It’s time for a refresher on what active dying is and what it might look like.
Caring for someone at the end of life or facing end of life yourself can be a pretty daunting experience made more so when we don’t know what to expect.
And, to be fair, there’s is a lot about end of life that we don’t know.
But when we can familiarise ourselves with what we do know it can really help to alleviate some of that fear, concern or stress.
The active phase of dying is the final stage of the natural process of bodily functions slowing down and/or ceasing. It’s important to understand what to expect and to learn the signs of active dying, but it’s also important to keep in mind that predicting when death will occur is still difficult.
It will happen anywhere between 2 weeks to just a few hours before death.
Keep in mind that everyone is different and don’t always exhibit all the signs.
So, here are some of the physical AND non-physical signs you might expect when someone is actively dying.
Breathing – will slow and, if you are fully present, you will notice that their breathing becomes irregular. Sometimes there’s rapid breathing before it starts to slow. There will be little spaces between each breath and these spaces will get longer and longer. You will be wondering, each time, if this is the last one. Breathing also becomes shallower. You may notice what looks like a gasping for air – this is natural and nothing to be concerned about and the person knows nothing about it. You may notice a rattling sound on the breath and in the throat which can be quite scary or uncomfortable to hear but it’s a perfectly normal part of the process and doesn’t usually cause discomfort to the person dying. More discomfort for the people listening to it! This is sometimes know as the death rattle. It might help to position your person on to their side to aid in the draining of any fluids if it is triggering coughing or choking episodes. All of these changes are natural and expected and is not thought to cause suffering.
Skin can become blotchy – the blotches pink or bluish in colour. The extremities such as the feet and hands might take on a bluish tinge. Their body might feel cooler but it might also feel very warm to the touch. If you suspect a temperature you can try to make your loved one comfortable by doing all the things you would usually do such as a cool flannel or removing layers of bedding. The important thing is to keep your person as comfortable as possible.
Eating and drinking – your person’s hunger will diminish. This is all perfectly normal so try not to force or encourage your person to eat – honestly, it won’t make them live longer but it may cause extreme discomfort as their body is shutting down and they are excreting less. The natural process of stopping eating and drinking sends their body into ketosis which makes them feel good and diminishes their urge to eat or drink.
Bowels/bladder – linked to eating and drinking. As the body shuts down that includes ALL bodily functions so you may notice them passing less (or no) urine and faecal matter. In laymen’s terms peeing and pooing will stop.
Speech – your person may talk about getting their bag ready, finding their passport or tickets. Sometimes this can happen even before the active dying phase too so don’t be surprised or concerned. Just know they are getting ready for the transition.
Muscles – the mouth and eyes will be partially open. Sometimes the mouth hangs wide open. This is because the muscles are fully relaxed. Do you know it takes muscles conscious effort to close your eyes and mouth?
Reaching – you may notice your person reaching out with their arms. This is quite a common phenomenon and is one of the mysteries of the process.
Visioning – this is another mysterious phenomenon. It is where the person dying sees people or things that we don’t. Sometimes it’s dead relatives or friends and sometimes it’s people they don’t recognise. They may tell you that a spouse, parent, grandparent, a dog, sibling is standing in the room, sometimes in the doorway. It usually isn’t unsettling for them but often provides a sense of reassurance. Wouldn’t it be lovely if we knew someone special was waiting to guide us into whatever comes next?
Wakefulness/sleepiness – your person will spend increasing amounts of time sleeping. Only waking for brief periods until they lapse into unconsciousness.
Your person will become less responsive.
Until their last breath is taken you won’t know it was their last breath.
But it does come.
The heartbeat ceases.
But don’t rush off anywhere.
Take your time to be with them for a little while longer.
There is no hurry.
Linger – I love this word.
Linger until you are ready to leave their side.
As much as we wish it not to be so there is an amazing transformation happening during the active dying phase.
Ultimately, trust that the body knows exactly what it is doing. It knows how to shut down. It knows how to die. Our bodies are amazing!
And just a reminder – your person or you may not experience all of these signs or any. Everyone is different and it doesn’t mean anything is wrong.
With much love
Nancy xx
HELD 