What happens when we die?
While we don’t know if anything happens afterwards, we do know exactly what happens in the moments leading up the end. DR KATHRYN MANNIX leads you through the last few steps on your body’s journey
Like giving birth, dying is a bodily process with stages and recognisable progression. Also like birth, the speed of the process can vary from person to person. Medical support is sometimes needed to make dying (or giving birth) as safe and comfortable as possible.
As dying approaches, most people lose interest in eating and drinking. This is normal: spoonfuls of ‘tastes for pleasure’ may still be welcome when meals have become too much to manage. Dying people consistently lack energy. Many of us have experienced profound weariness caused by illness: the ‘can’t get out of bed’ state of severe flu, or overwhelming tiredness as we recover from surgery. Sleep usually recharges our energy and can be part of recovery but, at the end of life, sleep gradually makes less impact as the body winds down towards dying.
A dying person spends progressively less time awake. What looks like sleep, though, gradually becomes something else: dipping into unconsciousness for increasing periods. On waking, people report having slept peacefully, with no sense of having been unconscious. If the dying person is relying on regular medications to keep any symptoms at bay, then now is the time to switch to medications that don’t require the person to be awake to swallow them. Skin patches, syringe pumps, or even suppositories can be used. It’s important to know that unconsciousness isn’t usually caused by the medications, but by the dying process itself.
THE FINAL MOMENTS
As dying progresses the heart beats less strongly, blood pressure falls, skin cools down and nails become dusky. Internal organs function less as blood pressure drops. There may be periods of restlessness or moments of confusion, or just gradually deepening unconsciousness.
We have no proven way to investigate what people experience during dying. Recent research shows that, even close to death, the unconscious brain responds to noises in the room. We don’t know how much sense music or voices make to a dying person, however.
Unconscious people’s breathing follows automatic patterns generated by the respiratory centre in the brain stem. Because they’re unaware of their mouth and throat, dying people may breathe heavily, noisily or through saliva in the back of their throat, yet without apparent distress. Breathing moves from deep to shallow and from fast to slow in repeating cycles; eventually breathing slows and becomes very shallow; there are pauses; and, finally, breathing ceases. A few minutes later, the heart will stop beating as it runs out of oxygen.
Knowing the pattern of ordinary dying and recognising its stages, helps companions to understand what they’re witnessing, to feel less afraid of unlikely complications and to have the confidence to send for help if medical attention is needed to address symptoms and so to enable ‘safe’ dying. You can find out more by watching the BBC’s short film on dying at bit.ly/dyingisnotsobad
“Eventually breathing slows and becomes very shallow; there are pauses and, finally, breathing ceases”