There is no certainty in this world except that everyone has to die at some point. Nevertheless, death is one of the last taboos in modern Western culture. For most people today, it does not come suddenly and unexpectedly, but slowly. This is due to advances in medical diagnosis and treatment. This usually gives those affected the chance to reconcile themselves with life and dying, to deal with unfinished business and to say goodbye.
Psychological dying process – phases
The death researcher Elisabeth Kübler-Ross has divided the psychological dying process into five phases. However, these are not seen as consecutive stages – the dying person can switch between the individual stages several times.
- Denial: The sick person does not want to accept the fact that they do not have long to live. He represses the news, denies it, perhaps believes there has been a mix-up, still hopes to be rescued.
- Anger: The sick person rebels against his fate, feels anger at God, at the doctors, at everyone who is allowed to continue living. This can also manifest itself in aggression towards relatives.
- Negotiating: The sick person tries to negotiate with fate, making promises in case they are allowed to live on for a while longer.
- Acceptance: In the best case, the person affected accepts their fate and reconciles themselves to it.
Physical dying process – signs
People also change physically before death. The process can also be divided into different phases:
- Rehabilitation phase: Although the disease progresses, the patient may recover from acute symptoms and can still lead a largely self-determined life. This phase covers the last months, rarely years, before death.
- Terminal phase: The patient is bedridden and becomes increasingly weaker. The symptoms increase. This phase can begin weeks to months before death.
- Final phase: This phase describes the actual dying process. Bodily functions gradually cease and the dying person’s consciousness turns inwards. Death occurs within hours or days at most.
The dying phase
What relatives can do
Most people do not want to die alone. Relatives can therefore do one thing above all: be there. However, some people find it easier to detach themselves from life when they are alone. If your loved one dies when you are not in the room, there is no need to blame yourself. You can assume that it was easier for them this way.
Do not try to get the dying person out of their inward-looking posture in their last hours, but accept their withdrawal. Realize that this does not mean that the dying person is no longer aware of their surroundings. Treat them with loving care and respect, especially in this phase. Even if your grief is great – try to let go on your part and give the dying person the feeling that it is okay for them to go.
There are also things you can do to make the patient’s last hours easier. Many dying people have difficulty breathing. Raising the upper body slightly and bringing fresh air into the room can make breathing easier. Ask the nursing staff for advice on this.
Gentle touch can give the dying person peace, security and well-being. However, remain sensitive. Sometimes even stroking can be too much and unpleasant. Quiet music and pleasant scents can also reach the dying person and do them good.
Dying process – signs of imminent death
Gradually, the organs cease to function. This is accompanied by a series of characteristic symptoms. It is important for relatives to be aware of these so that they can accept them as part of the natural dying process. Ask the medical staff or doctors about the various stages of the dying process so that they lose their fright.
Breathing: Breathing changes during the dying process, becoming shallower and more irregular. Some dying people suffer from shortness of breath and develop so-called gasping breathing. Shortly before death, so-called “terminal rales” are very common. This occurs because the dying person can no longer swallow or cough and mucus collects in the airways. This is difficult for relatives to bear. However, unless the patient is suffering from severe shortness of breath, the burden on them is less than it appears from the outside.
Brain and nervous system: Brain functions also deteriorate more and more as we die. Perception deteriorates and consciousness becomes clouded. The autonomic nervous system is also impaired. This can manifest itself in vomiting, bowel obstruction or incontinence.
Restlessness: Some patients are affected by restlessness in the last hours of their lives. They move their feet back and forth, pluck at the bedclothes. This restlessness can be alleviated with medication.
Hands and feet: The blood is increasingly withdrawn from the extremities as the patient dies. Hands and feet therefore become cold and turn a bluish color. Sometimes it collects in the skin of the feet and lower legs and forms dark spots there.
Digestive tract, kidneys, liver: The function of these organs gradually declines to zero as the body dies. The resulting poisoning of the body by metabolic products can lead to drowsiness and clouding of consciousness, as well as itching, nausea and water retention.
The heart: The heartbeat slows down when dying and becomes irregular, blood pressure drops. If the heart finally stops, the body cells are no longer supplied with oxygen. After a few minutes, the brain cells die – the person is dead.
