What Happens As Death Approaches: The Nuts & Bolts

By understanding the physical and emotional stages of dying we begin to reclaim death and dying as a normal part of life.

“The patient has been thinking about death from the moment they were diagnosed, and they have been protecting their family from that conversation. The family has been thinking about death as well but protecting the patient.”

David Maginley, author of Beyond Surviving

On average, 153,424 people worldwide die every day, so it seems we should have a better handle on death. We might think we should know the signs and symptoms of death approaching, yet we don’t. We simply don’t talk about it. But we shouldn’t be too surprised by our ignorance, because the topic of death has been taboo for nearly 100 years. In fact, we have done everything possible in our culture to push death away. Our dying friends and loved ones are moved from home to hospital, and the death rituals that are meant to support our grief journey have been farmed out as well. Our loved ones do battle with life-threatening diseases and are defeated when they die.

It doesn’t have to be this way.

“Dying doesn’t cause suffering. Resistance to dying does.”

Ira Byock MD, author of The Best Care Possible

Reflecting on one’s life experiences is a profound way to address our resistance to and fear of death. Finding meaning in the life we are living creates perspective. Have we lived well? Done the things we hoped to do? Are we leaving the world a better place? What kind of legacy do we leave behind? Writing for the Atlantic magazine, Emily Esfahani Smith explores emotional healing and meaning in life during the time between a terminal diagnosis and death. Read the article here.

There is no perfect death. It is a process unique to each of us. It can begin months and years before a person actually dies. Hospice pioneer Barbara Karnes, RN has published a number of very helpful booklets on the dying experience.

In Gone From My Sight she maps out the physical and emotional stages that can unfold three months prior to dying. Karnes starts with one’s personal recognition that they are dying. Often this deeper realization marks the time when one begins to withdraw from the outer world of activity and slowly turns inward and sleeps more. Interest in food may decline as well. When we are caring for someone who is dying, this is a time of simply being present.

Sue Brayne, MA, Psychotherapist and co-author of Nearing the End of Life: A Guide for Relatives and Friends, says that knowing what to expect can lessen our fear.

She and co-author Peter Fenwick, MD outline the many signs that someone who is nearing death may experience. The dying person may begin to share their desire to go away, take a trip, or pack their bags. They might express gratitude to their loved ones and those who have been caring for them. They may request an experience that is special to them, such as visiting a place or listening to music. This is also a time when they may want to resolve unfinished business.

In the weeks, days or hours just prior to dying, deathbed visions or dreams can occur. The dying person may see or talk to people no one else in the room can see. These experiences are a great comfort to the person who is dying and validating their experience rather than trying to correct them brings further peace.

So, what can we do when someone is deep into the work of dying? Holding their hand, talking reassuringly and being sure they are warm are just a few of the suggestions the Mayo Clinic offers on how to provide comfort and relief at end of life.

No matter what the journey turns out to be, we can remember that kindness and love are the best guides.

Death is a road well-traveled. Talking about death shifts this seemingly foreign invader back into our lives where we can see it as normal. We need to know what can happen at the end of life, because we will all take this journey.




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