Caring for a dying person, especially at home can be difficult and daunting. In their classic book Final Gifts, hospice nurses Maggie Callahan and Patricia Kelley share their years of experience of caring for terminally ill patients. Let us look at useful insights for caregivers about what actually happens just prior to and up to the time of death.
Caring for someone who is dying
When a mother becomes incontinent and her son must clean and change her; when a husband can no longer swallow and his wife must moisten his dry, sticky mouth; when a person is in unbearable pain and the family members can at best reduce it a little; these occasions can evoke great love and at the same time, generate great pain. When someone you love is dying, you will always feel deep sorrow, because you remember the person as healthy and active.
In their beautiful and profoundly moving book Final Gifts, hospice nurses Maggie Callahan and Patricia Kelley share their years of experience of caring for terminally ill patients. They provide useful insights for care-givers and family members on what actually happens just prior to and up to the time of death, so you know which signs to pay attention to.
Physical signs of impending death
- A dying person’s most common symptoms are weakness and fatigue. Most people weaken to the point where they can’t do much for themselves. They may not be able to walk, to turn themselves in bed, to concentrate on a conversation or even to open their eyes.
- Another sign is difficulty in swallowing and the resulting dehydration. No appetite may be more than just a lack of interest in food and water.
- Sometimes mucus gathers in the mouth, throat or lungs, and air flowing past it makes a rattling sound. This does not mean the person is having difficulty breathing; turning the patient onto his side often clears the air passages and reduces the rattling.
- As death nears, a person’s breathing may change: become irregular, speeding up for a while, then slowing down, even pausing for several seconds before starting again. Or the breathing can be loud for a while, then very faint and quiet.
- The body’s temperature may rise, while at the same time their hands and feet may feel cool, perhaps turning blue or becoming mottled. Sometimes the lips and nails turn blue.
- The person may sweat profusely and require frequent sponging.
- Output of urine and stool usually drops, with the urine becoming darker. Increased weakness may lead to incontinence.
- A few people may have involuntary, twitching movements.
Communications of the dying
- As the person gets weaker and sleepier, communication with others becomes more subtle. Many individuals ask for the company of one or two people who are particularly close or important to them.
- They may say they know they are dying, often by making reference to travel or change. Some people tell of talking with, or sensing the presence of people whom others cannot see, but who are accompanying them on their journeys. Still others refer to the peace and beauty of another place, invisible to those around them.
- When dying people begin to have these experiences, they often seem preoccupied, distracted, perhaps even a little puzzled. They may ask questions out of context, seem glassy-eyed or appear to be looking through others, as if focused on something beyond.
The final goodbye
- When the time of death nears, their attention drops and sometimes their eyes remain half open, whether they are awake or asleep. But even when they are too weak to speak or have lost consciousness, then can hear; hearing is the last sense to fade.
- Provided pain and discomfort have been well managed, the actual moment of death can be peaceful. Sometimes the last few breaths sound like sighs. If the dying person is alert, you may see a slight smile or a look of farewell or notice the eyes lose focus, then close. If the person is asleep or unconscious, you may not even realise it has happened.
- Being a caregiver to a dying person can be very difficult. How can you make the last days physically and mentally easier and peaceful for your loved one?
- A person can continue the process of ‘healing’ until his/ her last breath. What ‘unfinished business’ remains to be dealt with, so your loved one can pass on without regrets?
- How are you – the caregiver – coping with the approaching and inevitable loss. Who is helping you … and how?
Excerpts from the classic book Final Gifts by hospice nurses Maggie Callahan and Patricia Kelley.
More from this series
|Title||About the article|
|Part 1: Death Unites Us All||Traditional societies were closely connected with nature’s continuous cycles of birth-growth-decay-death, and marked these rites of passage with specific and well-established rituals and sacraments. Modern society seems to have lost this close contact with these natural cycles.|
|Part 2: Five Stages of Grieving||Dr Elizabeth Kubler-Ross, one of the world’s foremost authorities on the subject of death, describes the four stages of Denial, Anger, Bargaining and Depression that people pass through when coping with any severe loss, including their own death.|
|Part 3: Cancer’s Five Shocks||With cancer, there are five major ‘shocks’ that a person/ his family has to deal with.|
|Part 4: What Actually Happens at the Time of Death||Caring for a dying person, especially at home can be difficult and daunting. In their classic book Final Gifts, hospice nurses Maggie Callahan and Patricia Kelley share their years of experience of caring for terminally ill patients.|
|Part 5: Top Five Regrets of the Dying||Every single patient found their peace before they departed though, every one of them. When questioned about any regrets they had or anything they would do differently, common themes surfaced again and again. Here are the most common five.|
|Part 6: How to Die Before You Die||Perhaps the most exciting and empowering aspect of death is that it resets your clock to zero. By sharply ending what has gone before, it creates space for a new beginning – a rebirth of sorts.|
|Part 7: Quotes||We share some quotations (compiled by Arun Wakhlu) on the subject of Death|
|Part 7: Video (When I Die)||How do we approach death whilst embracing life? How can we change the conversation around death and palliative care for the terminally ill?|