What Is It Like to Know You Are Dying
What It Feels Like to Die
Science is only beginning to understand the experience of life's end.
"Do you want to know what volition happen as your torso starts shutting down?"
My mother and I sat beyond from the hospice nurse in my parents' Colorado home. It was 2005, and my mother had reached the end of treatments for metastatic breast cancer. A month or two earlier, she'd been able to take the dog for daily walks in the mountains and travel to Australia with my father. At present she was weak, exhausted from the disease and chemotherapy and pain medication.
My female parent had been the 1 to decide, with her md's approving, to stop pursuing the dwindling chemo options, and she had been the one to ask her doctor to call the hospice. Notwithstanding, we weren't prepared for the nurse's question. My mother and I exchanged glances, a footling shocked. But what we felt almost was a sense of relief.
During 6 and a half years of treatment, although my mother saw two full general practitioners, half-dozen oncologists, a cardiologist, several radiation technicians, nurses at two chemotherapy facilities, and surgeons at three different clinics—non in one case, to my knowledge, had anyone talked to her well-nigh what would happen as she died.
There's good reason. "Roughly from the last 2 weeks until the last breath, somewhere in that interval, people become too sick, or too drowsy, or too unconscious, to tell us what they're experiencing," says Margaret Campbell, a professor of nursing at Wayne State University who has worked in palliative care for decades. The mode decease is talked most tends to be based on what family unit, friends, and medical professionals run into, rather than accounts of what dying really feels like.
James Hallenbeck, a palliative-care specialist at Stanford University, often compares dying to black holes. "We can see the effect of black holes, but it is extremely difficult, if not impossible, to look inside them. They exert an increasingly strong gravitational pull the closer one gets to them. As one passes the 'event horizon,' apparently the laws of physics begin to change."
What does dying feel like? Despite a growing body of research near decease, the actual physical experience of dying—the concluding few days or moments—remains shrouded in mystery. Medicine is only commencement to peek beyond the horizon.
* * *
Until about 100 years ago, almost all dying happened quickly. Only modernistic medicine has radically changed how long the end of life can be stretched. Now many Americans who accept access to medical intendance dice gradually, of lingering diseases such as well-nigh terminal cancers or complications from diabetes or dementia, rather than quickly from, say, a farm accident or the flu. According to the Centers for Affliction Control and Prevention'due south about recent figures, Americans are most likely to dice of heart illness, cancer, or chronic pulmonary lung affliction.
For many who practise die gradually, there's a last, rapid slide that happens in roughly the concluding few days of life—a phase known every bit "active dying." During this time, Hallenbeck writes in Palliative Care Perspectives, his guide to palliative treat physicians, people tend to lose their senses and desires in a certain gild. "Kickoff hunger and then thirst are lost. Speech is lost adjacent, followed by vision. The last senses to go are usually hearing and touch."
Whether dying is physically painful, or how painful it is, appears to vary. "There are some kinds of weather condition where pain is inevitable," Campbell says. "There are some patients that merely get really, really old and simply fade away, and there's no distress." Having a disease associated with pain doesn't hateful you'll necessarily endure a difficult expiry, either. Most people dying of cancer need hurting medication to continue them comfy, Campbell notes—and the medicine usually works. "If they're getting a skillful, comprehensive pain regimen, they tin can dice peacefully," she says.
When people become also weak to coughing or swallow, some start to make a noise in the back of their throat. The sound can be deeply disturbing, equally if the person is suffering. Simply that's not what information technology feels like to the person dying, as far every bit doctors can tell. In fact, medical researchers believe that the phenomenon—which is commonly called a death rattle—probably doesn't hurt.
Ultimately, because well-nigh people lose awareness or consciousness in their last few hours or days, it'due south hard to know for certain how much they're suffering. "Nosotros generally believe that if your brain is really in a comatose kind of situation, or you're non actually responsive, that your perception—how you experience nearly things—may also be significantly decreased," says David Hui, an oncologist and palliative-care specialist who researches the signs of budgeted death. "Yous may or may not even be aware of what's happening."
* * *
A calendar week or two after nosotros spoke to the nurse, my mother sank into a country in which she was rarely conscious. When she was awake, simply the most basic part of her was at that place: the part that told her legs to move to get her to the bathroom, the automated steps in brushing her teeth and then wiping the sink afterward. Her heed turned abroad from her children and husband for the offset time.
I wanted to know what she was thinking almost. I wanted to know where her listen was. Being at the bedside of an unresponsive dying person can experience like trying to find out whether someone is habitation past looking through thick-curtained windows. Is the person sleeping, dreaming, experiencing something supernatural? Is her mind gone?
