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WE WILL ALL DIE
– and it's so valuable to learn more about it...
A few years ago I interviewed Denys
Cope for a radio show. Denys has spent many years dealing with
death and dying, and knows the subject very well.
I learned more in that one hour, and
had my point of view more profoundly changed, than in almost any
other encounter I've ever had. It had never occurred to me that
death is a systematic, predictable process – nor had I ever really
looked into it.
Denys has just published a short book
encompassing this information, which I want to strongly recommend.
The table of contents and some brief excerpts are below.
Book: Dying: A Natural Process
(36 pages, spiral bound)
Denys Cope,
RN, BSN, MSS
Nurse, Author,
“End-of-Life Coach,” Professional Speaker
$15.00 + $4.00 shipping (
Please add $1.00 tax if resident of New Mexico)
denysc@cybermesa.com (505-474-8383)
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Contents
Forward 1
Introduction 3
Part One - Preparing for the
Dying Process
1. Societal Views 4
2. Relationships - A Time For Healing 6
3. Guilt versus Acceptance 7
4. Spiritual Beliefs 9
Part Two - Stages of Dying
5. Nourishment- Our Need to Feed 9
6. Turning Inward 12
7. Pain and Symptom Control 15
8. Fear of Dying 17
9. Visioning 18
10. Hallucinations/Confusion versus Visioning 20
11. Labor Stage of Dying 22
12. Non Responsiveness versus Coma 22
13. The Sense of Hearing 23
14. The Transition Phase 24
15. Active Dying Stage - "Deathing" 25
16. The Mystery of The Timing of Death 26
Part Three - Caregiver Support
17. Being a Caregiver 28
18. Hospice 29
19 What Kind of Help Really Helps? 31
20. Assisted Suicide 32
21. Suffering 33
Conclusion
22. Reflections 35
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Excerpts selected from first
few pages, by JT, just to give you an idea of the richness
available in this little volume. (The following excerpts are
reprinted by permission) (c) 2004 Denys Cope , RN, BSN
Introduction
Most important is to know that the
dying process is not something to be feared. It is a very normal,
natural, exquisitely well-orchestrated physical and spiritual
experience, just like the pregnancy/labor/birth process, with
which it has parallels. I have found there is a pregnancy to the
dying process, a labor, and then a "deathing," instead of
birthing.
There is also remarkable physical and spiritual
support for
the transition. No matter what brings one to the dying process,
whether it is
cancer, old age, lung disease, heart disease, Alzheimer's, or any
other disease,
the process eventually becomes the same, except in the cases of
sudden or traumatic
death. The dying process is like being in a funnel; everybody
comes to this time
from different conditions, and then they move into the same
process. This becomes
a very recognizable phenomenon....
Throughout
the dying process we naturally begin to do that which conserves
energy. Our body is programmed for survival, to live as long as it
can, and to support life as long as it can. One of the ways it
does this is by conserving energy, in whatever way possible. We
eat less and lighter food because our body cannot utilize the food
as well. We do less and less physically as we turn inward toward
an internal focus. Very often these same changes in
lifestyle are also common in elderhood, and in themselves they do
not necessarily indicate that someone has started to die....
.... It was only in hindsight that
she could see she was withdrawing from the world and spending more
and more time resting and conserving energy. It was also
interesting that when, a month before she was diagnosed, her son
visited her from Hong Kong, bringing her granddaughters, Elaine
did find the strength to go out with them, because they nurtured
her energetically....
...This is not to say there is not pain and suffering during this
time, because often there is. But pain is related to the advancing
illness, not to dying. The actual dying process, the closing down
of the body's functions, is NOT painful. There are many times that
the condition that causes the death is not painful. In many
people¹s minds, dying and pain are always interconnected. They
think the more pain someone is in, the closer to death that person
must be. Advancing pain is related to advancing illness, and there
are many excellent ways available to control pain and discomfort.
Death, on the other hand, comes in its own timing regardless of
the presence or absence of pain.
Societal Views
As a society it is our challenge to
understand that death is not a failure. Death may come as the
result of actions or events that appear to have failed, but death
itself is not a failure. It is something we each will go through,
and it is as much a part of life as birth. Once we are born, it is
guaranteed that we will die.
