What really happens when you’re dying, according to an end of life expert
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Death is inevitable. It comes to us all, and just like giving birth, it’s a natural process of life. However, unlike birth, there are no ‘classes’ to prepare you for death — no rule book or tutorial that can set you up for the inescapable. So, it’s understandable that people fear it or want to side-step a discussion on the topic. But the reality is that death and the dying process are things that need to be spoken about, both to help the person who is dying and their loved ones deal with the situation (Picture: Marie Curie UK)
‘We’ve always said that we need to change the conversation around dying,’ Sarah Holmes, Chief Medical Officer at end of life charity Marie Curie UK, tells Metro. ‘There’s a sense that people don’t want to talk about it,’ she adds, comparing death to the good old British belief system that if we don’t talk about something, it means that it’s not really happening. ‘When someone says they’re having a baby, everyone wants to talk about it. When someone says they’re dying, people go quiet. We want to change that — and we’re here for both patients and families’ (Picture: Getty Images)
Here, Holmes explains the process of dying, from what physically happens to our bodies at the end of life to recognising the emotional stages. Ultimately, Holmes hopes that by engaging in open, honest conversations, we can remove the stigma around death and enjoy life until our very last breaths (Picture: Getty Images)
What happens physically at the end of life
According to Holmes, there isn’t a strict order for death. From a hospice perspective, it’s different for everyone, depending on their illness. However, the last organs to stop are usually the brain, lungs, and heart. ‘As the body slows down, people become more tired and sleep more. They eat and drink less as the digestive system begins to shut down,’ explains Holmes. Circulation also slows, which changes skin colour and temperature (Picture: Getty Images)
What happens physically at the end of life
Breathing patterns may become irregular — sometimes fast, followed by long pauses. People often think someone has taken their last breath, and then they breathe again. It’s all part of the body’s natural rhythm. The heart also slows down, and the skin can become pale or cool. Holmes says: ‘Eventually, the breathing and heartbeat stop, followed by the brain. It’s usually a very peaceful process. In most cases, people simply slip away’ (Picture: Getty Images)
What happens physically at the end of life
The very last phase — the changes in breathing and circulation — usually happen over a few hours or days, rarely lasting longer than a week, Holmes adds. However, she says that the gradual decline can take weeks or months, with people sleeping more and having less energy. ‘I often remind families that palliative care is about living, not dying. Dying itself is short. Just like birth, the act of leaving the world is as brief as coming into it’ (Picture: Getty Images)
Acceptance and emotional stages
‘One of the most important parts of end-of-life care is helping people and their families come to terms with it,’ says Holmes. Everyone is different in their journey to death. While some will have accepted their fate by the time they reach hospice care (typically older patients who have had a ‘good innings’), others still struggle to come to terms with their reality. The role of palliative care is to control symptoms and encourage people to make plans. This way, when these things are taken care of, people can focus on living right until the very end — saying what they want to say, doing what matters to them. ‘It’s often harder when there are unresolved emotions or unfinished business. Some people are at peace; others still struggle to let go,’ says Holmes (Picture: Getty Images)
The emotional journey
Emotionally, people who are dying — along with those around them — experience feelings similar to grief. People might experience denial, anger, sadness, or acceptance, though not everyone goes through every stage, notes Holmes. ‘Our role is to support them through whatever they’re feeling. Some prefer not to talk about dying at all — and that’s okay. It’s a coping mechanism. Others want to plan and talk openly. Many use that time to tell loved ones how they feel — to express love, say sorry, or make peace’ (Picture: Getty Images)
Supporting the dying
Talking about death is one of the best ways to help anyone through it. A hundred years ago, everyone saw death up close. It was part of daily life. Now it often happens in hospitals, away from view. ‘If we can make it normal to talk about death again, that helps people feel less alone,’ says Holmes. ‘Don’t avoid someone who’s dying out of fear of saying the wrong thing. What they need most is presence — someone willing to sit with them’ (Picture: Getty Images)
Supporting the dying
Holmes recalls working with a chaplain who compared death to the sun: it’s always there, but we don’t stare at it all the time. ‘It’s the same for people who are dying. They don’t always want to talk about it, but when they do, we should be ready.’ She also references Kathryn Mannix, a former palliative care doctor, who described these conversations as a dance. ‘Sometimes we step on toes, but that’s okay. You just apologise and keep going’ (Picture: Getty Images)
Why death is nothing to fear
‘It’s a completely natural process — the only certainty in life, says Holmes. ‘Talking about it doesn’t make it happen. Being open and prepared makes it easier for everyone. Palliative care helps people live right up to the end, so dying isn’t long or frightening. It’s simply part of living.’
Marie Curie’s free support line (0800 090 2309) and online resources are available to anyone requiring information and support relating to terminal illness, dying, death and bereavement. You can find out more here (Picture: Getty Images)
