Physical Changes in Dying

My first experience with the death of a loved one was unnerving. I did not know how to interpret the physical and mental changes I witnessed. I had no capacity to learn about death while it was unfolding before me; it was difficult enough just to be there.

In bringing a baby into the world, there are opportunities to take classes, read books, and listen to the experience of others. In helping someone leave this world, we can also learn to trust that, just as the body innately knows how to birth, it also knows how to die. Although each person and journey is unique, having some knowledge about what to expect can equip us to be present and supportive.

Following is a brief summary of what we might expect.

Withdrawal: Our loved one may become less interested in everyday life and no longer enjoy the things that once gave pleasure. She may decline visitors, and sit quietly by herself for hours. He may talk less, yet still communicate with touch or gestures. She may spend a lot of time asleep and be more difficult to awaken.

Disorientation: Our loved one may pick at her bedsheets, fiddle with her clothing, or participate in another seemingly aimless activity. She may be confused regarding times, dates and events. He may speak to people who we cannot see, often people who have already died. She may become anxious.

Reduced Appetite: It is normal to eat less and less, and simply not be hungry. She may prefer only soft foods, and then only liquids. As the body shuts down, the dying person may just want to suck on ice chips to wet their mouth. We are told this is not painful.

Bowel and Bladder: Constipation and incontinence may become a concern. “Accidents” may begin to happen. As our loved one gets closer to death, muscles relax further and control becomes more diminished. The quantity of urine decreases and often becomes stronger and darker in colour.

Restlessness: Our loved one may appear to be restless or agitated. They may seem confused, irritable, and appear to be in pain. This is common, and can be very distressing to those present. “Terminal delirium” is marked by extreme restlessness and agitation and may happen when the person is close to death. Medications may need to be adjusted. It is important that caregivers realize that what they imagine is happening may be very different from what the dying person is experiencing. If the ability to communicate has been compromised, pay attention to any signs that communication is happening in a new way.

Temperature and Skin Colour: As circulation decreases, our loved ones’ extremities begin to cool although their body is warm. He may feel hot and clammy one minute, and cold the next. Hands and feet, and then arms and legs, may become blotchy and mottled. Lips and nail beds become purplish or blue. Skin may take on a pale yellowish or bluish complexion.

Increased Energy: There may be a brief surge in energy, alertness, and engagement. He may want to get out of bed and talk to loved ones, and show interest in food again. This is common and lasts only a short time.

Breathing: Breathing may slow down. It may stop briefly and then restart again. There may be periods of no breathing for up to 45 seconds, followed by deeper and more frequent respirations. Breaths may be spaced further and further apart. Breathing may be shallow and quickened, or slow and laboured. Our loved one may gasp for air. Secretions may pool in her throat, causing a gurgling sound. When loud, this is often referred to as the “death rattle.”

Although the above list may be disconcerting, familiarity with the process may enable you to trust and relax into it. Being with a loved one right to the end, where the two worlds touch, can be a great privilege.

“There is no greater honour than to be with another as they journey Home.” – St. Brigit of Kildare

Written by Margaret Verschuur