If you are anticipating your own death, or that of a loved one, you may be wondering what to expect when the dying process really begins. The following is a brief introduction to the stages of dying, although there are of course some variations in the sequence or timing.
Before describing the process, I want to share my observation that those in their last days seem to get to a place where they detach from their bodily functions to a degree. In part because of this, with appropriate comfort care, the transition we call death can actually be quite peaceful, even as the body undertakes its final labours.
It can be a remarkable experience to be a companion at such a time and I consider it a privilege to have shared it with a few people. The testimony of those I know who have died and been resuscitated is that there is an element of euphoria attached to the final moments of awareness for the person themselves. I offer these comments with a hope that they provide a degree of comfort and a context in which to understand the stages of dying.
Within days or weeks of death, the body begins its “shut down”. It doesn’t do this all at once but in measured steps and stages. Since it is shutting down, it does not require as much in the way of food and drink. It conserves its failing energy and thus the person sleeps more and is less active. Once this stage has begun, the person feels full quickly when they do eat and may have trouble swallowing liquids. Interestingly, this decreased intake of nourishment, and its attendant weight loss, does not cause pain or suffering. On the contrary, it has been proven that it diminishes the experience of pain.
Closer to the time of death, in the last few hours or days, someone who is dying will become less responsive to those around them. This is when the detachment I mentioned above develops: the person may be conscious but seems to go inward, absorbed in their own thoughts, memories or spiritual experience. At the same time, blood pressure and body temperature lower, the pulse becomes irregular, and the colour of the hands and feet darkens somewhat, as blood supply is slowly withdrawn from the extremities and focussed upon the internal organs.
In the last days and hours, the body continues to shut down its processes, withdrawing energy from body systems, including those of elimination. Changes in body processes at this time may result in a period of restlessness and apparent mental confusion. Eventually this settles down as more muscle systems relax. Breathing becomes shallow and irregular, sometimes with long pauses between breaths, and finally stops altogether. When the muscle of the heart quits beating, we know that death has arrived.