The Moment of Death
The time of death is sometimes difficult for the physician to estimate beforehand. The patient may become unconscious some hours, even days, before death or may remain alert and conscious to the end. Painkilling drugs sometimes produce a state of semi-coma that can be misinterpreted by the family as a forerunner to death. The patient may develop an alarming breathing pattern called Cheyne-Stokes respiration, in which breaths increase in rapidity and volume until they reach a climax, then gradually subside and stop altogether. This period can last from five seconds through a minute before the process begins again. The syndrome is common in sick or elderly persons. Although it can be a forerunner to death, it is just as likely to last for several months or even to disappear altogether.
Do not be alarmed if the patient’s breathing makes a groaning or croaking sound. It does not mean that he or she is in pain. When a dying patient slips into a coma, the position of the neck and body produces the noise, which can be reduced by gently turning the patient’s shoulders or body.
Another alarming noise the dying patient may make is known as the “death rattle.” This happens because the unconscious patient is unable to cough up the secretions that accumulate in the back of the throat.
The attitude of the family and the patient alters at this stage. As the patient suffers from increased weakness, lethargy, discomfort, and pain, he or she begins to come to terms with dying. Death is no longer frightening. Often a person’s last days are spent more happily in the knowledge that he or she is dying, than in a state of uncertainty and doubt. It is easier for the family and patient to talk about death in a way that may not have been possible earlier in the illness. It brings comfort to everyone, and often closeness not experienced before.
