What do the different physical stages of dying look like?
2015-02-27 | Ulla Mextzel

Getting close to death and dying can be scary in our culture.

Whether we have been given only a few months to live. Whether we would like to approach the subject of dying, but don't know where to start. Whether it is just time to deal with our fears of death and dying.

Sometimes we need help.

Someone to hold our hand while exploring a foreign territory. Someone to put up some lights in an area that feels hidden away in darkness. Someone to help us prepare for a possibly wondrous journey. Someone to help us find our way home.

The different physical stages of dying

There is a rhythm to dying, also called physical stages of dying.

At the same time every dying is also unique. Following its very own internal script. Taking whatever time is needed to complete the last journey. And every completion looks different.

This nearing death experience, as some call, can be best described as a journey. This particular journey has a number of check-in stations. We might call them physical stages of dying. Not everyone passes by every check-in station.

Months

Some of us take our time and linger. Some of us get it over with quickly. For some of us dying is hard work. For some of us dying feels like a breeze. But all of us are heading towards the same destination. Passing through our physical stages of dying. Into death.

Some of the stages of dying start to be discernible a few months to a month before death occurs. That is when for many of us our journey into dying begins to become more apparent.

Some of us start feeling less active. We rest more. Doze more. Dream more. Feel more like withdrawing into our inner realms.

We eat less. Drink less. Participate less in life around us.

For some of us reliving our memories becomes more important than talking to our friends or loved ones. Especially the memories of our childhood. Our memories become a way to take stock of our lives and make our peace with it, if that is what is needed.

Weeks

We have already come so far on our journey towards death. Such an important journey. Yet there is still more to travel towards death. Luckily we have our check in posts a few weeks before death. We have our symptoms of dying. A road map. Sort of.

Because everyone's route is so different. So unique. So personal.

In these final weeks we tend to doze a lot. It must feel so comforting to drift off into that sweet land of dreams. A body resting. A mind relaxed.

Just like our children slept for weeks and months after they were born. All day and all night (if we were lucky). Only, newborns do need their food and they need it often.

Strange. These similarities. Between birth and death. Between being born and dying.

Just like our children did sleep for weeks and months after they were born. Sleeping all day long and all day night (if we were lucky). Only newborns do need their food and they need it often.

Strange. These similarities. Between birth and death. Between being newborn and dying.

Days

Our journey into dying is moving closer to its final destination. There are more signs of approaching death. We are down to a few days.

Just a few more days to be in this particular body at this particular time. Nothing more to do. Just letting go. Just letting go.

Death

Death now is very close. All the signs of death are here. The moment we have awaited for so long. The moment we have dreaded for so long. The moment we feared so much. The moment we were ready for. So ready.

Completion: The Five Final Tasks

It is good to experience a sense of completion before we die. To know that we have said what we needed to say. What we wanted to say.

We can actually experience the various physical stages of dying more fully, when we have that sense of completion. So we can focus on the task at hand. So we don't feel like we are being held back by words left unsaid.

This completion requires a few ingredients:

  • One is our willingness to simply acknowledge that we are dying. Whether very soon or somewhere down the line does not matter. We have a finite amount of time left. Let's use it well by being honest about what is going on. It allows everyone around us to be honest too.
  • Two is our openness to talk about dying with our loved ones. Especially with our loved ones. Yes, talk about death. Say what needs to be said. Hear what wants to be said.
  • Three is to actually take the time to talk. To make the time to listen. To allow the silences in between. To speak from our hearts. To hear with our hearts. To make room for feelings. All our feelings.

Here is a simple list of suggested things to say. Ira Byock calls them The Five Final Tasks.

  • Will you forgive me? Is there a forgiving that I need from you? Most likely something from a long time ago? Something I have carried with me for so long... Can I actually ask for it?
  • I forgive you Am I willing to let go of old wounds and hurts in the face of my dying? Let it just be? Let it rest? And can I say this to you face?
  • Thank you What a gift to say thank you one more time. Even if there is neither enough time nor enough words to thank you... for everything.
  • I love you This is something we can never say often enough. Never hear often enough. It feels so good to hear and say it, even one more time.
  • Good bye Can we actually say it, and mean it? Let it sink in, that this is a final good bye, at least in earthly terms? Feel all its weight? Feel all its finality? Am I ready to say good bye for good?

When we take the time to speak into these five tasks with our loved ones, they very much contribute to a sense of completion. They help make the leaving easier. They help us feel more prepared for the different physical stages of dying that await us. They help us die more at peace.

Signs and Symptoms Of Approaching Death

There are two phases which arise prior to the actual time of death: the "pre-active phase of dying," and the "active phase of dying." On average, the pre-active phase of dying may last approximately two weeks, while on average, the active phase of dying lasts about three days.

