What does it look like when someone is dying and what kinds of things can we do to help?
If you’re a caregiver to someone who’s dying, it will be enormously helpful for you to know what dying looks like. Like birthing, dying is an active process that typically follows a recognizable pattern. If you’re at the bedside of a loved one and wondering how you’ll know when they begin actively dying, here are the signs to look for over those last days and hours:
The Dying Process
The dying person will have less and less energy.
They’ll talk less.
They’ll spend more time sleeping or being awake with their eyes closed.
They’ll eat less and less.
They may have bouts of being irritated and aggressive or experience hallucinations and yell things that don’t make sense.
Eventually, they’ll stop eating entirely.
After that, they’ll stop taking in fluids.
Their skin will feel cool to the touch and extremities may start to have a blue cast.
When they’re very close to death, they’ll slip into unconsciousness, where their body will go through the last steps of shutting down.
Their breathing may have a rattling sound. This is caused by the muscles relaxing and sometimes from fluid buildup in the lungs, and is nothing that needs to be corrected.
The pattern of their breath will change. It may become quick and shallow or irregular and pause for 30 seconds, sometimes longer, between breaths and then resume.
Their breathing will be so soft and shallow it will be hard to detect.
Eventually they will breathe out and not breathe in again.
Sometimes this process takes hours, sometimes it takes days, but anyone who’s ever watched someone die knows that the dying person, as things progress, starts to focus inward and this is perfectly normal.
What Caregivers Can Do to Help
Here are some ideas for caregivers of the dying that will help you lean into the process, and stay present and connected as your loved one moves closer to death.
While your loved one is still alert:
Offer the opportunity for your dying loved one to share their life story with you. This “life review” process can help the dying person find value, meaning and closure. It can also help caregivers find closure.
Offer the opportunity for your dying loved one to express their fears. Often, just having the chance to share these fears can bring about calm so that the dying person can begin to let go.
Ask them what they want for their dying. Who should be there? What should the room be like? Actively participating in setting up the space can help caregivers feel a part of the process, making it easier to let go when the time comes.
Ask them if they’d like anything special to happen after they take their last breaths, a prayer, a small ceremony, clergy present, certain music, etc.
Read to your dying loved one. While too much chit chat can become exhausting for a dying person, reading from a favorite book can bring deep relaxation.
Sing to them or play their favorite music.
Sit silently with them, holding hands or if holding hands is too much for your dying loved one, make eye contact.
For those who are cuddlers, get in bed with them and cuddle. Breathe in unison while you do this. Always ask if this, or any physical contact is okay. Your dying loved one may reach a stage where they no longer want to be touched and you should honor that.
If you need to forgive your loved one or say sorry, do so now, gently and lovingly.
Tell them that you love them, especially if you've been meaning to tell them for a while.
Be aware that they may stop wanting visitors. Explain to your family and friends that this is a normal part of the transition.
Honor all requests from your dying loved one, even if they ask to be alone.
Each time you leave their side, do so with reverence, remembering that this may be the last time you see them alive and alert.
Once your loved one is unconscious:
Sit at the bedside in silence and mirror the dying person’s breathing pattern with your own. This will help you to be present without actually needing to be “doing” anything and becomes a meditation on your dying loved one.
Unconscious people can still hear, in fact hearing is the last sense a dying person will lose. Continue to gently speak to them, reassuring them that you are with them and discourage idle conversation from family or staff.
Sing softly to them.
Hold hands or gently place your hand on theirs.
Create an atmosphere that they would like, ideally after having had a conversation with them about this. Low light, candles, a beautiful view, certain fragrances, and music are all things that can make the space sacred for your dying loved one.
Is it normal to feel hurt or maybe even abandoned by a loved one who is turning inward as they die?
Absolutely. When someone we love is dying, we feel sad and sometimes scared. This is perfectly natural. Our loved one is leaving us and there’s pain in that truth. Just as it’s normal for a dying person to turn inward, it’s normal for loved ones to sometimes feel this turning inward as rejection. This is especially true for caregivers. If you feel yourself becoming angry, despairing or feeling rejected by your dying loved one, first, recognize that this is normal and allow yourself to feel the grief of their life ending. Find someone you can talk to about your feelings. Meditation, guided visualization, exercise and taking some time to be in nature can be enormously helpful. Next, focus on the love you share and recommit to being of service to your loved one while they die, always remembering that their turning inward is normal.
We all die and dying takes courage. Let the courage that your dying loved one has found be a final gift to you. If we allow ourselves to feel inspired by our dying loved one’s death journey and the support role we have played in it, we can begin to open up to things as they are and find peace in the ephemeral nature of life.