We all have our time, and yes, I would fight
for life just
like anyone else if I were diagnosed with a terminal illness. I
would do everything
within my power to facilitate a cure. However, once I had given it
my all and
it had become clear a cure was not happening, then it would be
time to look at
the end of my life.
...In [Aboriginal] culture, when a
person is born the tribe surrounds the baby and celebrates, and
the first thing the baby is told is, "We love you and support you
on your journey." The person grows and lives a full life. Finally,
when the person realizes it is time to die, a party is held, like
a graduation celebration. The last thing the person is told is,
"We love you and support you on your journey." Then the person is
left alone. He or she sits down, and within a matter of minutes is
able to intentionally close down the body and die. Now that is the
ultimate in conscious dying.
This ability is also a well-documented
phenomenon among Tibetan,
Hindu, and Zen Masters as compiled by Sushila Blackman in her
remarkable book Graceful
Exits:How Great Beings Die which recounts the death stories
of 108
spiritual masters.
We have heard of other indigenous cultures in
which it was
traditional for elders to leave the tribe and go out into the
wilds alone when
they knew it was their time to die. Perhaps we modern folks tend
to imagine the
elders went out there and were eaten by animals, or froze to
death, or starved
to death, or in some other way went through great physical
suffering. Yet I have
come to understand, as I learn more about indigenous cultures,
that it is more
likely they knew of a way to bring about their own death
naturally. With an intuitive
knowledge they understood it was time, knew where to go, knew what
to do, and
did it.
If this ability exists among any people, then
it must be available
to all of us...
Relationships - A Time for Healing
The dying often go through dramatic changes in the way they
live their lives when they know they have little time left. One
fellow I took care of, Paul, was among the angriest people I have
ever met. He was 51 and dying of bladder cancer. With a wry sense
of humor, he said of his disease: "Well, what do you expect for
someone who has been pissed off all his life?" And evidently, he
truly had been angry for all his life. Paul was a complex,
sometimes delightful, sometimes very difficult person to be
around. He was experiencing quite a bit of pain in the course of
his disease. To help manage this pain, pain specialist physicians
were continually involved in his care. Paul would get one
kind of pain under control and another would pop up. We would work
on that one, and another would pop up - he could never get
comfortable for long.
After several weeks of this pattern, it became
clear to those
of us caring for Paul, including his partner, that at some deep
unconscious level,
Paul needed his pain and he needed to suffer. It was, we supposed,
part of the
way he was trying to atone for a lifelong pattern of what he saw
as pretty poor
behavior on his part, with many people.
The last three weeks of Paul's life were very
interesting.
His 25-year-old son, John, and Paul's girlfriend, Sarah, did not
get along; they
were like oil and water. Paul finally asked for a family
conference and asked
me to mediate the meeting. A few minutes into the discussion, he
said to John
and Sarah, "You know, up until now I've been sick, but something
has shifted
and I know I'm dying and we don't have time for this any more. We
have got to
learn how to get along." From that moment on, the peace that
enveloped that household
was remarkable. Paul really seemed to stop suffering. And while he
had a tube
in his kidneys and still needed quite a bit of pain medication, he
had come to
a place of incredible peace. It was quite striking. In his last
three weeks of
life, Paul became a very soft and loving partner and father. We can
change
and grow, even in our final days, hours, and minutes.
Guilt versus Acceptance
...Every single
person alive today, from the most newly-born baby on, will have
died. Death is going to be part of our experience. So what are our
choices in response to this knowledge? We can feel responsible
for our situation and say, "Oh my God, I caused my cancer
because I ate the wrong thing,² or ³I'm sick because I¹m angry at
this person, or because I haven't been spiritual enough." We can
be like Paul, who said, "I've been pissed off all my life, no
wonder I have bladder cancer." He believed he was being punished
and had created the whole situation. Now illness can indeed serve
as a metaphor, and certain lifestyles do contribute to the
development of particular diseases, but Paul wasn¹t speaking in
metaphorical terms; he was feeling responsible for his
disease.
