We will all face this process one day, and it is assured that we will probably be witness to it as well. It’s part of who we are. When it’s your own family member, the process can be very difficult, and a strong support system may be the best we can do to get through it, we are too close to the situation to be of any help, we need help ourselves. Some people do well by discussing it; others go to that door with little or no discussion at all. There are no hard and fast rules; everyone goes through this final act in their own way. But allow me to say one thing to you before going on. You are not being selfish by feeling anger at this process, nor am I going to tell you that it will get better with time. You are going to miss them physically, and if you are reading this, you’re probably at the stage of just wanting this not to happen, or if it has already, you just want them back. You just want them back. That’s OK, and perfectly normal. You are not being selfish. It’s called love and right now it hurts.
But if you’re paying attention, there are signs that the process might be progressing in a more imperceptible manner that family members and even the medical professional might not be aware of.
Every effort, of course, should be made to maintain adequate and appropriate pain control, fortunately this has progressed to the level of fine art since my father passed away. No person should have to experience the kind of pain that robs us of our ability to die with respect.
But even when this can’t be achieved, any discussion the person is willing to participate in can help reduce their fears. Sometimes this cannot be accomplished by another family member; here is where the professional caregiver can work wonders. This process is made the more powerful by helping others through it; I would imagine that it helps each of us when we also face this process.
One of the most effective things you can do is ask the person how they think they are doing. Medical professionals are people too, and face the same fears the rest of us do, too often they are willing to tell the patient how they think the patient is doing to try and make it OK, which can overwhelm the patient into not saying anything. Patients know far more than we give them credit for and they have a need to be acknowledged and heard.
Never forget that the patient can hear you when you speak even when they are unconscious. I have witnessed more times than I can count, when the caregivers assume or at least forget that consciousness and awareness of their surroundings are not necessarily measured by the patient’s lack of response. I assume at all times that the patient can hear me, and even in extreme cases of brain damage, they are aware at some other level what is going on around them.
I am not going to get into other energetic processes observed in Buddhist texts, the majority of these are minute processes that only individuals practiced in identifying these techniques can actually see and feel, and don’t have much bearing on the average situation in the Western perspective. But they are certainly worth reading if you are interested, the references are in the back of my book. To a practitioner of energy work in the West, some of the processes are recognizable and can be observed.
But some of these energetic processes do seem to be associated with physiological and psychological changes that can be used as benchmarks for impending transition. What I found remarkable, that like the birth process, almost all of these stages with the exception of the last one, the actual exit of the person’s energy from their body, can be stopped and even reversed, and frequently are stopped unconsciously by the patient. As I have said, our intention drives us, and most often fear of dying, waiting for someone to come say goodbye, or even permission to leave are usually the reasons why these processes are temporarily reversed.
The most common sign that death is pending is when the temperature of the extremities drops to the point of feeling ice-cold to the touch. This is one of the preliminary signs and very easily can be turned back. But this always marks the beginning of the process. This correlates with the exiting of the “winds” in Buddhist literature, in a way, another word for physiological energy. It makes sense that as the body’s energy diminishes, so does the body temperature.
Just prior to transition, the heart and respiratory rate in all cases I have observed becomes irregular and spasmodic. At the very end, the respiratory rate drops down to two to four breaths per minute and the heart rate down to the 20s and 30s. This is a stronger, more immediate sign than losing body temperature, although I have seen patients pull back from this stage as well. Loss of body temperature can occur weeks ahead of transition, or just prior to it. The slowing of the heart rate and respiration usually means that transition is closer, just usually days away, perhaps a week at most, and again, sometimes just prior to passing.
A different process that many people find uncomfortable is the patient sometimes seeing or talking to people who have already passed over. Persuasive argument could be made for both sides of the issue, that brain function is deteriorating, the patient is losing contact with reality and is hallucinating, or that this is the beginning of the next reality. My feeling is to let them be, unless it seems to be agitating them too much. The patient can very easily control this phenomenon, by telling them to go away, we have more control over our surroundings that we realize. Sometimes that is all that is necessary, just telling the patient to tell them to go away. A good rule of thumb to remember is that if they are peaceful visitations, most likely they are real, or they are real to the patient and are serving a psychological need that the living cannot serve at this time. If they are disturbing, then perhaps thought should be given to administering an anti-anxiety medication.
This touches on another issue, the use of psychotropic medications with the dying. They can be invaluable tools to assist in the comfort of the transitioning patient. But the fact that the relatives are uncomfortable that Dad wants to talk about dying is not sufficient reason to medicate! Anti-depressants can be useful particularly when the patient is depressed and having trouble sleeping and eating and can make them much more comfortable. “Sundowner syndrome,” anxiety attacks that occur at the end of the day can be greatly relieved by the use of anti-anxiety medications. None of this should be taken as a mandate, every patient is different and I am not a licensed professional, it needs to be assessed on a case-by-case basis. But sometimes the discerning and appropriate use of these medications can do wonders and the family is not always in the best emotional shape to remember about these very useful tools.
The last process is the hardest to pin down as to when it exactly occurs. It can vary, and family members are frequently very puzzled and hurt by it. It is an amorphous stage, although an energy healer can generally identify it very quickly, because the patient’s energy field begins to “loosen” around the patient’s body. It starts looking like an old pair of socks that one has worn too long, usually grey-white in color and varying in shape, but overall getting much larger and grainy in appearance. This is when the patient begins to detach emotionally from this plane and all who live in it. Sometimes it is misidentified as the patient being overmedicated and repeated attempts are made to “bring the patient back to reality.” Family members would frequently come to me in tears, hurt and offended, not understanding that this is part of the process. To go “there,” the patient must let go of “here.” It is not that they love you any less or don’t want to talk to you, but they have more pressing matters to focus on right now. I have seen women in labor get this inward stare as well. At this point it’s no longer about you.
It may not be about you, but always remember to include yourself in the equation when talking about how to deal with this issue and your transitioning loved one. Caring for the emotional needs of the transitioning patient can be emotionally harrowing, and adding caring for the patient at home only adds more on the burden. You cannot do this by yourself. Sometimes we need someone to tell us in this in bold print! Over time you will be the one who suffers the most, and sometimes the unresolved issues between the patient and us can literally drive us crazy, they still know how to press our buttons! One needs to have help and to take breaks, to keep one’s energy up over the long term. There are many agencies out there and hospice care that can assist the family in this process.
Remember to grieve, you are not being selfish. You miss them, it’s a normal process. It also takes a lot of time, far more time to accept than our culture gives us time to for. I remember watching “Sleepless in Seattle,” where the character played by Tom Hanks was admonished by the telephone “therapist” after his wife had only been dead for a year, implying that he was “stuck” in his grief. It takes an average of two years to assimilate and accept a partner’s passing, and that is when the person left behind is processing their grief at an average rate! For many people it takes much longer! But again, our culture is uncomfortable with anything less than instant gratification and no pain. Life has pain. People who have gone through successfully have frequently told me that it’s not a thing you “understand,” it’s just recognized and assimilated into your lifeworld. It is what it is. Would the highs in your life be valued as much without the possibility of losing them? I doubt it.
One needs death to be able to harvest the fruit.
Without death, life would be meaningless,
Since the long-lasting arises again and denies its own meaning
To be, and to enjoy your own meaning,
You need death,
And limitation enables you to enjoy your own meaning.
Carl Jung, The Red Book
Copyright, excerpt from “The Anatomy of Death: Notes from a Healer’s Casebook”
Feel free to use it, but please give me author’s credit.