The pending loss and ultimate death of a loved one is life's most painful events. It is also one of Western culture’s least understood and most taboo topics. Often, we are left alone in dealing with their pain, loneliness, and isolation. In the days, months and weeks before a death occurs, it is helpful to plan ahead. This will both help ready the mind mentally for the loss and help prepare those around you. Ensure you know what your loved one's wishes are, so that they are respected. If funeral arrangements have already been made, have all documentation on hand and ensure it is up to date. It is also important to have all life insurance policies on hand, too. Although difficult, having a conversation in advance about funeral wishes and making the arrangements reduces the number of decisions that will need to be made at the time of death. It also provides an opportunity to talk about arrangements, concerns and feelings.
Death is a natural process as the body begins shutting down. Although there are typical signs, they may not always happen or in a particular sequence. Use this guide as an outline for better understanding the process. It is not intended to replace advice given by a health care professional.
Loss of appetite and a decrease in thirst are common. As the body shuts down, it no longer needs nourishment. People commonly feel it is necessary to encourage the person to eat in the hope of sustaining life, however, food and fluid may cause discomfort. The person may ask for ice chips, popsicles, ice cream or some other cold food choice. Do not be surprised if only a mouthful or two is taken. When swallowing is no longer possible, mouth care provides moisture and comfort. Do not offer a fluid if swallowing is not possible.
Output of urine and stool will decrease as the food and fluid intake decreases. Urine and stool may also change colour, be passed less frequently and in smaller amounts. Other factors such as immobility and medication may contribute to this. Your loved one may lose control of bladder or bowel function as the muscles begin to relax. In this instance, it may be necessary to use an incontinence brief. Ask a health care professional about the management of these symptoms. It is important to provide skin care and cleansing on a routine basis.
Increased sleeping is common. It may become more difficult to waken the person. As death nears, the person may slip into a coma and become unresponsive.
Restlessness and mental disorientation are common. Recognition of time, place and family members or close friends may occur. At times, your loved one may become restless. For example, he/she may reach out to unseen objects, pull at bedclothes or try to get out of bed. This can occur for many reasons such as a lack of oxygen circulation to the brain or changes in condition or medications. It would be helpful to discuss these changes with a health care professional.
Regular breathing patterns may change. Breathing may stop for 10 to 30 seconds or be replaced by rapid, shallow panting. These breathing patterns are normal and indicate the natural progression towards death. A moaning sound may also occur as the breath passes over the relaxed vocal cords.
Congestion is a common sign. Gurgling sounds occur when a person is unable to cough up normal secretions. This does not normally cause pain or discomfort. It may be helpful to turn the person to one side and gently wipe away secretions with a moist cloth. As secretions build up, keeping the head of the bed elevated (by using pillows) will make breathing easier. Sometimes medications can be ordered to help dry up secretions. Oral suctioning may be done, however, this usually causes an increase in secretion production.
Skin begins to change colour and become cooler to touch. The face may be pale and the feet and legs a purple-blue mottled colour. The circulation of the blood is slowing down. Although your loved one is cool to touch, he/she is usually comfortable. Offer a warm blanket but avoid using an electric blanket to prevent the risk of skin burns.
As death approaches, the person becomes quieter and less interested in physical surroundings. He/she may become withdrawn, less sociable and also be confused about time and place.
Vision-like experiences may occur. The person may see or speak to people and places not visible to you. Try not to explain away what the person is saying. Be supportive and listen.
The person dying may be going through different emotional. Feelings such as guilt, anger frustration, helplessness or sadness. Tears are a natural expression of one's feelings and may occur in both the person and his/her family.
Spiritual and cultural beliefs are often relied upon during this time. A member of the clergy, chaplain or a spiritual advisor can provide support to both the dying person and the family. It may be helpful for you to attend to your own special cultural needs at this time.
Even when death is expected, you may not be prepared for the actual moment it occurs. At the time of death:
The procedures followed prior to and after death by nurses, physicians and funeral directors will vary from province to province. If your loved one is living with a terminal disease, you should ask your physician and funeral director what the procedures are in your area.