The Act of Dying

The Act of Dying

Within the mysterious realm of paranormal research, discussion of the Afterlife is heavy and prominent. However, the real act of dying is usually only talked about when a death was traumatic or seemingly out of this world. In my everyday life, it is my job to look after those whom are in their last months, weeks, days, and hours. It is an honor to care for those whom are at their most vulnerable and make the best of what time they have left. Most of the time when people pass away under my care, it is quiet and peaceful. With that being said, the hospice house I work out of is very haunted. There is no need for a melodrama for a haunting to occur. My hope with this write-up is to share my knowledge and experience with caring for people dying; to bring an understanding of what it is like for people to transition from this life to the next.

So it Begins

Hospice services really begin when a person has a long-term disease (i.e. cancer) or acute injury or illness and there are no longer any more treatment options to explore. After this is determined two doctors sign off that they believe that their patient has six months or less to live. Now, of course there is no crystal ball and a person can and often does live beyond the six months prognosis. The main criteria for a person to stay on hospice services is for the patients’ health to have a continuous decline.

One of the first signs of decline with a loved one in hospice is the loss one’s appetite. A side effect of several medications is to change or diminish the sense of taste. I’ve had many patient only want sweet, rich food and drinks because it is the only substance that tastes normal. I have many times loaded mashed potatoes with sugar and cover meat loaf with maple syrup. It sounds unappealing to us, but to a person who is hungry but can’t taste anything, it is the best thing ever. We're taught that eating too much sugar is bad for our health but at this point in a loved one’s disease process...allow it. Family members are worried about their diabetic loved one’s blood sugar levels and try to limit their sugar intake. At this stage of the hospice patient’s life, high blood sugar is the least of one’s worry. Enjoy the time remaining you have with your family member.

It is the body’s purpose to keep functioning as well as it can. In order to do that, it needs to conserve as much energy as possible. Which is also another reason for the decrease in the want of food. On one hand, food is needed to nourish the person to keep on living; however the act of digestion takes a lot of energy. To compensate for the lack of food (for a little while) the body will simply use the fat and muscle reserves as nourishment. The end result is of course massive weight loss. This can be disturbing for concerned family and friends, as food is the source of life and love.

As much it is engrained in us to feed those we love, it is in dying person’s best interest to lead the way on this one. A great deal of time patient’s have explained to me that they do not feel hungry and even their once favorite meals, now have the appeal of eating a pile of dirt. There is no desire. That is the case much of the time. Now, if the want of a feeding tube is high, it can and is done. Just be mindful that even the tube feedings still have their limits. It will not stop death or prolong the person’s life in a meaningful way. As a hospice patient becomes weaker and weaker the tube feedings can and does cause more harm than good. Eventually the digestive system will stop functioning all together and the liquid nourishment will simply sit in the stomach. If the feedings are continued and the body is not using the food given, it will travel to other parts of the body. Namely causing a great deal of swelling in the hands, arms, and legs. Before ending up in the lungs, causing a person to basically drown.

The Pain is Real

Pain is one of most common symptom that needs to be managed. No matter the disease or age, pain is more often than not, inevitable. Between multiple organs shutting down and the lack of fat and muscle to act as a barrier from the outside world, dying can be very painful. When pain medication is first ordered, it is a low dose. Then over the next 24 to 48 hours, how much medication that is given is recorded. This determines how much medication is actually needed for each person to be as comfortable as possible. Every person is different and have unique needs. The medical staff does everything they can to allow the patient to direct what kind of care they need because the dying process is different for every person. No need to be scared of the narcotic medications for a number of reasons. For one, even though medications like Morphine and Dilaudid are given very freely; it is still monitored and controlled. The risk of overdosing is almost non-existent.

Even with a pain pump that administered the narcotic medication around the clock automatically. It is still a controlled dose that is given over a period of time. A side effect of this increase in sleeping. This is can bring up questions of quality of life. Bear in mind that in many cases it be one of two situations: One: the person actively dying is awake but in pain. Or two: the person is asleep but comfortable. Most hospice professionals will advise family and friends to make the most of the time their loved one is awake and allow them to sleep as they need.

