Look for Part 1 of this series HERE!
One to Two Weeks Prior to Death
Expect that you will be sleeping most of the time now. As you die, consciousness will be harder for you to maintain. Those who attend you will be able to arouse you from your slumber, but upon awakening you may experience a period of disorientation.
Those around you may find you confused at times. They may even report that while you slept you seemed to talk to people who were not there. Your sleep may appear to some as restless and fitful. This will most likely add to the agitation of those who witness it. They may misinterpret these events and imagine that you are in distress.
If you are not in distress, you can reassure them with confidence that this, too, is natural and that they should be at ease.
Breathing exercises like those practiced by expectant mothers, deep and paced, are helpful for all concerned.
Remember you are in charge of your dying environment. The anxiety of those who attend you, if left unchecked, can disturb your sense of well-being and cost you the serenity you seek.
As you approach your death there will be discernible changes in your body. For example, you will lose weight. Your blood pressure will drop. Your pulse rate will either increase from its usual range to upwards of one hundred fifty beats per minute, or decrease to near zero.
Your body temperature may fluctuate wildly. At times you will feel feverish, at other times you will feel a chill. You will experience an increase in perspiration, and what some describe as clamminess.
Those who attend you should be prepared to deal with all these eventualities. Cold compresses and extra blankets should always be easily available.
Your skin color will change: flushing with fever at one minute, becoming bluish with cold at another. Often a pale yellowish pallor will appear. Your hands and feet will become pale or even bluish as your heart’s ability to move sufficient blood through your body diminishes.
Expect your appendages and abdomen to swell and change color as bodily fluids begin to pool. This can also result in a change in your skin’s texture.
Gentle massage with a light lotion is comforting for both you and the person doing the massage. Don’t be afraid to ask for touch.
Your breathing will also begin to change. At times your respiration rate will increase from its usual range to forty breaths a minute or more. At other times your respiration rate will decrease to nine or even six breaths a minute.
You will want to prepare those who attend you for when you will stop rhythmic breathing altogether. This most often occurs during sleep.
Congestion in your lungs will cause a rattling sound in your lungs and upper throat, and may be accompanied by a dry cough. All of these changes will come and go.
Have those who attend you keep your mouth and lips moist. Ice chips on your tongue and glycerin swabs for your mouth and lips are ideal for this purpose.
One or Two Days to Just Hours Prior to Death
You may have a surge of energy just before death, particularly if you have recently discontinued all your medications, except those you take for pain control. (Many of the medications you consume to treat your illness can have unfortunate side effects. Eliminating them during your dying process often gives your body an opportunity to rebound, resulting in an energy surge.)
You may have periods of heightened alertness and clarity unlike what you have become used to. You may resume eating even though you may not have eaten anything for days.
You may even have a renewed interest in being with people. This is an ideal time for closure with those you love. Giving and receiving farewells and offering blessings, as well as ritualizing this most important passage can be uplifting and life affirming for all involved.
If you are afforded this effervescence, know that it will be short lived. Time is at its most precious now. Use it wisely.
Immediately following this small window of renewed vigor the signs of death’s embrace will become more pronounced.
This can be a time of great distress for those who will survive you. They may have misinterpreted your rally of just days or even hours ago to mean that you are getting better. They should be reassured before this happens that all is on course and that your death is near.
There will be an increase in restlessness now as your body tries to compensate for a decrease in oxygen in the blood. Your breathing will become slower and more labored. It’s not unusual for your breathing to stop for long periods before resuming. Sounds produced by the congestion in your lungs will become more audible.
Those who attend you can ease your labored breathing by changing your position in bed.
Don’t expect to be present during much, if any, of this final stage. Your work is done. All you have to do now is let go. Nature will take care of the rest.
If you are registering any sensory input at all during this time it is most likely through your sense of hearing.
Those who attend you should be aware that they can be an enormous help to you at this time. To die peacefully with soft music playing in the background and with words of goodbye and thank you ringing in your ears will make all the difference in the world for both you and them.
Your eyes may be open or semi-open but you’re not seeing anything. For all intents and purposes, you are no longer here. All that remains is for your body’s mechanical systems to shut down.
Your eyes will have a glassy look to them or they will be tearing. Your hands and feet are now purplish, your extremities, back and buttocks are blotchy. Your dying is complete when you stop breathing.
However, what appears to be your last breath often is not. One or two long-spaced breaths at the last moments of life are not uncommon. When these finally subside, you are dead.
Your death, like most things in life, needs formal recognition. An official such as a doctor, hospice nurse or coroner must make that pronouncement.
Some final thoughts.
Throughout your dying process, those who survive and attend you will be looking to you for direction. They will expect and want you to express your needs and desires for as long as you are able. But even when you are no longer able to communicate in any form, crucial decisions continually need to be made. For example, when would you like life support systems such as oxygen removed, and by whom?
The wise person will have clearly and unambiguously addressed all such concerns both verbally and in writing. Durable Power documents and/or a Living Will are specifically designed for this purpose.
Remember there is no one particular way of dying well. In the final analysis, you will probably die the way you lived. However, if you wish to achieve an awareness, appreciation and acceptance of your own dying while participating in it, you can, but it will take work and commitment.
This kind of conscious dying won’t eliminate the pain and poignancy of separation, but hopefully you will learn how to face these and live through them to the end.