The Symptoms of Dying
We recently came across two remarkable articles written by Dr. Sara Manning Peskin for The New York Times describing what she refers to as, “The Symptoms of Dying.” Her first piece reviews in great detail the common physical symptoms that accompany dying. By contrast, her second article explores the more gentle and mysterious moments in this difficult process. Taken together, the pieces provide valuable insight into something we’ll all one day experience. They also speak to the value hospice services provide dying patients and their families.
Death as a Physical Symptom
In “The Symptoms of Dying,” Manning describes with visceral detail and touching beauty how the body responds at the end of life:
Dying has its own biology and symptoms. It’s a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions.
Each of these symptoms – from the death rattle, to air hunger, to terminal agitation – come in reaction to the body shutting down. One passage in particular stands out:
Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing, but aren’t usually uncomfortable for the dying person. They are well-treated with medications. With hospice availability increasing worldwide, it is rare to die in pain.
While dying is a difficult process, it doesn’t have to come with excruciating pain. Hospice doctors and nurses understand these physical symptoms and can treat them in ways that provides relief. End-of-life transitions can come, then, with a bit more peace.
The Mystery of Terminal Lucidity
While our bodies do fight against death, they’re also naturally insulated against its worst symptoms. In her second article “The Gentler Symptoms of Dying,” Dr. Manning describes the peace and mystery many experience in their final moments:
The human body’s most compassionate gift is the interdependence of its parts. As organs in the torso fail, the brain likewise shuts down. With the exception of the minority of people who suffer sudden death, the vast majority of us experience a slumberous slippage from life.
Before this final, peaceful passage comes, some experience a phenomenon known as Terminal Lucidity, which Manning describes this way:
The mysterious exception is “terminal lucidity,” a term coined by the biologist Michael Nahm in 2009 to describe the brief state of clarity and energy that sometimes precedes death. Alexander Batthyány, another contemporary expert on dying, calls it “the light before the end of the tunnel.”
Manning describes patients who were comatose months or uncommunicative for years, who suddenly come to life in the hours before their death. Terminal Lucidity occurs for patients with a variety of maladies and doctors can’t explain exactly why. Manning ends her piece with the story of her own grandfather, who after days of incoherence spent 10 minutes talking clearly to his children and grandchildren the day before he died.
Taken in isolation, something like Terminal Lucidity could be frightening and confusing for patients and family alike. But under the careful watch of hospice professionals, these events are explained and contextualized in ways that offer peace and perhaps healing for those involved.
While some of her words may be difficult to read, Manning’s twin pieces offer a powerful glimpse into dying. While it’s a process many people don’t like to discuss, it’s one we’ll all encounter sooner or later. If you have questions about the role hospice plays in end of life transitions, feel free to contact us at (602)-497-4100. You can also fill out our contact form and we’ll reply right away. Southland Hospice serves the greater Phoenix area. If you or someone you love is in need of hospice care and lives nearby, we’d be more than happy to talk.