While all of us wish to live a long and healthy life, it is inevitable that we die at a certain time. When a person goes through the dying process, there are physical and mental/spiritual dynamics which take place interdependently. On the physical plane, the body goes through the process of shutting down. This process ceases when all the physical systems stop functioning. This post will discuss these physical changes that occur in the process. A subsequent blog post will go over the mental/spiritual aspects of the dying process.
Physical shutting down of a dying person’s body is an orderly, progressive series of physical changes which are not medical emergencies requiring interventions. These changes are the natural method by which the body prepares itself to stop functioning. Not all these signs and symptoms will occur with every person, nor will they occur in this particular sequence. Each person is unique and needs to do things in his/her own way.
The person´s hands and arms, feet, and then legs may be increasingly cool to the touch, and at the same time the color of the skin may change. This a normal indication that the circulation of blood is decreasing to the body’s extremities and being reserved for the most vital organs. Caregivers can keep the person warm with a blanket but should not use one that is electric.
The person may spend an increasing amount of time sleeping, appear to be uncommunicative or unresponsive, and at times be difficult to arouse. This normal change is due in part to changes in the metabolism of the body. Caregivers or family can sit with their loved one, hold his or her hand, and speak softly and naturally. They should plan to spend time with their loved one during those times when he or she seems most alert.
The person may seem to be confused about the time, place, and identity of people surrounding him or her including close and familiar people. This is also due in part to the metabolism changes. Caregivers can identify themselves by name before they speak, and can speak softly, clearly, and truthfully when they need to communicate something important for the patient’s comfort, such as, “It is time to take your medication.”
The person may lose control of urine and/or bowel matter as the muscles in that area begin to relax. Caregivers can protect the bed and keep the loved one clean and comfortable.
The person may have gurgling sounds coming from his or her chest as though marbles were rolling around inside and these sounds may become very loud. This normal change is due to the decrease of fluid intake and an inability to cough up normal secretions. Suctioning usually only increases the secretions and causes sharp discomfort. The person’s head can gently be turned to the side to allow gravity to drain the secretions. His/her mouth can also be gently wiped with a moist cloth. The sound of the congestion does not indicate the onset of severe or new pain.
The person may make restless and repetitive motions such as pulling at bed linen or clothing. This often happens and is due in part to the decrease in oxygen circulation to the brain and to metabolism changes. Caregivers should not interfere with or try to restrain such motions. To have a calming effect, they should speak in a quiet, natural way, lightly massage the forehead, read to the person, or play some soothing music.
The person´s urine output normally decreases and may become tea-colored, referred to as concentrated urine. This is due to the decreased fluid intake as well as decrease in circulation through the kidneys. A hospice nurse can determine whether there may be a need to insert or irrigate a catheter.
Fluid and Food Decrease
The person may have a decrease in appetite and thirst, wanting little or no food or fluid. The body will naturally begin to conserve energy which is expended on these tasks. Caregivers should not try to force food or drink into the person. Small chips of ice, frozen Gatorade, or juice may be refreshing in the mouth. If the person is able to swallow, fluids may be given in small amounts by syringe. Glycerin swabs may help keep the mouth and lips moist and comfortable. A cool, moist washcloth on the forehead may also increase physical comfort.
Breathing Pattern Change
The person’s regular breathing pattern may change with the onset of a different breathing pace. A particular pattern consists of breathing irregularly, i.e., shallow breaths with periods of no breathing of five to thirty seconds and up to a full minute. This is called Cheyne-Stokes breathing. The person may also experience periods of rapid shallow pant-like breathing. These patterns are very common and indicate decrease in circulation in the internal organs. Elevating the head, and/or turning the person onto his or her side may bring comfort. Caregivers or family can hold the loved one’s hand and speak gently.
The above-mentioned physical changes, which can happen in a dying person, are the natural method by which the body prepares itself to stop functioning. This shutting down process ceases when all physical processes have stopped. Not all these physical changes may be seen in every dying person and they do not need to occur in the order which has been presented. Caregivers should not try to change the loved one during this time but should give full acceptance, support, and comfort. Hospice care personnel and social workers can help educating the loved ones.