What Dying Bodies Do

Preparing for a Good End (Part 4)

Few today have been the primary caregiver to a dying loved one, even though dying at home is on the rise in the United States. Instead, many still die in medical facilities cared for by nursing staff, often alone or with family who fear the dying process and visit minimally. As a result, most people outside of medicine know very little about a dying body.
What Dying Bodies Do
(DC Studio/Shutterstock)
Sharleen Lucas

Follow the "Preparing for a Good End" series here.

In this series, we'll examine ways of making meaning in the face of death, offering tools founded in traditional wisdom and scientific evidence to help our readers live well right to the very end. 

For many people, death feels contrary to all that is good in life, like the wrong finale or a mysterious curtain falling in the middle of an act.

Yet, evidence suggests the body sees it differently. Many palliative care experts argue that a body dying naturally of old age or an incurable illness knows how to die in a comforting and possibly euphoric way.

Except in rare cases, the final stage of death isn't as painful and disturbing for the dying as it is for the loved ones watching. Learning to trust the body's natural dying process may feel absurd. Still, according to experts, this acceptance increases peace when death approaches.

Understanding the Dying Process

A few years back, during my work as a hospital RN, our physicians admitted a petite older woman, whom I'll call Delores, from the emergency department into my care.

When our staff rolled her into the hospital room, I saw a deep sadness in the eyes of her husband; I'll call him Tom. We settled Delores comfortably into bed, an IV machine dripping fluid into her vein. I shut the door to the busy hallway, and Tom and I sat down in chairs next to Delores and began a gentle conversation about her situation.

As a patient of our local hospice, Delores was in her final days of a natural dying process. Her husband had grown distressed when she became increasingly unresponsive, no longer eating, drinking, or moving. Thinking she was suffering from thirst and hunger, he called 911 instead of calling hospice to ask for their advice.

The EMTs and paramedics who answered the call didn't ask whether she was in hospice, something ambulance first responders should be experienced enough to assess. The emergency and admitting physician didn’t question whether IV fluids and admission to a bustling, noisy hospital were in Tom and Delores’s best interest.

Rehydration of an actively dying patient can be a form of overtreatment because it won't cure his or her condition and can increase distress. When multiple organs fail, they stop processing fluid adequately, causing it to seep into the lungs and tissue.

An irreversibly dying body seems to understand this and quiets the uncomfortable feelings of thirst and hunger, according to an insightful article by palliative care expert Rebecca Gagne-Henderson. When the body ignores nutrition and hydration as a part of the dying process, it starts a cascade of complicated physiological events that release neurotransmitters such as endorphins, oxytocin, and serotonin. Instead of suffering, these chemical messengers increase a dying patient's comfort, possibly even inducing euphoria.

Tears welled in Tom's eyes when I explained this as he realized he’d misunderstood what she needed and perhaps wanted. Rather than sitting at home holding Delores's hand, he'd unwittingly set them both on an unnecessary journey to the hospital, fraught with stress and discomfort.

Had he understood the dying process, he could have called hospice for comfort care and gathered loved ones around Delores’s bed.

Trusting the body’s knowledge of dying gracefully increases peace at the end of life for everyone involved.

The Labor of Dying

Few today have been the primary caregiver to a dying loved one, even though dying at home is on the rise in the United States. Instead, many still die in medical facilities cared for by nursing staff, often alone or with family who fear the dying process and visit minimally. As a result, most people outside of medicine know very little about a dying body. Surprisingly, the same is true for many medical practitioners.

Each person’s dying journey is unique. However, like birth, the body labors through the process with common symptoms during one’s final weeks.

Award-winning hospice nurse, educator, and author Barbara Karnes explained the typical dying process in an interesting way during an interview with hospice physician and podcaster Karen Wyatt.

"There are natural, normal ways that we get out of our body. That's part of how we release," Ms. Wyatt said. "Nothing bad is happening. Nothing pathological is happening."

To die well, palliative care experts recommend a team of support beside the dying person throughout the journey. But, in the end, as Ms. Karnes said, the way one dies is highly individualized.