The Labor of Breathing

As the disease process runs its course the second most complained about symptom is shortness of breath and/or general difficulty breathing. At this point all the bodily functions are not working as they should be. Fevers come and go as the body is no longer able to regulate body temperature. Wet secretions build up in the mouth because the dying person as lost his/her ability to swallow; this also creates the breathing sounds most commonly known as “The Death Rattle”. The lungs working overtime with the heart to keep the body oxygenated. When there are short and rapid breaths taken, that is a sign that medication needs to be given. The patient is breathing a lot but not enough oxygen is being dispersed to the rest of the body.

I’ve had patients that are still able to communicate describe this feeling to me as they feel like they are drowning but there is no relief of death in sight. This sensation also causes a great deal of anxiety and panic for the person being treated. This act of hyperventilation is commonly known as “Air Hunger”. One of the best medication duos to treat air hunger is a combination of Morphine and Ativan. These two medications together relax the muscles around the lungs. As a result the lungs are able to expand and fill with more air. Essentially slowing down the breaths per minute but allowing more quality breaths.

Visions of the Other Side

Modern medicine relies heavily on what can be observed by the medical professional. Within hospice care that is the case well...for the most part. Before a person becomes fully unresponsive something fascinating happens very often. If a person cannot speak, they can still be seen reaching out to the ceiling as if trying to grab hold of something or someone. If someone doesn’t have the strength to reach out, they can still be seen following something with their eyes that we cannot see. For those whom can still talk have told me that their long dead mother/father/grandparents are here waiting for them. One gentleman I took care of shared with me that his beloved dog from childhood was here and slept on his bed all night. Our doctors tell us to let them know when our patients begin to experience these visions so they can call the family to let them know that their loved one has days to hours left. The phenomena of having visions of the other side is experienced buy all ages, races, religious beliefs, and their lack of. Most of the time it is a comfort to the dying person and their families. That they are not going to alone on the other side and one day all the family will be together again someday.

This Is It

The moment that made me decide to work in hospice was the time when I held the hand of an old man as he took his last breath. I was working as a CNA in a physical therapy, assisted living center. I really had a connection with this gentleman. At the time I didn’t know what his prognosis was. I figured that he was there for strengthening and would be going one. I was off for a weekend and when I came back Monday I found his room empty. I thought he went home. That was not the case. He was moved into a private room with a hospice nurse. He was actively dying. I checked one him frequently that night. I watched his breathing become short and shallow. Then he would have periods of time where he would not take a breath at all. Then maybe he would take a four breaths per minute. He was dying but he looked so peaceful. The look in his eye was soft and understanding. The final time I looked in on him, the hospice nurse got up from her chair and said to me, “This is it.” I rushed over to his bedside and took his hand. He inhaled a few negligible amounts of air. I told him I cared for him. As I said that he seemed to use the final bit of strength he had to squeeze my hand. Then he slowly released my hand as he exhaled his final breath of air. That was it.

The “guppy breathing” that my special man was doing in his last minutes. His skin was grey and pale and his eyes focused on nothing in particular. This is all signs that a person has minutes left. “How do you know?” The families often ask us when we tell them. We just know, we have seen it so much, we just know. The small changes that can change everything, let us know what is happening. How far their beloved is in the dying process. It all signs and symptoms.

We can never tell just how much time a persona has left on this physical plain. It seems a lot of times the dying person has more of a sense then we do. “I’ll go after my birthday party tomorrow.” I had one man tell me. I chuckled and moved on. He had his party with this adult children and grandchildren, when hours later, he was gone. Just like that. Or a brand new person comes onto my unit and declares, “I am dying. I can tell.” Then just like that, gone in less than two hours. Some are even completely unexpected. One morning we were prepping to discharge a lady in her mid 50’s to go home that early afternoon. We went out of her room and then returned 30 minutes later and she had passed away in that short amount of time.

It seems to me that those whom were very stubborn people in their prime, continue to be very proud. They seem to be determined to pass on in their own time and their own way. It is really is a different experience for everyone. My job is not just give pain medication and give baths. My work and those whom I work with, do everything we can to make the most what of is left. I have made Christmas in July for a lady that just wanted to have one more Christmas but wasn’t going to make it that long. I have made flower crowns at lighting speed for a bride. I have prayed with a Buddhist monk. It was all to make sure the person I am caring for transitions into the next life, as peacefully as possible. I’ve seen a lot of death in my work, but I have learned that it is only a physical death. There is definitely another life beyond this world and the act of getting there can be and is very beautiful.