Our other choice, as Levine says, is to become
responsible
to the situation in which we find ourselves. This means
saying to ourselves,
Okay, I've got this illness. Now what can I do to maximize or gain
the most from
whatever it is this illness has to teach me? Further, we can put
another question
to ourselves: Is this a time for me to really, in a heart-felt
way, say ³Thank
you, God."?
Nourishment- Our Need to Feed
Many people
ask, "How do I know when my loved one has begun dying?" I have
found that one of the first considerations is whether the person
has changed their relationship to food. When dying begins, the
body naturally withdraws from nourishment, from that which
sustains physical life. The person is switching from a physical
energy source to a spiritual energy source, so usually there is a
natural diminishing of appetite with accompanying weight loss.
People eat less and lighter food because their
body cannot
digest the food as well. Their metabolism slows down, their
activity level slows
down, and they grow weaker. Significant weight loss is one of the
criteria considered
when a person is being assessed for hospice.
The body has a wisdom beyond the mind. When a
person has a
growing cancer, much of the food taken in feeds the cancer. When
the appetite
diminishes and less is eaten, the cancer receives less fuel, and
in a basic way,
does not grow as quickly. When a person has advanced cardiac or
lung disease,
the body wants to conserve energy, so the tired heart or lungs do
not have to
work any harder than necessary. Eating and digesting food takes
energy. When
the appetite and eating decreases, the body can conserve whatever
energy is available
for the more important job of keeping the heart beating, or taking
the next breath.
When someone is dying and losing their
appetite, we often
project onto them our need for them to eat. We want them
to eat because
feeding our loved ones is our way of nurturing them. If a person
is not eating
very much, normally it means they are sick. We want them to eat
because if they
do, we believe, they will be "better," and they won¹t die.
As we watch a person eat progressively less and
less, we may
be afraid they are "starving to death." The truth is, a dying
person has a natural
and gradual loss of appetite, and does not need the same quantity
of food...
..Many people will lock their lips at this point, and will not
allow you to put
anything in their mouth.
On the other hand, some people continue
to eat until
the day they die. This whole process can go very quickly or very
slowly. Just
like labor and birth, it is very individual.
...The withdrawal from food and fluids eventually puts the body
into a fasting state. And what is the purpose of fasting? The
first purpose most people think of is cleansing, but another
primary aim is the enhancement of spiritual experiences. It is
clear that the body naturally puts itself into a fasting mode.
Therefore, what the dying person is doing is entering an altered
state that makes disconnection from the body and the connection
with the spiritual realm much easier.
Fasting actually creates comfort for
the person at
this stage; it has a sedative effect.
... The body is unable to use the fluid because it is in the
process of shutting down. If a person is given fluids at this
stage it can result in swelling, or edema, and eventually the
lungs can fill with fluid. In this case our loved one will be in
great respiratory distress as a result of something we were doing
to try and create comfort.
The work of the
caregivers is to learn to trust the process, and listen to their
loved one...
The dying person's
relationships change in layers. The first layer affected is that
of our social connections. We stop having energy for those people
who, while they may be important to us, are not deep
relationships. Next to be affected, as our energy decreases, is
our close circle of friends, those who are dear to us but who are
not our core relationships. Eventually, the only people we have
energy to be with are our core people, those who are our family -
both literally and in a deep love sense. These are the people for
whom we do not have to put on a social face, the ones whose love
sustains and nurtures us. Again, throughout the dying process we
are doing what conserves energy....
Fear of Dying
I find that many people enter the dying process
with a tremendous
amount of fear. Many have told me it is not death, but the process
of dying that
is frightening. A very precious woman, Maria, taught me a great
deal about this.
She, as many patients do, came to the dying process terrified of
what would happen.
She was fearful of the pain, of suffering, and of being a burden,
and also terrified
of what would happen to her family that she was leaving behind.
Soon after she
came into hospice Maria was put on an anti-anxiety medication,
which was helpful
adjunct to the emotional support she was receiving. I watched her
over the next
five months as she moved through her dying process, and about a
month before
she died there was a profound shift in her apparent fear of dying.
Somewhere
along the way, she seemed to have done the introspective work, and
she came to
a place of great peace....
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