5 Things People Don't Know About Dying- But Should

As a Registered Nurse and Death Doula, I have had the honor of sitting bedside for those who are passing, and I have had the honor of supporting and guiding their loved ones through the end-of-life process. In my experience, I have found a common factor that contributes to the mystery and misunderstandings that surround dying. That common factor is a lack of knowledge. As a society, we don't speak about death enough, and when we do, it is often wrapped in fear and confusion. Often, when I work with individuals and their loved ones, I am greeted with a list full of questions. Once I am introduced into the picture and start to give answers to the questions, the fears lessen, and a sense of clarity sets in.

In this post, I hope to do the same. I want to gently shed light on five things most people don't know about dying-but should. Whether you're preparing for the passing of a loved one, know someone who is passing, curious about the death process, or just simply want more information, I can assure that something within this post will bring some form of clarity or knowledge that you needed.

1.) There Are Signs Before You Begin to Transition

2.) Individuals Will Stop Eating and That's Okay

3.) There are Three Common Medications Used for End-of-Life

4.) Every Death Is Unique and Not One is the Same

5.) Individuals Can have a Moment of Clarity Before They Go

What is the "transtional" time you may ask. It's the period prior to someone's departure from this world. Often, individuals will show signs/symptoms leading up to this period. This can be weeks or days prior to this time, but there are some key indicators that signal this is coming. I won't go over all of them, but I will lay out the significant one's that we look for in the end-of-life profession.

• Changes in eating patterns:

  This is the number one sign/symptom we look for. Someone can go from eating three meals per day, then all of sudden they are down to one or no longer interested in food at all. Not even their favorites. They begin to have swallowing difficulties, and this is because the part in their brain that has function over swallowing starts to shut down. You can see this when they attempt to swallow it will be followed by coughing or they might not swallow and will hold this in their cheeks. This is known as "pocketing". Individuals may start to only take sips of fluids, but along with food, they will not be very interested in drinking either. I will go more in depth about eating and drinking in the next point, as this is a huge concern for loved ones.

• Changes in Urination Patterns

  Since the individuals aren't drinking or eating as much, they will start to have a decrease in how much urine they are putting out. Also, as you start to transition, your organs begin to shut down, including the kidneys which are essential in making urine. Not only will you start to see less and less urine, but the color itself will begin to change. Not to ruin cola for anyone, but the urine will become a cola color. This is due to the function of the kidneys becoming less and less with time.

• Changes in Breathing Patterns

  Individuals will start to show what's known as "mouth breathing". You can notice this when they doze off. It will look much like snoring to the untrained eye, but it does present differently. It will almost look like they are holding air in their cheeks then puffing out. As time goes on, the sound will increase to what sounds like a snore, but there will be a faint rattle when they breathe out. If you listen close, this rattle will sound like gurgling of water or tiny bubbles. Individuals will also have apnea. This is a period in which you stop breathing, which is to be expected during this time. Apnea can start from 5 seconds and can go up to 2 minutes or longer. Keep in mind, the body is shutting down, so what a healthy individual needs to survive normally, does not apply in the end-of-life realm.

In some cultures, and to some individuals, food is how we express our love. Not only does food play a role in love language, but food is essential for life. So, when loved ones stop eating, it becomes a huge concern. When we think of not eating for days or even drinking fluids, we think they are going to starve. This is actually far from starvation, it's the bodies last way of making energy naturally. Sounds contradicting, I know. As our bodies start to shut down, it goes into what is known as ketosis. You may have heard of people taking on this diet, eating more fats. In ketosis, your body burns fat for energy. So, when our loved ones stop eating, their bodies, and ours, go into ketosis. It starts to burn all the fat that has ever been stored to continue fueling the body, that's why individuals don't report a sensation of hunger. It's not that our loved ones, or even ourselves, are giving up. It's just our bodies turning on the backup generator to keep things in motion.

As stated in the first point, people start to lose the ability to swallow properly. The coughing that you hear after attempting to swallow, is actually a sign of aspiration. This is not good. Aspiration is when food or fluid gets into our lungs. This can lead to pneumonia, which then will lead to more difficulties with breathing. Remember, breathing patterns are already changing during the natural process of death, and we don't want to exacerbate that anymore. Pushing foods and fluids when people aren't fully awake or responding well, will lead to individuals aspirating. I know it's hard to sit back and not attempt to give food or fluids because you want to care for the person who is passing. There are proper ways to do this, but with guidance from medical professionals like me. The best thing you can do is BE PRESENT. THAT IS MORE THAN ENOUGH.

Attempting to give food or fluids at end-of-life can lead to discomfort and can potentially harm the individual who is passing. Remember, all the organs are shutting down, this includes their stomach. When our stomach slows down, it's not moving that food, so it will sit there. Have you ever eaten so much and just felt like you had a boulder in your stomach? That's the best way to describe how the food will sit in the stomach. Not only this, but it can also lead to aspiration. Since the stomach is coming to a halt, there's nowhere for the food to go, and it can go upward. Yes, that means vomit. Vomit that can go into the lungs. That's not good or what we want for our loved ones.

