If you have never seen anyone die you may be afraid of what will happen. But the moment of death is usually peaceful.
Caring for a person during the last few weeks and days of life can be stressful and demanding. Many different feelings and emotions may surface at this time. This article should help you to understand, anticipate and respond to some of the signs you may notice.
Carers are often concerned that death will be a painful experience for the person. However, the time before death is generally peaceful. There is a gentle winding down that may take several days. The body starts to ‘let go’ of life. If restlessness does occur, it can be treated.
Not all the signs discussed in this article will occur with every person, nor will they occur in any particular sequence. Sometimes these signs appear a few hours before death, sometimes a few days. These physical signs are part of the normal, natural process of the person’s body gradually slowing down.
Apart from the signs described here, you may notice other changes that worry you. The palliative care team is there to assist you by providing information and support.
Please ask for help at any time. The team expects to have increased contact with you in the last stages of the person’s life.
You can bring enormous benefit to the person you are caring for simply by sitting with them, holding their hand and speaking in a calm and reassuring manner. Even when the person does not respond, they can probably hear you.
Don’t underestimate the value of these simple things. ‘Being with’ can be more important than ‘doing for’.
Changes you may notice and what you can do to help
Appetite and thirst
The person’s appetite and thirst may decrease, and they may have little desire to eat or drink. This concerns many carers, but is a natural process and is not painful for the person. Sips of water, or a moist mouth swab will help them. You can ask the nurses to show you how to help with mouth care, if you wish. Attempting to feed someone who is unable to swallow may make them distressed.
Sleep and alertness
Changes happening in the person’s body mean that they may spend a lot of time asleep, may be drowsy and difficult to wake up. It is best to talk to the person when they seem most alert, and allow them to sleep when they want to. There is no need to shake the person or to speak loudly. It is best to speak softly and naturally.
The body’s temperature may change. At one time the person’s hands, feet and legs may be increasingly cool to the touch, and at others they may be hot and clammy. Sometimes parts of the person’s body become blotchy and darker in colour. This is due to the circulation of the blood slowing down and is a normal part of the dying process. If the person indicates that they feel cold, use light bedding to keep them warm. Too many bed clothes may make them hot and restless. Provide good ventilation; a fan to circulate the air and cool damp towels can help if the person seems hot.
The amount of urine that the body is producing decreases due to the reduced amount of fluid the person is drinking. The urine may become stronger and darker in colour. Many carers are concerned that the person will lose control of their bladder and bowels. This does not happen to all people, but if it does there are pads, diapers and special absorbent sheets to enhance comfort and hygiene. A member of the palliative care team will advise you about what is needed.
As coughing and swallowing reflexes slow down, saliva and mucus may collect in the back of the person’s throat, causing a gurgling, bubbling or other noise. This noise can be a concern to carers, but does not usually cause distress to the person. To help improve the situation you can lift the person’s head and support them with pillows so that their head is turned to one side. Medications can also be given to slow down the production of saliva and mucus and thus improve comfort.
Regular breathing patterns may change. Sometimes the breathing may be fast, and at other times there may be long gaps between breaths. Breathing may be shallow or noisy. This, too, is due to blood circulation slowing down and a build-up in the body’s waste products. It is not painful or distressing for the person.
Due to the decrease in circulation of blood to the brain and to other changes happening in the body, the person may become restless or agitated. To have a calming effect, speak in a quiet natural way, lightly massage the person’s hand or forehead, or softly play familiar music. Let a palliative care team member know if the person becomes restless or agitated. Medications can be given to reduce the problem.
How will you know that death has occurred?
• Breathing stops
• No heartbeat or pulse can be felt
• The person cannot be woken up
• Eyelids may be half open
• Sometimes their mouth may also be open
• Pupils are fixed
What should you do?
You don’t have to contact anyone immediately unless you want to. It is important that you do everything in your own time. There is no need to hurry. Telephone a relative or friend if you want them to be with you. If the person dies during the night you can call them straight away.
You may place the person in a comfortable position because their limbs will stiffen. You can sponge away any perspiration or body fluids that worry you. It is not necessary to bathe the person completely, unless you want to. If not just done by a team of professionally trained embalmers and beauticians dedicated to rendering their immaculate services with a genuine heart for deceased body.
If you have already made funeral arrangements, you should contact the funeral service care provider according to your beliefs and be guided by them. You will need to make a police report by taking the patients ID and any documentation on their illness to the police station to obtain a burial permit. If the person dies in the hospital, the medical officer in charge will make the necessary arrangements.
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