“We, the watchers [of a loved one’s death], can participate,” she said. “We can be there. We can support ... but it’s not our story. It’s not our ending. They’re going to die in their own manner according to their own personality.”

Signs and Symptoms During One’s Final Days

This individualized dying presents in many ways. While there are common physical symptoms of death during one’s last weeks and days, they vary depending on different illnesses, personal needs, and levels of spiritual peace.

For example, patients who didn’t have much pain in their aging or disease process rarely feel increased pain during their dying process. Some patients reminisce and talk more, while others withdraw. One patient may wait to die until a loved one arrives, while another waits until everyone leaves the room. Patients with pain may wish to be highly medicated, while others choose minimal medication to focus on family time despite the pain.

Regardless, there are common signs and symptoms of death labor, as Ms. Karnes calls it, typically spanning one to seven days. Health care providers call this final labor of death “active dying.”
  • Complete loss of hunger and thirst
  • Dry mouth
  • Bowel and bladder changes
  • Excessive sleep
  • Altered consciousness, often drifting in and out of awareness in a dream-like state, possibly with visions
  • Unresponsiveness
  • Lack of movement
  • Restlessness, fidgeting, or agitation
  • Sudden arm or leg movements
  • A dramatic surge of energy or awareness days or hours before death
  • Dropping blood pressure and irregular heartbeats
  • Cool, mottled skin as less blood flows to the arms and legs
  • Irregular, gasping, or loud and gurgling breaths, known as the death rattle

Trusting the Dying Process

For loved ones, death can be hard to watch. For the dying, “it’s an incredibly beautiful and mysterious mechanism,” Ms. Gagne-Henderson wrote.
While “the watchers,” see the frail, sunken skin of our loved ones, touch their cold arms, and hear their loud, gurgling breaths, the dying no longer feel these discomforts. Instead, they’re on solitary journeys of separation from their physical bodies into a more dream-like or possibly spiritual state.

As Ms. Karnes described it, “we’re hearing and witnessing their dream” during one's labor to get out of one's body. She says that the dying become more spiritual and less physical, which we may never fully understand as watchers.

It's tempting to define what is happening through our own belief system or sense of physical discomfort, but, as palliative experts explain, a patient rarely is in as much distress as our perceptions tell us.

Due to a lack of research, we’re not exactly sure what happens neurologically and spiritually as a patient dies. However, we have clues through stories and a few studies of near-death and end-of-life experiences.
Some researchers and end-of-life experts theorize that neurotransmitters or changes in the brain are responsible for dreams, visions, and out-of-body experiences. Other experts, such as Ms. Karnes, who has seen thousands die, including children, are certain that people are encountering another dimension or the afterlife. Either way, those left behind see and study the physical effects on the body.
Ultimately, Ms. Karnes says that perhaps it's better to embrace the body's dying process than strive to solve every mystery—something no one can fully decode until death.

Treasure the Journey

Since the common perception of death may be worse than reality, experts recommend consulting with hospice to increase end-of-life understanding, support, and peace in the journey.
When your loved one’s breathing changes to gasping, irregular, or disturbing, rattling breaths, remember this is normal as he or she weakens. The loss of his or her gag reflex means the gurgling secretions aren't uncomfortable.

When a loved one fidgets or seems mildly agitated despite trying every tool to increase comfort, remember that he or she is likely laboring through death. Don’t be afraid to get close, hold your loved one's hand, and talk to him or her. Since hearing is the last sense to go, your words are likely getting through.

When he or she converses with someone you can’t see, recalls comforting dreams of dead loved ones, or experiences a sudden, shocking burst of energy, remember that this is part of a beautiful and mysterious dying journey. Being the watcher is a gift to cherish.

Next: Planning your funeral can help loved ones grieve, connect, and say goodbye.

Read the entire "Preparing for a Good End" series here.
Sharleen Lucas, R.N., is a freelance writer with medical, spiritual, and emergency care expertise. After two decades of serving patients and families at the bedside or as a spiritual care director, she’s committed to empowering readers’ physical and spiritual well-being by boiling down health information with the warmth and skill of an RN next door. You can find her at RNextdoor.com