Signs of Dying with Suggested Cares - Part 1.

Signs of Dying with Suggested Cares

Appreciating the preciousness of human life, based on the understanding of one's body constantly changing, ageing, moving toward death since birth and the uncertainty of life helps us appreciate life and prepare for death. It is natural for one's body to decay especially when accelerated by disease processes. In the final stage when life-sustaining systems begin to shut down, physical, mental, emotional and spiritual changes may occur over weeks, days or hours. Each person's experience is unique, but there are some general similarities.

The following is a very simple account of the normal changes that may occur in the final stage of living, commonly called "dying", with some suggested ways of caring. It is intended to help the dying and their loved ones to understand and be prepared for these changes, in order to provide appropriate safe support and comfort holistically.

Physical Weakness / Lack of Energy / Loss of Interest in Everyday Things

As the body's systems weaken less oxygen is available to the muscles, the life force weakens, and more effort is needed to complete everyday tasks and one may become embarrassed, discouraged, ambivalent, depressed, irritable and/or just naturally become more interested in matters that seem more important: matters of the mind, heart and spirit. This is often a time of self-examination, of questioning, of looking for the meaning of life.

Caregivers can best help by assisting the person with physical tasks, while being sensitive to their feelings, maintaining their dignity and attending to their comfort as much as possible, especially with regard to symptom control and protection from injury. Love and humour can take the tension away from a stressful situation. Laughter opens the heart and can free one to see past appearances and circumstances, leaving the burden of self and entering into a instant oneness with another, that is blissfully rewarding. Psychological and spiritual support means being along side as a good friend: patient, non-judgmental, compassionate, allowing the person's own wisdom to evolve. When regrets appear, see them as lessons learned, encourage memories of meaningful events and practice rejoicing, by seeing the benefits of the kind actions of one's life, allowing whatever faith, hope and love the person has, to exist and develop freely. 

Withdrawal from Family and Friends / Increased Sleepiness / Coma

Neither family, friends nor wealth can be taken with us when we leave this world. Much of the packing it all up and leaving it behind is a solo job and one needs time and privacy to do it. Visitors can be very exhausting and the person may feel they have to entertain their guests even if they can't get up out of bed. Too many visitors one day will often result in the person being more tired and/or more withdrawn the next day. Sometimes the person may sleep more, be difficult to arouse or uncommunicative. This may be due to disease processes, medication, or the person's desire to withdraw from social contact. Simply being a loving presence near the person, holding their hand, sending loving thoughts, silently praying, meditating, just being there for them provides a comforting, safe and peaceful atmosphere that facilitates the person's inner work. The caregiver should try to respect the person's wishes and be aware of what personal desires come up in their own mind and how these can be addressed without disturbing the mind of the dying. Be careful of what you say over their body while the person is asleep or unconscious, they may hear you and it could upset them. Many people who have recovered from a coma (a state where there is no response to voice or touch stimuli, though eyes may still be open) have reported being aware of what others said and even thought in their presence.

Random jerks or twitches can be due to dreams or nightmares, you can reassure them with your kind tone of voice and/or a gentle touch on their hand or arm. The dying are very sensitive to what is communicated by the caregiver's body, speech and mind and the caregiver can become more aware of reactions and messages from the person by watching and listening. The eyes, facial expressions, and breathing changes often indicate what the person is feeling or thinking. The reason why communication is possible on this level and why you can trust your deepest intuition is because the basic nature of every being is pure and knowing, as Christians may say God-like or as Buddhists say having all pervasive, indestructible wisdom nature. Awake or asleep this is always present and available if one is relaxed, open and receptive, but it is much more familiar and easy for those who are habituated to this awareness through meditation practice. The depth of one's spiritual practice is communicated by its own power and has remarkable benefits for others. Stripped of dogma and doctrine, reputation and position, sex, age, and relationship, leaving one's 'self' to enter nakedly with no agenda, into unity with the person, even for a brief moment liberates both parties from the bondage of duality temporally and is profoundly comforting.

Loss of Appetite

Food is a fuel that helps sustain life. As the digestive system gets weaker, food may become more of a discomfort than an enjoyment, some medications may change the tastes of food, and finally the energy required to process the food becomes greater than the energy derived it. Any of these may produce a loss of appetite. Eating habits change. The person may become overwhelmed by a "normal size" meal. He/she may take a few mouthfuls of their "favourite" meal and feel full. Small attractively presented meals may tempt them. But consider who is getting the satisfaction - family and friends who want to nourish their loved one, so that the person can get better and live longer? It's often the hardest thing for the family to face; but the refusal to feed the body is not a refusal for nourishment. It is a sign that priorities have changed to nourishing the soul/spirit/mind. Forcing the person to eat or making them feel guilty if they don't, only isolates and distances them even further. The person approaching death needs to know that it is OK not to eat. Respect and acceptance brings people closer together which comforts the dying person and the caregiver too.

Difficulty Swallowing

As the swallowing reflex weakens, swallowing becomes difficult. It may become frightening for the person to attempt to eat or drink or the person may be slipping into unconsciousness. It is best to offer very small amounts (half a teaspoon) and observe the throat to see if swallowing has taken place. Tolerance of food generally progresses from solid to soft to liquids (soups and dietary supplements), to ice chips and spooned or sucked water. It is safer to feed a person who is upright, but if the person is used to eating in an incumbent position, it is generally easier to swallow if their head is kept straight, not turned to the side. The sucking reflex seems to last a long time as the caregiver will see when attempting to clean the person's mouth or teeth. Mouth care is important for comfort and dignity. Medications can be crushed and capsules opened and mixed with jam, jelly, yoghurt or like foods. Do not crush time-release or long acting medications. Discuss with your nurse or doctor any problems with medications; alternative medications or modes of delivery are available. Do not give food or liquids to a person who is unconscious. It may cause the person to choke or to inhale the foreign matter.

Confusion

The level of awareness and cognition can change frequently and unexpectedly, due to many causes (i.e. disease processes, tiredness, medication). When a person becomes confused, there can be a decrease of oxygen to the brain and they may not recognise familiar people, places, the time of day or year etc. or they may hear voices or see visions. Do not negate what they say or argue with them. This is their personal reality, which can be a pleasant comforting experience for the person and could also be a sign that the person's mind is peaceful or joyful with happy expectation. But if their experience upsets or disturbs them, gently touch or stroke their arm or hold their hand and speak calmly with a soft reassuring voice and remind them of who you are, where they are, what day it is etc. Aromatherapy and their favourite music or chanting of their faith, is also helpful.