Death is defined medically as the irreversible cessation of circulatory and respiratory function and all functions of the entire brain. There are many possible signs that precede death: increasing periods of sleep or disorientation and confusion; decreasing food/fluid intake and responsiveness to stimuli; more restless or repetitive activities; urinary or bowel incontinence; irregular or shallow breathing; and changes in breath or sweat odor. While these physical changes are occurring, remember that the person may still be able to understand things being said to or around him/her.
If you are the caregiver for a dying person, do be aware of your own needs and emotional processing in the midst of (or after) providing care. The range of emotions associated with the death of a loved one is enormous and can follow varied patterns for different people and for any individual over time. Grief can vary depending on the relationship and attachment to the person who died, perception of preventability and suffering, circumstances around the loss, extent of and response to prior losses, concurrent stresses or losses, religious/spiritual beliefs, other support, and the personality and health of the grieving person. The grief experience also varies greatly among cultures and there is no one right way to grieve. Emotions during grief can include sadness, anger, guilt, relief, fear, and anxiety. Physical changes can include rapid breathing or heart rate, chest or throat tightness, or feeling faint. There may be confusion, poor concentration or memory, and impaired judgment after a loss. You can support a grieving person often by just listening in an accepting way, tolerating periods of silence, and avoiding clichés to make the person feel better.
For our own deaths, we can make things easier for our loved ones by having specific instructions available through advance directives (living wills, durable powers of attorney, and do not resuscitate orders). When creating these documents, it is important to know that a patient has the right to refuse any or all medical treatments and that legal immunity is given to caregivers complying with a valid living will.
The thought of death brings up many questions (some philosophical and some practical) that can be pondered before the time comes. What are your greatest fears about dying? What do you think follows after death? Where would you want to be when you die? Who would you want to be with you when you die? What could caregivers, family, and friends do to support you? What are your thoughts or concerns for those you would leave behind? Are there any particular people or organizations you would want notified on your death? What do you want for a ceremony after you die, if any?
Death is not failure, but a part of the natural cycle that allows us as individuals and all of life to continue. I think we as a culture need to spend more time talking about death to be more comfortable with the process, and be able to truly provide the support needed to those dying and grieving.
© Kimberly Hindman, 2008
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