5 Things No One Ever Told You about Dying

     I have never met anyone who works closely with the dying who fears death and yet the general public has an intense fear. This fear is brought about by the unknowing - not knowing what it is like to die or see someone die and not knowing what happens after death. We generally do not know how we ourselves will die and many of us feel uncertain about what (and even if anything) happens after death. Our perceptions and beliefs about dying come largely from external sources whether that be the overly dramatic, sensationalized and inaccurate portrayals of death in the media or religious teaching. Very few of us witness natural death up close and even fewer still witness enough of death and dying to see patterns.

Photo courtesy of M. Kessler

     At New England Pet Hospice, we believe that knowledge is power.  Knowing what comes next helps us prepare and not be as fearful in the moment.  My goal in sharing these concepts with you is to let you know that what you may be seeing is a normal, natural part of dying. It is not a crisis. It is not a sign that your animal is suffering or that you are doing anything wrong. If we are lucky enough to have a long life and die naturally, it will all happen to us also.

    
     PLEASE NOTE: here we are talking only about natural, non-traumatic death.  We are not talking about animals who have suffered an accident, injury or curable illness.  Keep in mind that although these concepts are common, but not necessarily universal.  If you are disturbed by how your animal is acting or what he or she is doing, please talk to your veterinarian.  Individual animals may vary and may require additional or other care to keep them comfortable.

     For this post we are assuming that physical pain is well controlled by appropriate pain medications.  Pain should never be left uncontrolled.  As a hospice, we are committed to effective, consistent pain relief and control.

     1.  Natural death is often a slow, rarely dramatic process. Bodies shut down slowly, system by system. Bodies waste away. Minds appear to come and go. This process may take days, weeks or even months. It may seem interminable and it is quite normal to wish it would be over while at the same time wishing your time together would never end. Try not to feel guilty or disturbed by these conflicting feelings.

     2. As you go through the dying process, your world contracts. First perhaps to your immediate neighborhood, then to your home, then a room and finally a bed. We are all bedridden at some point in our final days. So are our animals. The fact that your elderly cat does not or cannot leave her bed is not a sign of a problem; it is a normal part of the dying process. In the final stages of death, our world contracts even more, to what is inside us. Our bodies themselves are more than we need. We recede to a quiet place inside to finish our business with this world. The fact that your dog no longer lifts his head and wags his tail when you enter the room is as normal as a 90 year old woman who in her final time spends much of it sleeping. It does not mean nothing important is happening; it means the work is internal.

     3.  We all lose control of our bladder and bowels at the end of life. We enter the world as infants without that control and we die that way as elders. The same is true for animals. They come into this world relieving themselves when the need occurs and exit it the same way. Just as we would not leave an infant or grandfather to sit in excrement, we must not do so with our animals. There are many outstanding products and methods for managing incontinence in our dying and elderly companions.

     4.  The dying do not need to eat.  A body at the end if life has no need for fuel. The digestive system is often one of the early systems to slow down. Appetite decreases, food loses appeal, and we fill up quickly. At the very end of life, we all stop eating and drinking also. Although hard for us to see, this is perfectly normal. As nurturers, we want to feed the ones we love; it is a natural instinct. Whether the patient is human or animal, we will often go to great lengths to get the dying to eat - preparing special foods, coaxing, begging, and even force feeding. Although loving, these attempts are often detrimental to our loved ones. When the digestive system slows or stops functioning, eating only causes gastrointestinal distress, which can be painful and disruptive. When your terminally ill loved one stops wanting to eat, let them stop. They will not starve to death, they will not have hunger, and they will not suffer.

Stella, by S. Kent

     5.  All bodies waste away at the end of life. Long before we stop eating, our GI tract stops absorbing food well.  The dying may perplex us by eating large amounts and yet still losing weight. This is because they are not absorbing the food. It simply goes right through them. If they want to eat and take pleasure in it, there is no harm, but do not be disturbed if they seem to waste away anyway. It can be quite disturbing to see a being at the end of life. They may look like no more than a skeleton covered in skin. With humans, if we ever see a person at this stage, they are usually covered with blankets or clothing and we are unlikely to appreciate the severity of their body condition. With an animal, the condition is right before your eyes every day. Others may even think you are mistreating, neglecting or abusing your animal. It is a good idea to get a letter from your veterinarian stating that the animal is in hospice/end of life care and is not being abused, but rather cared for lovingly and appropriately just in case anyone questions you. Know that even though your care is excellent, this process is common, normal and not distressing for the dying.

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