We say "on average" because there are often exceptions to the rule. Some patients have exhibited signs of the pre-active phase of dying for a month or longer, while some patients exhibit signs of the active phase of dying for two weeks. Many hospice staff have been fooled into thinking that death was about to occur, when the patient had unusually low blood pressure or longer periods of pausing in the breathing rhythm. However, some patients with these symptoms can suddenly recover and live a week, a month or even longer. Low blood pressure alone or long periods of pausing in the breathing (apnea) are not reliable indicators of imminent death in all cases.

Signs of the pre-active phase of dying:

  • increased restlessness, confusion, agitation, inability to stay content in one position and insisting on changing positions frequently (exhausting family and caregivers)
  • withdrawal from active participation in social activities
  • increased periods of sleep, lethargy
  • decreased intake of food and liquids
  • beginning to show periods of pausing in the breathing (apnea) whether awake or sleeping
  • patient reports seeing persons who had already died
  • patient states that he or she is dying
  • patient requests family visit to settle "unfinished business" and tie up "loose ends"
  • inability to heal or recover from wounds or infections
  • increased swelling (edema) of either the extremities or the entire body

Signs of the Active Phase of Dying

  • inability to arouse patient at all (coma) or, ability to only arouse patient with great effort but patient quickly returns to severely unresponsive state (semi-coma)
  • severe agitation in patient, hallucinations, acting "crazy" and not in patient's normal manner or personality
  • much longer periods of pausing in the breathing (apnea)
  • dramatic changes in the breathing pattern including apnea, but also including very rapid breathing or cyclic changes in the patterns of breathing (such as slow progressing to very fast and then slow again, or shallow progressing to very deep breathing while also changing rate of breathing to very fast and then slow)
  • other very abnormal breathing patterns
  • severely increased respiratory congestion or fluid buildup in lungs
  • inability to swallow any fluids at all (not taking any food by mouth voluntarily as well)
  • patient states that he or she is going to die
  • patient breathing through wide open mouth continuously and no longer can speak even if awake
  • urinary or bowel incontinence in a patient who was not incontinent before
  • marked decrease in urine output and darkening color of urine or very abnormal colors (such as red or brown)
  • blood pressure dropping dramatically from patient's normal blood pressure range (more than a 20 or 30 point drop)
  • systolic blood pressure below 70, diastolic blood pressure below 50
  • patient's extremities (such as hands, arms, feet and legs) feel very cold to touch
  • patient complains that his or her legs/feet are numb and cannot be felt at all
  • cyanosis, or a bluish or purple coloring to the patients arms and legs, especially the feet and hands)
  • patient's body is held in rigid unchanging position
  • jaw drop; the patient's jaw is no longer held straight and may drop to the side their head is lying towards

Although all patients do not show all of these signs, many of these signs will be seen in some patients. The reason for the tradition of "keeping a vigil" when someone is dying is that we really don't know exactly when death will occur until it is obviously happening. If you wish to "be there" with your loved one when death occurs, keeping a vigil at the bedside is part of the process.

The Gifts of the Last Hours

The last hours filled with signs of impending death can feel very special. They can be like a moment of hushed silence in the middle of a busy street. Like the sense of wonder just before a sunrise on the ocean. Like a holy moment in church full of imagined angels singing. Like a long prayer deeply soothing us.

They have a similar quality to the time right after a baby is born. That same feeling. That same sense of wonder.

As if they are like gateways. Gates to the other side. Gates to our souls.

The last sense to go, is hearing, which means your loved one can hear you even up till the very end, even though he or she cannot respond by speaking. Your loving presence at the bedside can be a great expression of your love for your loved one and help him to feel calmer and more at peace at the time of death

Some Signs of Death

Amongst the signs of death actually having occurred are things such as:

  • There is no response to either questions or touching.
  • No more breaths in or out.
  • The jaw is relaxed, the mouth slightly open.
  • No heartbeat is to be felt.
  • There might be a sudden release of bowel and/or bladder.
  • The eyes are staring fixedly on one spot.
  • Most likely, the eyelids are slightly open.
  • The pupils may be enlarged.
  • No more blinking for the eyes.

These signs of death are pretty simple and straight forward. The life force has left the body. The body is not functioning any more. The body is dead. There is death.

Practical things that have to be done

  1. Contact the physician who declares death
  2. Contact your spiritual leader
  3. Contact the undertaker
  4. Notify family and friends
  5. Contact the lawyer or bank
  6. Make Funeral arrangements
  7. Notify Internal Affairs
  8. Contact insurance brokerage
  9. Funeral
  10. Read the will / last testament
  11. Allow yourself to mourn
  12. Take control and responsibility for your life

You are going home

You are going home
once again going home
leaving this earthbound
existence behind
ready to soar again
outside of space and time

You are going home
riding on the wide wings
of comforting sleep
leaving your essence free
to roam far away
and yet so close

You are going home
to remember
all that you are
have always been
and always will be

You are going home
once again home

- Ulla Mentzel -

In loving and celebrating our letting go into death’s arms
We are graced with being birthed breathtakingly into more living
~~~~~
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