There is a roughly predictable sequence of events that occurs in the last few days of life, as the body systems shut down.
While knowledge of the steps of the process may not be intuitive, you can take comfort in knowing that what to do and say often is.
The particular caring you can provide at this time may be your final gift to someone you love.
The idea of being with someone in their final days can be alarming when taken out of the context of the relationship leading up to that time.
When you remind yourself that this is the same person you have loved and known before these moments, you may be better able to relax into the experience with them.
Remember that it is believed that the last senses to decline are touch and hearing, so continue to talk to your loved one, to hold their hand and to let them know that you are there, even if they are not consistently responsive.
The words "I love you" and the warmth of touch are powerful communicators.
Final steps and stages: 1.
Restlessness, muscle aches and tenderness may be experienced by the person who is dying.
What you can do: With permission if possible, provide gentle massage with a lubricating oil or lotion, or help them shift position for greater comfort.
Also, as needed, advocate for your loved one with health care professionals to ensure that needs for pain relief are met.
2.
As a person approaches their final days, there will be changes in body temperature and purple blotches may appear on the extremities, visible signs that circulation is slowing down.
What you can do: Keep talking and touching, adjust pillows to reduce pressure points, make sure they are covered and comfortable.
Gently massage the discolored areas.
3.
Within 48 hours or so of death, the individual will typically lose interest in eating and drinking.
This is entirely normal.
In fact, it is known that lower fluid intake actually reduces pain: part of the body's way of managing the end-of-life.
What you can do: You can provide gentle relief from dryness by moistening their mouth with tiny sips of water through a straw or ice chips, and also by treating their lips with lip balm and skin with moisturizers.
4.
The dying person may have moments when they believe they are seeing or hearing things you do not also see and hear.
What you can do: Stay connected and provide reassurance but do not challenge what they are experiencing.
Remember that it is real for them and that is what matters.
5.
As the hours pass, your loved one may lose the ability to speak, meaning you may not know for certain what they are feeling or what they might need.
What you can do: You can give loving imagination to anticipate what is needed.
Test out the options, if possible, by asking them to nod or squeeze your hand instead of using words.
Consider playing relaxing music of a type you know they enjoy.
6.
Eventually the dying person may lose their vision, although their eyes may remain at least partially open, sometimes staring fixedly.
What you can do: Remember that the staring is part of the process and is not an attempt to communicate anger or any other feeling.
Stay close and continue to let them know you are near.
7.
The person who is dying may have an interval of difficult or irregular breathing.
What you can do: Be an encourager.
Tell them they are doing fine, that you are there, that it is okay for them to let go.
Give them the gift of your attention and touch, along with affirming messages.
As a caregiver you need to take care of yourself as well as the person who is dying.
Do what you can and say what you want to say, and then take breaks as you need them.
Perhaps there are people who can spell you off.
Be prepared, however, for the fact that your loved one may die when you are not present.
If this happens, you need not feel guilt.
To offer your presence, your words, your touch and your faithfulness to someone who is dying is to offer a gift without measure.
Take comfort in that and be at peace.