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
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
Part One - Preparing for the Dying
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
22. Reflections 35
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
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
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....
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
.... 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
...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.
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
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
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
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
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....