What to Expect When a Person Is Dying

Everyone will die, some sooner than others. It is a natural, normal and universal part of life. Yet, most people have little experience with the dying process or know what to expect when a person is dying.

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During this period, it can feel like you are walking into a dark and unfamiliar tunnel. The following information shines a light in that tunnel, describing the phases that most people exhibit during the dying process. While every person and situation is unique, there are some generalities, and some knowledge of that process can help you be truly present as a loved one navigates this final journey.

Even early on, when terminally ill people still feel pretty good and are able to participate in enjoyable events and conversations, they begin to gradually withdraw from the world around them. Their attention is drawn to internalizing all that is happening, gaining a sense of the meaning of their lives, wrapping up their affairs and relationships and accepting the inevitable end of their existence.

Then, as death comes closer and physical decline is significant, they spend an increasing amount of time resting quietly or sleeping and becoming less responsive. Their senses, however, are often still active. Be aware that when you speak in their presence, even if they seem comatose, they may hear every word.

Dying people gradually lose interest in eating and drinking, and their intake increasingly diminishes. Family members may get alarmed, especially when loved ones begin to lose weight or start to reject food and water. A common reaction is to force eating and drinking, either through physical or mechanical/medical means, believing the person will otherwise starve to death or die of thirst. Yet, this is a serious misunderstanding.

As the body dies, digestion shuts down, kidney function decreases and the person naturally resists what the body can no longer handle. Forcing fluids and feedings beyond that point can actually increase the suffering. Allow the person’s own body and desires to determine food and drink.

The decrease in kidney and bowel function, combined with the breakdown of body tissues that then need to be eliminated, have several effects. Urine becomes darker in color or quite cloudy, and may have a strong smell. Muscles in the lower body relax, and dying people often become incontinent in bladder, bowel or both.

These changes can be embarrassing for the person. You can help preserve dignity by normalizing and accepting the process, while ensuring the dying person stays dry, clean and comfortable.

When people come closer to death, they increasingly use metaphorical language or tell stories of awareness on another plane. It is common, for instance, that they report seeing others in the room whom no one else can see or have conversations with a person who died years ago. They may also talk in terms of travel, saying they have to pack their bags, find their passport or get on the train.

Often, family members believe loved ones are talking nonsense, hallucinating or under the influence of medication. In reality, this is the typical symbolic language of a dying person.

Do not try to contradict him or her; it is far more helpful to engage in conversation about it. Be interested in what the person reports. Inquire what's needed to pack or when the train is coming. Remember, your loved one is referring to his or her death.

These symptoms may be difficult to interpret. Check first for any sign of physical discomfort. If all seems well, the restlessness may be caused by unresolved tasks or desires, spiritual concerns or emotional distress.

Sometimes dying people want something to happen or someone to arrive. They may need reassurance that family members will be OK.

Always listen to everything your loved one says, ask simple questions to help clarify where possible and see if you can determine a message or a need you can help fulfill.

Though it doesn’t happen in every case, a dying person may get a final surge of energy hours or days before dying. A comatose person may suddenly wake up and talk animatedly with family for hours (or even a day or two) before drifting back into unconsciousness. Others may be unusually alert and clear-headed, want to eat a favorite food or be awake for an unusually long period; women may want to put on makeup.

Despite the hope this can raise in family members, a surge is not a sign of healing or recovery and it will soon end. While it lasts, though, it can be precious time for family members to talk and have meaningful time together.

Physical changes increase when death is days or hours away. As circulation slows, blood may pool on the underside of the body or cause bruise-like spots. Lips and mucus membranes begin to lose color and become gray. Extremities cool, even if the person’s core remains warm. Breathing patterns change, sometimes including gurgling sounds, as if air is moving through water. Any discomfort can be eased, and mucus can be suctioned.

Overall, although these normal changes may bother the family, they are rarely painful or disconcerting to dying people.

When death is imminent, the person is totally unresponsive. Blood pressure is very low, the pulse is weak and breathing becomes increasingly shallow. Usually the mouth is open, whether rigid or relaxed, and the eyes are often half-open but unfocused. Sometimes family members report seeing their loved one’s face light up shortly before dying, perhaps opening the eyes, reaching forward, speaking a few words and/or breaking into a broad smile. Regardless, breathing gradually stops completely, there is no pulse and the eyes turn glassy.

No matter how well-prepared you are, or how fully you expected the moment to arrive, death can still feel like a shock. It is often comforting for the family to remain by the bed, touch the person’s body, say a final goodbye and support each other for several minutes or hours.

Allow yourself to feel whatever emotions surface at the time, from relief to sadness. When you are ready, take leave of the one you love and move forward into a world that will never be quite the same again.