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.
Keep in mind that everyone is different and don’t always exhibit all the signs.
So, here are some of the 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. This is known as Cheyne-Stokes breathing. 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 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 loved one on to their side to aid in the draining of any fluids if it is triggering coughing or choking episodes.
Skin can become blotchy – the blotches are usually 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 loved one 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.
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.
Wakefulness/sleepiness – your person will spend increasing amounts of time sleeping. Only waking for brief periods until they lapse into unconsciousness.
Your loved one 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 loved one or you may not experience all of these signs. Everyone is different and it doesn’t mean anything is wrong.
I have only touched on the physical aspects of dying in this post.
I will talk about other aspects such as agitation, confusion and other aspects of behaviour, emotion and what your loved one might see or hear in another post.
With much love
Nancy x
HELD 