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01 Dec 2012

Death, dying & spirituality, by The Reverend Pamela Sheath

The dying process usually begins well before death actually occurs.

Death is a personal journey that each individual approaches in their own unique way. Nothing is concrete, nothing is set in stone. There are many paths one can take on this journey but all lead to the same destination.

As one comes close to death, a process begins; a journey from the known life of this world to the unknown of what lies ahead. As that process begins, a person starts on a mental path of discovery, comprehending that death will indeed occur and believing in their own mortality. The journey ultimately leads to the physical departure from the body.

There are milestones along this journey. Because everyone experiences death in their own unique way, not everyone will stop at each milestone. Some may hit only a few while another may stop at each one, taking their time along the way. Some may take months to reach their destination, others will take only days. We will discuss what has been found through research to be the journey most take, always keeping in mind that the journey is subject to the individual traveler.

The Journey Begins: One to Three Months Prior to Death, for some it may be sooner as for those given a terminal prognosis from a medical team.

As one begins to accept their mortality and realizes that death is approaching, they may begin to withdraw from their surroundings. They are beginning the process of separating from the world and those in it. They may decline visits from friends, neighbors, and even family members. When they do accept visitors, they may be difficult to interact with and care for. They are beginning to contemplate their life and revisit old memories. They may be evaluating how they lived their life and sorting through any regrets. They may also undertake the so called five tasks of dying.

The dying person may experience reduced appetite and weight loss as the body begins to slow down. The body doesn't need the energy from food that it once did. The dying person may be sleeping more now and not engaging in activities they once enjoyed. They no longer need the nourishment from food they once did. The body does a wonderful thing during this time as altered body chemistry produces a mild sense of euphoria. They are neither hungry nor thirsty and are not suffering in any way by not eating. It is an expected part of the journey they have begun.

One to Two Weeks Prior to Death

Mental changes

This is the time during the journey that one begins to sleep most of the time. Disorientation is common and altered senses of perception can be expected. One may experience delusions, such as fearing hidden enemies or feeling invincible.

The dying person may also experience hallucinations, sometimes seeing or speaking to people that aren't there/ or nobody else can see them. Sometimes these are people that have already died. Some may see this as the veil being lifted between this life and the next. The person may pick at their sheets and clothing in a state of agitation. Movements and actions may seem aimless and make no sense to others. They are moving further away from life on this earth.

A friend once told me as she had a near death experience, that the closer she got to heaven the less hold earth and family and friends had on her. Her desire changed from wanting to be here, to wanting to be there, wherever that was.

Physical changes

The body is having a more difficult time maintaining itself. There are signs that the body may show during this time:

  • The body temperature lowers by a degree or more.
  • The blood pressure lowers.
  • The pulse becomes irregular and may slow down or speed up.
  • There is increased perspiration.
  • Skin color changes as circulation becomes diminished. This is often more noticeable in the lips and nail beds as they become pale and bluish.
  • Breathing changes occur, often becoming more rapid and labored. Congestion may also occur causing a rattling sound and cough.
  • Speaking decreases and eventually stops altogether.
Journey's End: A Couple of Days to Hours Prior to Death

The person is moving closer towards death. There may be a surge of energy as they get nearer. They may want to get out of bed and talk to loved ones, or ask for food after days of no appetite. This surge of energy may be quite a bit less noticeable but is usually used as a dying person's final physical expression before moving on.

The surge of energy is usually short, and the previous signs become more pronounced as death approaches. Breathing becomes more irregular and often slower. "Cheyne-Stokes" breathing, rapid breathes followed by periods of no breathing at all, may occur. Congestion in the airway can increase causing loud, rattled breathing.

Hands and feet may become blotchy and purplish (mottled). This mottling may slowly work its way up the arms and legs. Lips and nail beds are bluish or purple. The person usually becomes unresponsive and may have their eyes open or semi-open but not seeing their surroundings. It is widely believed that hearing is the last sense to go so it is recommended that loved ones sit with and talk to the dying during this time.

Eventually, breathing will cease altogether and the heart stops. Death has occurred.

Death, dying and spirituality is a part of life that we meet often.

It is a common experience for those of us who work with older people.

It is a huge priviledge to be able to care for someone who is in the last months, weeks, or days of their lives.

But you may have some questions about how we relate to those who are dying.

And at this point I would like to take some time to ask you some questions:

If you were the patient:

  1. How would you like to be treated? (talk this through)
  2. How would you like people to talk to you? (talk this through)
  3. How would you like people to react around you? (talk this through)

We at all times like to be treated with respect, with honesty and with compassion.

It is no different for those we care for. Whether they are long term residents, or those with special needs, or those who are dying.

Death is a natural part of life, and the conversations I have are not around the fear of death, but of the unknown way in which death will claim them. Most older people understand that death is near, and it does not worry them. In fact a lot are waiting and wanting death to come, but it is the manner in which it will come that worries them.

Most people say to me they would like to go to sleep at night and not wake up.

Is that what you would want too, or is this what you have heard from a resident? (talk this through)

People who speak openly about death are mostly well prepared, but do not want it to be a long drawn out ordeal. Not for themselves or their families. Some do not want death mentioned and change the subject quickly if anyone talks around the issue of death. We need to respect each individuals ideas and choices they make at this time. Gently caring for them and making them comfortable.

How often do we see families sitting beside mother or father, a relative, for days and days before death comes. This is not what most people want for their families, they want a quick, painless and tidy death. (talk this through)

Yet we know that this is not often the case, and so do they.

How many of you have been met with the request to do something that would hasten a person’s death and relieve their suffering? (talk this through)

How do we relieve a persons fear of “how will I die”? Is there something we can do or say that will have meaning and relevance for the person? (talk this through) prayer, talking, sitting with them, remembering special days and memories. Reminding people of the value they have and the qualities they have and the contribution they have given to their families and maybe the communities and the world.

In my experience of sitting with people in times of death is to be there, quietly sitting, maybe holding a hand or touching some part of the body, so they know someone is there.

Sometimes there is the expectation that I will pray for them, or the families have that expectation, and I am happy to do so, but often it is just the fact that I am there that gives families comfort and strength. (praying silently)

The one thing I am very conscious about is what is said in the room of a person who is dying, because we believe that the last thing to go is the hearing, and so let us remember that what we say is important. Let us not carry on a conversation about our own lives, our own work, or something totally unrelated to looking after this person… Don’t carry on personal conversations!

On a spiritual level let us remember that God and his angels may well be present in the room with us, also waiting and watching for this loved one to pass over. We are told that God would send his angels for us, and who are we to argue with that…

Has anyone seen a person reaching out just before death, or dying with a smile on their face, incredibly peaceful? (talk about this, what may they be seeing?)

Let us remember that each person’s life is valuable.

Let us remember that each person has lived a life, full of richness and experience.

Let us remember that each person has been part of a family, and may have family around them still, caring and sharing memories.

Let us remember that each person has a spirit, and the spirit lives on throughout the ages.

Let us remember to care for each individual as we ourselves would like to be cared for.