Understanding the Dying Process

Join SevenPonds each month as Tani Bahti, RN, CT, CHPN offers practical on-hands guidance in an attempt to demystify the dying process. An RN since 1976, Tani has been working to empower families and healthcare professionals to have the best end-of-life experience possible both through education and the development of helpful tools and resources. The current Director of Pathways, Tani is also the author of “Dying to Know, Straight talk about Death and Dying” considered by SevenPonds as one of the most practical books on the topic. According to Founder Suzette Sherman this is “the book I will have at the bedside of my dying parents some day, hopefully a very long time from now.”

“If I had only known….”

The pain behind those too frequently uttered words is the reason my focus is on educating others about the dying process and all the end-of-life issues that accompany it.

The purpose of this monthly blog will be to demystify the dying process. By understanding the natural wisdom of the body as it goes through these changes, people can be better prepared, have less fear and make more informed decisions regarding care and interventions.

“Can you check my wife? I think she is dead!” The emergency call came in Saturday morning from a family not on our hospice program.

I knew she would not make that trip and I didn’t have time to mince words as I told the family she was dying.

On arrival, I saw a woman sitting on the couch, propped up by friends since she was unable to hold herself up. Eyes sunken and unable to focus, yellowed skin, belly swollen though the rest of her body was skeletal. It appeared her liver was failing and that death was close. Her husband was pushing a spoon of pudding into her mouth, urging her to eat, as he had been instructed by the physicians to ‘keep her energy up.’ The plan was to travel to a new cancer center out of town on Monday to explore possible experimental treatment to extend her life. I knew she would not make that trip and I didn’t have time to mince words as I told the family she was dying. I explained how and why her body was shutting down and what was needed to make sure she was as comfortable as possible. Her husband, Andy, listened attentively.

It was bad enough that Andy was feeling the pain of only just understanding that his beloved wife was imminently dying. His pain was further exacerbated by learning too late that his best intentions in providing care and pushing food only created more discomfort.

“Why didn’t someone tell me she was dying? She is the love of my life, and we’ve never argued except recently when she wouldn’t eat. I didn’t know she couldn’t.” He hung his head in guilty misery that overtook his anger.

“Why didn’t someone tell me she was dying?”

Wanting the best for his wife, he agreed to hospice care, and we quickly obtained the hospital bed and meds she needed. Gary climbed up onto her bed and held her the final 26 hours of her life while family surrounded the bed. She was embraced in love as she died.

What was missing for Gary, and too many people, is the knowledge that when the body is preparing for its final months, weeks and even hours, many natural processes kick in to promote comfort. There is ample research about how the body begins to shut down to die.

Depending on the disease, the appetite begins to wane and the weight begins to drop. This feels unnatural to family, and it is difficult to see a loved one shrinking in size. The understandable fear is that they are starving to death. The truth is that they are not dying due to lack of eating, but not eating due to the fact that they are dying — that their body is beginning the process of shutting down.

The ability of the digestive system to break down and move food through begins to decrease. The inability to swallow without choking may occur. To force food at this time would be to create nausea, bloating, discomfort.

Forcing food, or the use of artificial nutrition and hydration at the end of life can actually increase discomfort and even hasten dying

Forcing food, or the use of artificial nutrition and hydration at the end of life can actually increase discomfort and even hasten dying through fluid overload and aspiration and even increasing tumor growth

When experiencing a terminal illness, the expert on what to do or not is the person undergoing the changes. Only that person knows what it feels like to be in his or her body. Because we want to best care and comfort, we must listen, even when it means not forcing food and fluids.

What are other ways you can provide nurturing care other than providing food? Softly brushing hair, giving a gentle, loving massage, reviewing photo albums and sharing old stories through laughter and tears.

In the end, the most important thing we need to feed is the spirit.

You may want a copy of Tani’s book “Dying to Know, Straight talk about Death and Dying” to help demystify the process and offer words of wisdom on the many aspects of dying.