though we had often butted heads, there was not one instance in my entire life when he wasn’t there for me when I truly needed him.

I wanted to show Dad proper respect and kindness, but not knowing how I should handle the situation with my dad nearing his death, I called one of my closest friends, Stuart Pellman, who had already dealt with the death of both of his parents.

He wisely told me, “Get one-on-one time with your dad. Even if he’s unconscious, tell him you love him, ask him to forgive you for anything you may have ever done to trouble him. Tell him you forgive him for anything he might have ever done to upset you, and then tell him you’ll always remember him.”

And that’s what I did.

Dad and I held each other for a long while, and then I left the room and allowed my brother some privacy to do the same.

Later that night, after the other members of my family had gone home, I joined my dad for a very intense and private conversation.

I said, “Dad, you’ve never asked me what I think happens when a person dies.”

“I’d like to know what you think about that, Kenny,” he responded. “Because I’ve begun to see my brothers and sister and they’re reaching out to me.”

My dad had no religious beliefs, but I had some. So I said, “Dad, I don’t know this for sure, but I believe when a person passes, there is another plane that presents itself. In that place are all the people you have known and loved.”

As I began to describe this, he started to cry. Then he turned toward me and told me he was ready.

I asked him if I could record the rest of our exchange on my phone so I could always have it to watch when I missed him. He said okay, and this is what transpired:

Ken: “Dad, you know that what’s going to be next is going to be beautiful and your vision’s going to be back and you’re going to be a young man again.”

Dad: “I’m ready for that, Kenny.”

Ken: “And you know we all love you, and you’ve always loved us.”

Dad: “I know it, Kenny.”

Ken: “So, what you’ll need to do is let go and not worry about anything because everything is going to be looked after. All we need is for you to be relaxed and calm and just drift off into the white light. Can you do that, Dad?”

Dad: “Absolutely.”

Ken: “I love you, Pops.”

Dad: “I love you, Kenny.”

My father died peacefully that night. With help from all of us, he went out on his own two feet.

Ultimately, even with all his frustration and anger, my dad died a good death. At the end, his pain was minimal. His mind was calm. He found a way to think about leaving his body as not being frightening. And although he had been blind for years, at the very end, he began to describe beautiful waterfalls, flowers, birds and castles.

When my time comes, I hope that my wife Maddy will kiss me goodbye and at least one of my kids—maybe even both—will be there to lovingly guide me out of my body.

Complete Article ↪HERE↩!