I found a cassette tape under a bunch of papers and put it in my recorder that barely works. This is where it began:

(regarding the 'hole' inside of us or the empty space inside when we lose someone precious to us) " ... no longer a fearful place ... There is peace emanating from it. Whenever a death occurs, wherever a life form dissolves, God, the formless and unmanifested shines through the opening left of the dissolving form. That is why the most sacred thing in life is death. That is why the peace of God can come to you through the contemplation and acceptance of death ... "    -- Eckhart Tolle, Stillness Speaks

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When someone is dying a natural death, there is a breathing pattern that usually happens. It goes something like this: a deep breath or 2, then holding it, followed by a shallow breath or 2, and so on. It is an uneven pattern of inhales and exhales. It can be scary if you don't know it is coming.

Another thing that happens is as the person gets closer to death, the time between inhales widens. When breaths are towards 20-30 seconds apart, death may be happening very soon. I say "may" because there is always someone who may have this breathing pattern and live much longer. Overall, breaths will be getting more shallow and the time between inhales will space out.

There are exceptions to everything, but generally this is what you will see. Of course right now I want to tell you all the ways it could be different and how many ways breathing can look even with the above very general guidelines. The best thing to do is when you are going through this time, ask your hospice doctor or nurse about it and ask them to show you what you will be seeing. I do this with the people I care for. I show them some ways it can look and when it happens, they aren't as startled.

The pattern is called 'cheyne-stokes' respirations.

" ... Cheyne-Stokes respirations refer to a rhythmic change in respirations wherein breathing becomes shallower and shallower variably with a slowing in respiratory rate that culminates usually in complete cessation of breathing for several seconds to more than a minute. This is followed by progressively stronger respirations that become exaggerated and quite deep. This pattern is thought to result from abnormal brainstem responses to CO2 levels in the blood - initially undercompensating and then overcompensating. Cheyne-Stokes respirations can occur in other nonterminal disorders such as heart failure and stroke. It is interesting to note that patients who are able to speak generally say that no distress is associated with this breathing pattern. From this we may extrapolate to dying patients, who usually cannot speak with Cheyne-Stokes respirations, and presume that the syndrome is not disturbing to the patient. However, family members and clinicians may assume or project distress into this syndrome and thus often need to be coached. I usually explain that the pattern results from a breakdown in "cycling" between the lungs and the brain and that, as far as we know, it is not bothersome to the patient ... "            Palliative Care Perspectives-- James L. Hallenbeck, MD

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Tell a Story 12/18/2009
 
When a person is dying, she is retreating from everything outside of her. She has little energy for anything outside of what is going on in her internal world.

She cannot respond the same to conversation. It takes much effort to answer questions. To engage someone in the normal back and forth conversational style can be overwhelming for her. Instead, tell a story. Tell her what you did today or whatever is on your mind. But don’t ask questions. What she has energy to tell, she will. Do not be concerned if she does not respond to you the way she used to or even with a hint of a smile. She cannot.

It is not about you. Just keep talking to her if you want to verbally connect. Otherwise, your presence is enough.



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When a person is approaching the end of their life, things outside of them begin to lose appeal. You will start to notice they are not doing some of the things they have enjoyed over the years. They begin to not want to see people. This is not to be confused with depression.

For the rest of this article, put the illness of depression aside. What I am talking about here is the 'going inward' of a person who is dying. The person may be depressed as well, or has fought it their whole life, but this process is outside the realm of depression.

What is happening is their focus is now internal. We believe this is the busiest time of life. They are doing what we call 'life review,' and they are preparing for the ultimate journey from their body. It may appear to you they are depressed when they are refusing guests, activities or watching their favorite show. They are not. The closer they are to their death, the more you will notice the withdrawal.

When you see this, know they are working out their lifetime. They are looking back over their life intensely. What this may look like is a strong need to tell you stories and share pictures. You may start hearing about people and incidents that you have never heard before ... and they will be sleeping more.

When you begin to notice this process is happening, what you do to support them now is to sit down and listen. Don't change their story. If they are telling it with the wrong details, etc. let them. The gifts to give right now are time and your listening ear. Priceless.
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