For many dying people, "the brain does the aforementioned matter that the body does in that it starts to sacrifice areas which are less critical to survival," says David Hovda, the managing director of the UCLA Brain Injury Research Centre. He compares the breakup to what happens in crumbling: People tend to lose their abilities for circuitous or executive planning, learning motor skills, and—in what turns out to be a very important function—inhibition.
"Every bit the brain begins to change and beginning to dice, different parts become excited, and ane of the parts that becomes excited is the visual organisation," Hovda explains. "And so that's where people begin to run into light."
Recent enquiry points to prove that the sharpening of the senses some people written report besides seems to match what nosotros know virtually the brain's response to dying. Jimo Borjigin, a neuroscientist at the University of Michigan, first became intrigued by this field of study when she noticed something foreign in the brains of animals in some other experiment: But earlier the animals died, neurochemicals in the brain suddenly surged. Although scientists had known that brain neurons continued to burn down after a person died, this was dissimilar. The neurons were secreting new chemicals, and in large amounts.
"A lot of cardiac-arrest survivors describe that during their unconscious flow, they have this amazing experience in their brain," Borjigin says. "They see lights and and then they draw the feel as 'realer than real.'" She realized that the sudden release of neurochemicals might help to explain this feeling.
Borjigin and her research squad tried an experiment. They anesthetized eight rats, then stopped their hearts. "Suddenly, all the different regions of the encephalon became synchronized," she says. The rats' brains showed college power in different frequency waves, and likewise what is known equally coherence—the electrical activity from different parts of the brain working together.
"If yous're focusing attention, doing something, trying to figure out a word or trying to call back a face up—when y'all're doing high-level cognitive activity, these features go up," Borjigin says. "These are well-used parameters in studying human consciousness in awake humans. And so, nosotros idea, if you're alert or aroused, similar parameters should also go up in the dying encephalon. In fact, that was the example."
* * *
In her terminal couple of weeks, when my mother's listen seemed to exist floating off somewhere else most of the time, she would sometimes lift her arms into the air, plucking at invisible objects with her fingers. Once, I captured her easily in mine and asked what she'd been doing. "Putting things away," she answered, smiling dreamily.
This half-dreaming, half-waking state is common in dying people. In fact, researchers led by Christopher Kerr at a hospice middle exterior Buffalo, New York, conducted a written report of dying people's dreams. Most of the patients interviewed—88 per centum—had at to the lowest degree one dream or vision. And those dreams usually felt different to them from normal dreams. For ane thing, the dreams seemed clearer, more real. The "patients' pre-death dreams were frequently and so intense that the dream carried into wakefulness and the dying often experienced them as waking reality," the researchers write in the Journal of Palliative Medicine.
Lxx-ii percent of the patients dreamed about reuniting with people who had already died. Fifty-nine percent said they dreamed about getting gear up to travel somewhere. Twenty-eight percent dreamed about meaningful experiences in the past. (Patients were interviewed every solar day, so the aforementioned people often reported dreams about multiple subjects.)
For most of the patients, the dreams were comforting and positive. The researchers say the dreams often helped decrease the fear of death. "The predominant quality of pre-death dreams/visions was a sense of personal meaning, which frequently carried emotional significance for the patient," they report.
In patients' final hours, afterwards they've stopped eating and drinking, afterward they've lost their vision, "near dying people and then close their optics and announced to be asleep," says Hallenbeck, the Stanford palliative-care specialist. "From this signal on … nosotros can only infer what is really happening. My impression is that this is non a coma, a state of unconsciousness, as many families and clinicians retrieve, simply something similar a dream state."
The exact moment at which this happens—when a person enters a dream state, or even when a person starts dying—is hard to pinpoint.
That was truthful in my female parent'southward case. In the early hours one morning time afterwards information technology snowed, I was keeping watch with two of my mother'southward friends in her library, the room where we'd moved her to accommodate a hospital bed. She seemed peaceful, and in the dim light of the morning, nosotros stood at different points effectually the bed, listening to her raspy breathing.
She made no dramatic moves or indications that she was about to leave united states. She didn't open her optics or sit upwardly suddenly. She took a last, slightly louder breath, and died.
"It'southward like a storm coming in," Hallenbeck says. "The waves started coming up. But you lot can never say, well, when did the waves start coming up? … The waves go higher and higher, and eventually, they carry the person out to body of water."
Source: https://www.theatlantic.com/health/archive/2016/09/what-it-feels-like-to-die/499319/
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