Did you know that the body prepares itself with natural changes during the dying process? This progression produces psychological, emotional and spiritual thoughts for us. Hopefully, we will be better able to prepare ourselves for death when it comes knocking on our door. Each of us has an expiration date. Hopefully, your date will be far in the future.
In reference to our planning for the death of a loved one, hospice assisted us with the care and preparations for my mother. They provided a team of professionals and specially trained volunteers to address the dying process as well as psychological, emotional, and spiritual needs of the patient and family. Hospice is available 24 hours a day, 7 days a week for support, consultation, and visits. They also provide extra equipment aids if needed. We received a hospital bed, side table, chair for the bathroom, and a wheel chair while my mother was at home. After my mother moved to the nursing facility, these items were no longer necessary as they would have been a duplication.
Below is a proposed time line for the death of our loved one. As you are now aware, death can be a surprise or a peaceful ending to a long life. The time periods of the dying experience below was developed by Barbara Karnes, RN which is called "Gone from my Sight" and given to us during hospice. It gave me much comfort during my mother's dying process which is divided into four time periods. The periods listed below are only an approximation.
One to three months prior to death, there is a withdrawal, an understanding that our loved one is dying. It becomes real as when the person begins separation from this world. Some of the results from the cessation of life are the reduction of food and water. There is usually little interest in eating and drinking. Since food is the way we energize our body, we eat to live. When a body is preparing to die, it is perfectly natural that eating should stop. At this time nothing tastes good, cravings come and go and liquids are preferred to solids. Meats are the first desire to disappear, followed by vegetables. If our loved one still can eat, we allow the consumption of whatever is appetizing, but it should be taken slowly and in small amounts. Chips of ice may be refreshing in the mouth. A cool, moist wash cloth on the forehead may also be welcome, but dehydration is no longer is uncomfortable. My mother stopped eating and taking food intravenously which signaled her desire to separate from life.
As death becomes more immanent, lack of socialization becomes more obvious. My mother didn't want to be with anyone which contradicted her many years of social interaction interests. It is normal not to feel like socializing when feeling weak and fatigued.
One to two weeks prior to death, disorientation becomes more evident. Sleeping is more prevalent. My mother spent an increased amount of time sleeping and became uncommunicative, unresponsive, and difficult to arouse at times. This is in part was due to changes in the metabolism of the body. Our loved one processes his or her life with the eyes closed which is the reason for the increase of sleep. The patient can hear what we say so no negativity is accepted. He or she is preparing for their death in a quiet environment.
The breathing patterns may change and become shallow, irregular, fast or abnormally slow. There is a moaning like sound on the exhale. We thought that my mother was in distress, but it was the sound of air passing over the relaxed vocal cords. We elevated her head to make her more comfortable.
Due to changes in circulation, the person's arms and legs may become cold and/or discolored. Irregular temperatures were as a result of the brain sending unclear messages for physical changes thus producing sweating. To be more specific, blood pressure often lowers. The pulse beat increases and the body temperature fluctuates. In addition, there is an increased perspiration. The skin color changes to flushed with fever, bluish with the cold. A pale yellowish pallor accompanies approaching death. The hands and feet are often pale and bluish because the heart can't circulate blood through the body at a normal flow. Breathing changes also occur. Respiration may also increase. My mother's skin did not change colors even though her blood pressure, pulse beat, and body temperature fluctuated. She also did not have increased perspiration. Obviously, every one has a different experience with impending death.
Restlessness caused my mother to pull at her clothing. She also responded to people who didn't exist. This is a result of a decrease in oxygen circulation to the brain and a change in the body's metabolism. We didn't interfere with her. We played soft music and read to her in order to have a calming effect. My mother also had conversations with her deceased sisters. She had one foot in each world. Focus was changing from this world to the next; she was losing their grounding to earth. We listened to whatever my mother said and accepted it calmly.
She had no control of her urine or bowels as the muscles in the area began to relax. We gave her diapers so she would always feel clean. In addition, the urine output normally decreased and became more concentrated such as the color of tea. This is probably due to a decreased fluid intake and lessening of circulation through the kidneys. We had a catheter inserted to assist in this area.
One to two days, to hours prior to death produced a surge of energy. I call it a rally. My mother, who hadn't spoken in months, was quite vocal. She was also active and enjoyed the company around her. She ate a large meal and seemed quite complete. The spiritual energy for transition from this world to the next had arrived and it is used for a time of physical expression before moving on.
Minutes prior to her death produced oral secretions which became more profuse and collected at the back of her throat creating gurgling sounds coming from the chest. The head of the bed was raised in order not to stimulate the gag reflex. Before our loved ones leave earth, we need to give him or her permission to do so. During the last days of dying, the loved one's body begins the process of shutting down which will end when the physical systems cease to function.
My mother tried to hold on as long as she could. I told her that I would see her at the other side and not to be afraid. She did so much for me. Now it is time for her to be with my father. I read my mother her own private eulogy which she loved. She nodded and smiled. I held her hand. She squeezed my hand and she understood. She said "I lo...." with all of her remaining breath. She was finally ready to die. I said good-bye and cried, and cried, and cried. She died a few days later.
I was not there at the exact time of my mother's death. I was there for the dying process which I am very thankful for. I had an extra sense of relief to know that her suffering was over. She died at a nursing facility which seems to be a common venue for death.
The separation becomes complete when the breathing stops. That appears to look like the following according to Barbara Karnes, RN: "the last breath is often followed by one or two long spaced breaths and then the physical body is empty. The owner is no longer in need of a heavy, nonfunctioning vehicle." My mother was under hospice care so they made decisions and kept her comfortable. I know she died in peace. She entered a new location and a new life. Hospice ordered morpheme and she was gone in a few days. I saw a happy face on the moon the evening of her death. To let go of a loved one, is to accept the fact that they are gifts.
As we approach death, our personal relationships with life and death will set the stage of our acceptance of the new life that awaits us and our loved ones. Fear and unfinished business are two big factors in determining how much resistance we put into meeting death. Hopefully, my understanding of "Gone from my Sight" will help you to understand the dying experience and prepare for the death of your loved one. Let go. It is time for your new beginning.
By Roberta Mark Engel
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