How t he Mental Processes Change When Death Approaches
Often there is a pulling away from the people and daily routines that once seemed so satisfying and necessary. Every death is probably unique to every individual but there is a common pattern many people exhibit who are facing certain death. When the profound truth and acceptance of death hits them, this may be an especially difficult time for the dying person because all the caregivers, family, and loved ones are generally trying to outwardly show hope and encouragement to live longer rather than die!
Now the dying person's thoughts may turn to more important things like life's successes and failures, good and bad choices made, and unfinished business with people. These thoughts are very profound and private so may not seem acceptable or appropriate to share with caregivers, family, and loved ones.
A very personal discussion on dying may be a whole new way of relating to others and hard to do because it is so emotional and personal, especially if the topic of death had always been ignored or denied.
The patient facing certain death often tries to sort out the truth about this life and what will happen when death finally comes. Sometimes religious past teachings may help, but some teachings about Hell and damnation may frighten them. Some dying people who seldom attended any religious services may hurriedly dive into a religion hoping for some special treatment in the death process. The dying generally may quietly make his or her own judgements of their moral self. Many Near Death Experiencers report that an important part of their NDE process was a "life review". See more on the NDE here
Some people may start a life review and realize how they truly ran their life as others would see it. This truth about themselves and the forthcoming death can not be ignored now and depression may set in as they realize it is too late to correct past wrongs. The undeniable truth about what kind of life they really created, and knowing no one can help them prevent their passing, may cause them to further withdraw from everyone. Now is one of the last chances for everyone to extend forgiveness, express love, and say goodbyes. How they do this, and even if they do it, is a difficult decision for many.
If the dying person does not have the energy, or courage, to express these deep emotions of love at this point it may help them in their transition if family and loved ones can be bedside and speak their loving best wishes for a divine transition now, with no guilt or regrets for anything. Permission to depart the physical world and go peacefully and freely into the spiritual realm may be very helpful and greatly appreciated by the dying person.
What Happens With One Foot in the Physical World and One in the Spiritual Realm
One or two days prior to death the patient may show a slight surge of energy, more communication with caregivers, and positive attitude as if he or she suddenly recovered a bit. This is an indication that a connection has been made with the spirit realm. Spirit helpers on the other side are now providing energy to say good bye and transition into the spiritual realm.
Frequently just a day or hours before death a change may take place in the dying patient that is important but it is often missed or disregarded as being hallucinations. This behavior should be watched for by family and caregivers. It is called Nearing Death Awareness (NDA) and is covered here.
How the Body Starts to Physically Shutdown
- The body's first step leading to death usually begins by stopping the intake of life sustaining food and drink. There is no need to further strengthen the body from this point on. Food becomes unappealing and the digestive system stops functioning normally. Generally dying patients first give up solid food, then the softer foods next, and finally even refuse drinks. This is a signal that no more outside energy is desired to maintain this physical body. Spiritual energy and some sort of will to live - or fear of death - keeps the body going now from day to day.
- As death approaches, the energy levels start dropping in all body systems from lack of life sustaining nutrients. Hands, arms, feet and legs begin to cool and become discolored in spots as the blood circulation decreases.
- The organs slow down functioning. The normal cleansing action and elimination of waste and toxins slows down or stops, and this aids in the natural dying process of the body. The patient grows weaker and sleeps most of the time as the body takes its natural course in the dying process.
- Blood pressure may drop and heart rate may become fast, faint, or irregular. Breathing and swallowing become labored. Bowel and bladder muscles may lose control.
- Patient's speaking and caring for self diminish. The brain, starving for normal nutrients, periodically functions erratically and incoherently. Muscles may jerk in legs, arms, and face.
- Patient may reach a point where they no longer can be awakened. However, often they are still aware of what others say to them and feel their loving touch.
In many cases of normal dying the tendency often is for the family and caregivers to seek medical assistance for every abnormal sign. If breathing is labored or pulse is erratic, then assistance is requested with the good intentions of making the patient more comfortable and extending life a little longer. Here is the problem: The normal course of action for the patient is to proceed with the dying process; however, the medical people are dedicated to extending life with all possible equipment and drugs! Admittedly, they are getting very good at relieving abnormal symtoms and extending life a little longer even when there is no point to it. (Never forget that most medical people and facilities make money by providing service. Once the patient dies their income stops!) Therefore it is very important to establish beforehand who and how treatment decisions will be made when the dying patient can no longer make decisions, which actually can be quite early in the care-taking process.