There are three common medications used at end-of-life, they are known as the comfort kit medications in hospice. For those not on hospice, they may not get these medications unless they have a medical professional taking care of them, like me, who is able to get orders from the physicians. The hospital will use these as well when someone is passing in the hospital, not all, but some.

There are other medications that we use for end-of-life, but I just want to touch base on the common ones.

1.) Morphine:

Morphine is used for shortness of breath and pain. As medical professionals, we are assessing the rate of which someone is breathing for shortness of breath. Yes, morphine does slow down your breathing, but in home setting or living facilities we use oral. This means it is not the same as IV Morphine which hits your system quicker. Oral morphine takes longer to kick in and also only stays in the system approx. 4 hours. As for pain, we are looking for body language that signals ques of pain, we have a special scale that we use for those that are not responsive to look for pain rating.

MYTH BUSTER: Morphine does not speed up the process of death.

2.) Ativan (Lorazepam):

This is used for "terminal restlessness" at end-of-life. As stated, there are signs before you depart, and this is one of them. Terminal restlessness can look different per person. It will look like the individual can't get comfortable, they are constantly up and down, extremities moving up and down, reaching for things not there, talking to people not there, needing to "go home", needing to "go to work", needing to "pick up the kids", or anxiety. Not only this, but some individuals can get terminal agitation. This presents as aggressive behaviors. Ativan is used to help ease these symptoms so individuals can remain safe, and just like Morphine, it does not stay in system for long, approx. 4 hours when using oral.

3.)Levsin (Hyoscamine):

This is an under the tongue tablet that dissolves and is used for secretions. Do you recall in point #1 when I said if you listen close to their breathing you will hear a rattle? This is for that! The rattle, not to gross you out, is actually secretions the organs are releasing. This tablet helps slow those down and dries them up, so the individual doesn't have that blocking their airway.

I always tell families that every person is like a snowflake, not a single one is the same. Much like when you came into this world, departing from this world will be just as unique. To some, this may seem obvious, but in the work, I do, I often get loved ones stating, "Well when so and so passed, they didn't need this, or they didn't go through that". You may have had experience with someone else's passing, but the next, or even your own, will be completely different.

For some individuals, they have a peaceful and quick passing. No need for medications to help keep them comfortable. Just smooth sailing. For others, it's a different case. For others, they may need an increase in medications or frequent doses of medications to help maintain their comfort level. In some extreme cases, I am having to go back and forth with the physician because the medication regimen is not working. Sometimes, the tiniest ladies require huge doses. Seems crazy, I know. Which is why I often face loved ones who fear that we are "killing" their loved one. This is not the case. I wouldn't be taking orders that could potentially harm or kill anyone, that's not my intention. I am here to provide comfort is what I tell families. To ease your minds, you would need to drink the whole 30ml of the Morphine bottle to kill someone. Some do require a lot of narcotics, but the physician orders things spaced apart safely so we aren't overmedicating people.

Some individuals, as stated, go quickly. Within a few days or even the same day. While others can go for weeks or even a few months. Yes, months. I have cared for individuals who stopped eating and showed signs of end-of-life, but it continued for two months. Crazy to think people can go months without eating, but it is possible. Anything is possible in the realm of death. I have seen some unexplainable things in this field that not even modern-day science can explain.

The best thing I can say, is to always expect the unexpected when someone is passing.

If you have ever been with someone who is passing, you may have witnessed what is known as the "rally". This is a period in which someone becomes totally lucid before they pass. Up until this point, they may have been unresponsive, haven't spoken or not responding to you. Then, all of sudden they come to. They start having full conversations, speaking crystal clear, and/or wanting to eat or drink. A lot of loved ones will think the person is rebounding or getting better, but unfortunately this isn't the case. I don't want to dismiss this possibility because I have cared for a woman who went through end-of-life three times. We always joked with her that she was a cat, and she found humor in it too. She went a week or two being unresponsive with no food or fluids and then rebounded. Unfortunately, the third time, she knew she wasn't going to make it this time around. She even looked me in the eyes and said, "this time isn't funny". I loved her so much and I always love telling her story. So, yes, people can rebound, but it is very rare.

I like to think the rally is a person's final way of leaving a good memory in their loved one's minds. A time you get to experience the person for who they were before all the complications came about. It's their final goodbye in which they too get to be present surrounded by their loved ones before officially leaving this world. Typically, after this occurs, the person will pass the same night or within the next 48 hours.

Death is Sacred and a deeply personal experience-one that deserves honesty, tenderness, and understanding. By learning what to expect, we can ease some of the fear and open space for connection, comfort, and even healing. I always say, "knowledge is power".

If You found this helpful or curious about the dying process, I invite you to reach out. There are many more topics around the dying process I didn't cover here, but as Registered Nurse and Death Doula, I am here to support, educate, and give compassion to individuals and their families. I am the light the helps navigate through the darkest of times.

Thank you for reading-and for being part of a conversation that truly matters. Feel free to share this, maybe someone you know is going through this or you know others who would benefit from reading this.