Dying is the process of going from perfectly good health to no health at all.
For some this is an instant event, and a short journey. They leave home in the morning and have an unexpected meeting with death. This could be in motor vehicle accident or a sudden massive heart attack. For these very little happens when they die. It is all over before it even begins.
For most people though death follows a process of dying. This is often a longer journey than expected and it is hard work. It is the physical process of diminishing returns until there is no way to sustain biological function and the body stops working altogether. We often only think of dying as the events that happen in the last 24-48 hours of life, when biologically everything is chaotically coming to an end. In truth we start dying the day we are born; it is hopefully a long and pleasant journey until we hit the final hurdle of an incurable illness at the end of our biological lives.
We take living for granted, as we should, but in fairness we should also taking dying for granted and be prepared for this change in our lives, when living must give way to dying. Often this transition is subtle, and it sneaks up on us in old age. Sometimes this change is more abrupt as with a medical diagnosis such as cancer. When our bodily function cannot keep up with the demands of life, we are technically dying.
Dying is often a gradual process and in this transition from being healthy to being dead, there are a lot of things to consider.
The body becomes increasingly frail and weak. With cancer, people often lose weight, they lose their appetite and become increasingly dependent as they become frail. This journey is associated with increasing medical appointments, the symptoms associated with the illness and for some, pain. The changing physical symptoms are not the only things to contend with.
With increasing illness and approaching death emotions run wild. They are often fragile and need some care. They can be predicted, and they include the emotions related to loss. People feel afraid or angry or sad and depressed. Some are in a bargaining phase of loss. People may feel guilt. The emotions can be unpredictable and out of control and understanding these are important in the process of dying because these emotions can be destructive if they are left untamed.
Then there are the spiritual considerations when it comes to dying. For some this spiritual awareness offers comfort and hope when all else seems to be failing. The spiritual aspects of dying should not be left unattended.
Then finally, in dying, there are the lists of important things to do such as advanced directives and wills, testaments and funeral planning. There are also the fun things to do. Make sure you arrange a professional photo shoot so that there is a good photo of you for posterity. Plan a big party to celebrate your life. Do something outrageous that you have always wanted to do. Before you know there is very little time to do anything at all because when you are dying you run out of time.
In the last weeks of life, when we all agree that we are dying, the body becomes increasingly weak and burdened by the disease process that is dominating the picture. The symptoms of the illness such as cancer are apparent. In the dying phase eating and drinking are no longer a priority. More and more time is spend sleeping and resting and the events that are happening in the world are no longer important. When you are dying you no longer worry about the football results or the gold-price. Sleep becomes a good friend and with most things, those who are dying need assistance in their daily tasks. Those dying tend to be bed bound as the body can no longer cope with everyday tasks.
At the end of life, in the last few days, we die when our physical bodies are no longer able to sustain life. Death is different for each disease. From a cancer perspective, the body becomes so weak, and unable to function that it eventually affects the function of the brain. At the end of life most people lapse into a coma and die unaware of the drama unfolding around them. Death ultimately occurs when the heart stops beating. This is hard for the family to see but for the person dying, this will all be a natural end to their life.
At the time of death, the dying person should be well supported by the palliative care team so that the physical body will not be suffering. Most people will be on a syringe driver – a device that provides adequate pain control as life is ending. At the end of life, like at the beginning of life, there is the period of travail and then it is over. Dying does not take forever, it passes quickly. The storm is soon over and may we as mortals be prepared at the time of death and be at peace, accepting the inevitability of death. But that’s not all. There is evidence to suggest that at the time of death, our souls leave our now useless physical bodies and return to God. We are reunited with the loved ones who have gone before us. These are the accounts of those who have had a near death experience. It is exciting to think that death is not the end of the road but the beginning of the new chapter. All these are discussed in “Death, Dying and Donuts” by Dr Colin Dicks. You may not agree with all his views but if you want to know more about dying, this is a great place to start.