Medical Assistance May Delay the Natural Dying Process
In developed countries like the U.S., family and loved ones may demand medical staff exhaust all medical resources available to extend and delay the normal death process. The value of these attempts, although well intended, is often questionable, expensive, and generally address only one symptom or process such as breathing, blood pressure, or pain.The main point is generally ignored: how important are a few more days, weeks, or months of life? And what will the cost be in comfort for the patient and cost in money to pay the medical doctors and staff?
In too many cases (especially in my own mother's case) the medical attempts to prevent death often only condemns the patient to months or years (such as my mother's case) of an ongoing life of pain and miserable existence bed-ridden and dependent on caregivers to feed and clean them. Not only is that often humiliating to the patient but also expensive! Helping a dying patient transition quickly is a far greater gift of love.
The Struggle to Resist Death
In the final stage of the dying process the body's signs of struggle to stay alive may intensify. Breathing, heart rate, body temperature, and other body functions may increase, decrease, or become increasingly erratic. Much like being born, the transition to or from the physical body realm and the spiritual realm can be difficult.
The mental states that can hinder a smooth transition from the physical body to the spiritual realm are often these life-long attitudes and beliefs:
- Hidden fears about death that come from myths about Hell and damnation taught in a religion.
- Resentment and anger about dying. Maybe cursing everyone from God down to the doctors, caregivers, and family for "letting this happen".
- Hanging on to possessions, wealth, or loved ones with great fear of letting go and losing control. This may extend the basic body functions a long time with great effort to keep breathing.
- A feeling of guilt from abandoning and leaving loved ones behind and properly uncared for by the dying patient.
My Plans for Dying
I have observed in other families where a member was dying that good planning and education of the patient, family, and caregivers was totally missing, thereby resulting in major problems in decision making and care of the dying. Mostly it was missing because everyone didn't like talking about death.
Understanding the normal death process can help me, and other dying patients, make the best decisions for a speedy exit rather than maybe laying drugged up and unconscious for days.
I understand that when I am ready to die I will need to let go of my body and the material world in order for a smooth transition to the spiritual realm. Understanding how the transition from physical to spiritual realm works will greatly facilitate this process -- and now there is abundant information now on how the transition works.
I want my family and loved ones to accept that I must be released and allowed to die free of attachments and expectations of theirs and others. The most important thing for all concerned is to recognize that hanging on to hope that there may be a miraculous reversal of the dying process usually is a useless exercise that may delay a normal death.
I don't want to feel guilty and hesitant about letting go and dying a normal death. I do not want to try to meet the expectations of caregivers and loved ones that I might recover and not die. I will be best served if all concerned express their approval for me to let go and die peacefully and with love and support from all concerned.
I am preparing a script that might be read to me during the last hour or so of my death that may help me release. This ritual comes from the Tibetan Book of the Dead but I have rewritten it with less Tibetan terms and deleted all their good and evil deities. My version with instructions for use at my death is here.
Signs That Death Has Occurred
- Breathing stops
- Blood pressure cannot be heard
- Pulse stops
- Eyes stop moving and may stay open
- Pupils of the eyes stay large, even in bright light
- (sorry about this mess) Control of bowels or bladder is lost as the muscles relax
Don't Dial 911An important note: If you call 911 or Emergency Medical Services (EMS), during an expected death at home, the law often requires that EMS try to revive the patient or take them to a hospital. This can complicate the situation and delay the natural dying process. Additionally, the VA advises that expenses for a 911 response may not be covered by the VA. It is important that my family, friends, or caregivers are ready and know exactly whom to call, so that they don't dial 911 and end up with medical life sustaining treatments as well as unnecessary expenses.
Do Call One of These After I Die
If I die at home and I am a hospice patient, call the hospice agency to report the death. A hospice nurse will come to the home and pronounce the death. The nurse may also call a crematorium for arrangements to pick up my useless and expired body. I desire it be cremated as soon as practical and at minimum expense with no frills. (NOTE: It is less involved if I am officially in hospice at time of death.)
If I am not a hospice patient, then you must call Emergency Services to notify the local police or sheriff of the death. A coroner or medical examiner may be required at the scene if the death was sudden. Sacramento County EMS: (916) 875-9753