Being with some one as they die is something you will never forget. For some, the experience is one they don’t want to remember. Others eventually make piece with the memories and still others cherish them.

I watched my Mother and a very close Aunt (my godmother) take their last breaths. It was hard to do. At the time I had no idea what to expect. They were both on life support and pain medication, and both had advance directives saying that wasn’t how they wanted to die. My brother and I had to make the decision to remove life support and let them go. It was a time of highly charged emotion and grief. I grieved for years over the loss of both of them.  I grieve still.

The passage of someone you love into what comes after is not easy, ever. However, having an understanding of the dying process and the grieving process might help you ease your loved ones passage, and provide you with a handle to survive the situation without guilt or remorse.

Here are some tips that may help if you are saying goodbye to a loved one at life’s end.

Tips to cope with watching a loved one die.

Be wary of anticipated grief – grieving prior to death when you know death is coming.

Both Mom and my aunt were hospitalized for hip replacement surgery and had strokes afterward. Both were hospitalized for weeks – slowly slipping towards death after their strokes. We anticipated their passing and started grieving before they were gone.

Try to help your loved one as they pass from this life to the next, instead of making yourself and your grief the focus before they are actually gone.

Be wary of early grief – grieving the loss of capacity or capability in a fairly healthy person.

Both Mom and my Aunt slipped into a state of unconsciousness weeks prior to death. They had feeding or breathing tubes and were unable to communicate with us. We started missing them way before they actually died. My Father-in-law had Alzheimers – his wife did her grieving while he lived, but after he was not mentally with her anymore. Read more on early grief on AgingCare .

Try to find ways to really be with your loved one, to let them know you are there – whether or not they respond.

If the process is long, take time for yourself, take care of yourself and accept help.

Our good friend was diagnosed with cancer and given several months to live. His wife kept him at home (as he wished) and cared for him – but she didn’t have consistent help – and they had just lost their only son in an accidental death from a car accident. She struggled with immense depression and physical exhaustion.

Know what your loved one wants their death to be like.

Do they want extreme measures taken to save their life? Would they rather be awake and have some pain or be pain free and possibly unconscious.

We did not have these conversations with Mom or our Aunt. We guessed that they would want pain relief, but couldn’t know for sure.

Don’t be surprised of saddened if they don’t respond or don’t want you in the room.

Towards the end of life, your loved one may just want to have one or two people around them. Part of that might be to lessen the confusion and allow them peace and quiet to come to grips with their death. Know that it doesn’t necessarily reflect on their attitude or emotion towards you.

Say what you need to say.

Whether or not the dying person wants you in the room, you need to come to terms with your feelings, history with them, and unresolved issues with your loved one. Make time to say what you need to say, even if the dying person doesn’t appear to be receptive or listening. You need this to handle your own emotions after your loved one dies.

Prepare for dying stages and support them through each stage.

Some or all of these ‘symptoms’ of dying may occur – or possibly none of them depending on the situation.

Loss of appetite for food and drink.

The person dying may lose the reflex for swallowing, making it hard to get moisture. You can give him ice, Popsicles and etc (with doctor approval of course) to keep his mouth and throat moist. Let him eat what and when he wants – it may just be a bite or two.

Loss of interest in socializing.

Your loved one may be tired or weak and may have trouble speaking. As mentioned above, she may only want one or two people in the room with her at a time.

Sleepiness.

She may sleep more and be unresponsive, but she may still be hearing you. Hearing is suppose to be the last sense to to.

Restlessness.

He may appear to be restless – picking at the blankets or moving in a repetitive manner. Some think this may be due to a reduced level of oxygen in the brain. Stay calm and reassuring and remind the dying person that you are there by gently stroking their forehead or hand or reading or talking to them.

Disorientation and confusion.

Your loved one may not recognize people or things she has long known. Don’t ask her to try, go ahead and identify yourself to her. She may also believe that she is hearing and seeing a departed friend or relative. Go along with what she is experiencing. If she is seeing or hearing someone, ask what that someone is doing or saying. According to PBS documentary On Our Own Terms:

“This is not a hallucination or a reaction to medication. It signifies a person beginning a normal detachment from this life, preparing for the transition so it will not be frightening.”

Another aunt of mine died in the late 1950’s after being one of the nation’s first open heart surgery patients. While home prior to death, she and I were visiting (I was 10) and she told me she had seen Jesus and he had spoken to her.

Loss of bladder and bowel control.

This is normal and can be dealt with by using diapers or a protective pad. Urine may decrease in volume and be tea colored instead of the normal whitish yellow – due to decreased fluid intake and reduced circulation through the kidneys.

Changes in breathing rhythms.

As death approaches, the rhythm of breathing can become irregular – shallow and fast or periods of no breathing for up to around 30 seconds then a large intake. Raising your loved ones head or turning it to one side may help. These changes are normal and don’t necessarily indicate pain or distress for the dying person.

Congestion.

Buildup of fluids in the chest and throat may cause gurgling noises that can be quite loud and have been nick named the death rattle.

Color changes.

Extremities may be hot or cold and may turn darker or blueish due to the body pulling all circulation to its core. Try to keep the person warm if they seem cold or cool if they seem warm. Sometimes there is an odor – due to all of the changes happening within the dying person’s body.

Letting go.

Your loved one’s body usually will perform a somewhat orderly shutdown – this is normal. However he may try to hang on if he feels there are things he must do – if there are unresolved items. It may be helpful to offer reassurances to your loved one that what he cares about will be OK after he is gone.

This may help your loved one die more comfortably. Let your loved one know you are there in the manner that is most comforting to both of you – lying beside them, holding them, speaking to them, holding their hand and etc.

Death.

Breathing stops, all signs of life are gone and the person is totally unresponsive. Eyes may be half open and staring, the mouth may sag open.

Grieving.

After your loved one dies, try to let go of guilt, bad feelings and ugly memories you may have lingering. It may help to memorialize them in the way they might have wanted and to put some ceremony around remembering them.

As the family executor, you should understand that the emotions of family and friends will run high during and after this dying process and may cause strife and difficulty in getting your loved one’s estate settled.

Remember that death is a normal and natural part of life – it comes to us all. No one really knows what comes after death. You can believe what ever it is that gives you the most comfort.

Robert Lanza, a scientist and theoretician wrote in Is Death the End? Experiments Suggest You Create Time  

“Without consciousness, space and time are nothing. At death, there’s a break in the continuity of space and time; you can take any time — past or future — as your new frame of reference and estimate all potentialities relative to it. In the end, even Einstein acknowledged that “the distinction between past, present and future is only a stubbornly persistent illusion.” Life is just one fragment of time, one brushstroke in a picture larger than ourselves, eternal even when we die. This is the indispensable prelude to immortality.”

How did you cope with watching a loved one die?