WHEN DEATH APPROACHES, Part 2                                                                                                                                                                                                    This This article lists specific signs of impending death. 

Remember that illness is fatiguing. No matter the strength of the patient’s willpower, energy levels will be low and their ability to reason may be impaired making decision making a distinct challenge. 

Both patient and caregivers need to develop a tolerance of the patient’s physical and emotional limits.  Slow down.  Rest.  Sense what the body and mind have to say, and then respect these limits.

The symptoms below are associated with the body’s shutting down and drawing nearer to death.

Breathing       As the body shuts down, breathing patterns may change.  Respiration might be irregular or      shallow or there might be apneas [5 – 30 seconds of no breathing].  This is a common sign of decreased circulation.  Elevating the upper half of the body may help.  When natural secretions accumulate in the throat, rattling sounds can be heard.  The patient drinks less and loses the ability to cough or swallow.  Unnervingly the rattling noises can be quite loud but the person is not choking.  Sometimes it helps to turn the body or the head to the side placing pillows behind the back and the head.

Confusion       Time and place awareness become muddled.  As organs begin to fail, so does the                        brain.  The person may not recognize familiar faces or may speak to people who are not there. This is not a hallucination or a drug reaction.   Respond in a calm voice.  Gently remind them if they forget but do not argue or belittle their experience.

Coolness         As blood circulation decreases, limbs and extremities cool to the touch.  Keep                              the person warm with an extra blanket and a shoulder wrap.

Excretion        Urine may be dark or decline in volume as the kidney functions less effectively.                            Patients usually reduce their fluid intake despite repeated attempts to entice them to drink.  A loss of bladder or bowel control is common as the muscles in the pelvic area relax.  Employ disposable pads and adult diapers.  The skin is also  an organ so note that skin can begin to break down on the backside and around private parts.  Assist the patient to lay slightly on their side by plumping pillows                                    under one side of the body.  This will take the pressure off skin on the backside and allow for improved air circulation.  It is essential that the patient be kept as dry and clean as possible.

Hearing           This is the last sense to leave us, thus the many encomiums to keep talking even                          when you think they can’t hear you or they are not responding normally.   Your vocal presence is an expression of your love and can be very calming for your loved one.

Eating             As energy needs wane appetite declines.  Ice chips help with the associated                                  dehydration. 

Restlessness    The patient pulls at the bed linens, becomes agitated, and is unable to remain in                          one position.  They might even flail limbs and mutter while asleep. These involuntary movements are common as the patient nears death.

Sleepiness       As the patient’s metabolism slows down, he or she spends more time sleeping                              and less time awake.  He or she may even be hard to wake up.  Plan quality time with family and friends to coincide with the time of day he or she is most active.  It is important to speak directly to the patient and talk as if they can hear you,  even when there is no response.

Socialization   As oxygen to the brain declines, the blood flow also declines.  The patient may be mentally preparing themselves for death and talk less or not at all. 

Coma              Some patients go into a coma or semi coma during the dying process.  Talking to them does not wake them up, neither does your touch.  Their eyes might remain partially open. Never presume that they cannot hear you.  In the death process,  the very last of the five senses to be lost is hearing.

This time of transition is physically difficult and emotionally draining for the caregiver.  I hope that the ability to explain and recognize symptoms of dying will help family members prepare themselves and their loved one better.