It’s the moment that will come to all of us, but our society generally avoids thinking about death. Those who spend their careers with the dying say that a little preparation is all that’s needed for a good end of life.
Nikki Johnston, Palliative Care Nurse Practitioner
People die as they live – some are angry, others are spiritual. Whoever you are, you don’t change when you are dying.
Palliative care is not just about dying – it’s also about living. It’s about making the last days and weeks as good as possible. Death is something we just don’t talk about in our society – it’s hidden so people have a very individual response.
Sometimes death is very sudden. But the majority of times, people are elderly or have a disease and so become tired and sleep a lot. They start sleeping more than they are awake. Next the eating goes and generally their thirst disappears, too. They become inactive, in bed, not walking or moving.
Once they become unconscious, their breathing patterns change – it’s called “Cheyne-Stokes breathing”. There are gaps in breathing and then they take big breaths to catch up. It can be quite scary to watch if there is a big gap. You think they have died, and then they take a big gasp, but it’s a natural process. Unconscious Cheyne–Stokes breathing can last a few hours or last anywhere up to two weeks.
Sometimes people wake up for a short time just prior to death. I see lovely things happen during that brief window; they will say “I love you, it’s OK that I’m going”. I have also seen many people have visions of people come to collect them. I believe they’re communicating with something beyond what we can understand.
Sometimes families are by the bedside for many hours and leave to have a drink and their relative dies. Other times people seem to wait until someone arrives. I wonder if there is some control over this? It happens when it happens and that’s OK.
There is a sense of knowing when a spirit leaves the person. There is life and breathing and then they stop breathing and the person is gone. All that is left is the body. Often they look so calm. If someone has been really sick and struggling, once they die they look younger and they look peaceful.
Relief from pain and suffering is definitely important, and so is emotional support. I have seen people die who didn’t have relief and it’s not nice. When someone who is dying has relief from their suffering, sometimes their past will come up – did they get it right, have they got regrets, are there people they would like to say sorry to or reconnect with? These are really important to feeling they are ready to die.
Some people want death to come and it doesn’t come fast enough. Waiting to die can be one of the most difficult things for the person and their loved ones. As a health professional, continuing to turn up and supporting everyone involved shouldn’t be underestimated. Letting them know that there are options is important, too, like not taking antibiotics for pneumonia.
There is a lot of money poured into keeping people alive, but at the end of life we are trying to treat death as a normal process and quality of life must come into it. I don’t think it’s necessarily understood well. There is not just one way of doing it.
Some people get a lot of strength from knowing what’s going to happen after they die. If they believe they will go to heaven or a higher place, they get comfort from that. Religion or spiritual beliefs can definitely give them strength and reduce fear. But that’s not true for everyone – sometimes people draw on other strengths.
Death is a leveller, it will happen to every one of us. It’s such a privilege to do this work. It’s so honest.