There might be some swelling (oedema), which is usually due to fluid accumulating, and this can make the skin look ‘tight’. Their muscles are wasted, in particular if there has been a long illness and there is increasingly poor muscle tone (so it eventually becomes hard to get up to go to the bathroom). Towards death, the body becomes weaker, and this is when people used to say, “she took to her bed”. This is due to poor circulation which is a very natural phenomenon when death approaches because the heart is slowing down. Their extremities may feel hot or cold to our touch, and sometimes their nails might have a bluish tinge. Sometimes their pupils are unresponsive so are fixed and staring. Their eyes might be glassy or ‘milky’ and may be open or shut. What might we see in their body which can indicate that death draws nearer? Their face may appear quite pale, white, bluish or yellow if they are jaundiced. Choking can become an issue, and this is another reason why eating diminishes, as a way of protecting the person from that. At some point the swallowing reflex diminishes or becomes absent, so eating becomes harder. Eating at end of life can often make someone feel very unwell because their digestive system has effectively shut down already. Losing our appetite at this point is a very natural and normal phenomenon. If we can take on board that the body knows exactly what it is doing, it knows it does not need the fuel like it used to and it’s also trying to conserve energy for its vital functions, like maintaining a heartbeat, and taking a breath. This can be very distressing because as caring human beings we want to nourish and feed our loved ones because the underlying thought is, if you don’t eat, you will die and I don’t want you to die, so you must eat. Towards the last weeks and days they may refuse food altogether. A dying person’s need for food diminishes and they naturally eat less. She is talking about retrospectively realising that there has been a slowing down process and that it has been unfolding for a while, sometimes even un-noticed. It is not an exact science and many a medical professional has been confounded by patients improving unexpectedly, outliving a prognosis of death and even recovering spectacularly! That said, hospice nurses, palliative care nurses and doulas as well as many doctors have seen a lot of dying patients, and they do understand that there are definite indicators that the end is approaching when a patient has been declining over a period of time.ĭenys Cope RN, BSN, a hospice nurse from the USA puts it very well in her book Dying A Natural Passage when she says that “a person naturally begins to do things that conserve energy”. In particular, I am writing this blog because when my own mother died, had I known some of these things then, I would not have gone home that evening and then I would have been able to be with her when she died. It can be very helpful to understand the signs of impending death because it can inform decisions that you might make, such as should you stay or go right now, is this a good time to go on holiday or not or shall we call family members from abroad and so on. We all come to death in different ways but unless there is a sudden or traumatic death, there are recognisable signs which if we know what to look out for, can guide families and loved ones to know roughly where the dying person is on that trajectory. The way people die is entirely individual to them, a unique experience for each person.
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