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Understanding the Dying Process

By Dr. Ong Tien Kwan

Why do we want to understand the dying process? What benefits can we get from understanding the dying process? How would this knowledge change the way we see and experience death?

We want to understand the dying process because just like the birthing process, the dying process is a very natural process. Just as we learn to reduce our fear of maternal and infant death arising from the birthing process through a comprehensive understanding of the entire birthing process, in the same way we can allay our fear of death and even enhance our spiritual experience of death through a comprehensive understanding of the dying process.

By seeing the dying process as a natural part of life, we can also change our attitude towards seeing death as a failure. This change can actually transform our death experience for the better.

Since we are made up of a physical body and the mind (or spirit/soul), we shall take a look at the changes that happen in each of them as we die. We are referring here to a slow and gradual death, not sudden death due to accident.

Physical Changes

As we are dying, the physical body gradually breaks down, involving every system.

In the cardiovascular system, the heart pumps weaker and blood circulation becomes sluggish. As a result, skin appears mottled and the peripheries become cold. Blood pressure is generally low. The person appears weak and tired.

The respiratory system also becomes weaker. Breathing becomes difficult and laboured. Phlegm gets accummulated in the throat and mouth.

The renal system also starts to shut down. Urine output decreases.

In the gastrointestinal system, the person's appetite reduces. Food and water intake become minimal. There is gradual loss of body weight.

The muscles become shrunken and smaller. Body becomes weaker.

Caring for the Physical Body

As the body deteriorates, our nursing goal is simply to maintain hygiene, give comfort and reduce pain.

Maintaing hygiene involves daily bath or wiping the body, dental hygience, change of fresh and clean clothing, clearing of urine and cleaning of bowel output.

To provide comfort, we need to feed the dying person with appropriate types of food and drink, to wet the lips when dried, to turn the body every couple of hours if he or she is bed-ridden.

Most of these tasks can be performed by family members or friends, or a qualified nurse. However, when managing pain, most time professional help is required, especially if the pain is due to a terminal illness, involving bone or nerve pain.

Fortunately, we now have hospice care - a branch of medicine whether the healthcare professionals are specifically trained to care for the dying.

Psychological Changes

A dying person goes through a gamut of emotional changes, including these few major emotions highlighted by Dr. Elisabeth Kubler-Ross in her groundbreaking book "On Death and Dying" - denial, anger, bargaining, depression and acceptance. However, there are also other emotional experiences as well, ranging from mild frustration to major fears.

Social Changes

Social changes are also noticeable in the dying person. He or she becomes more reserved, withdraws from public, clears away old stuff, sometimes needing communication with specific persons, reconciliation and closure.

Spiritual Experiences

A dying person often gets unique spiritual experiences as his or her condition deteriorates. These experiences are often called end-of-life or deathbed phenomena.

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