Last time we covered the first stage of the active dying process: Dissolution of Earth.
This stage is the first and generally takes the longest. The next stages are usually completed in a matter of days at most, though, as I mentioned in the last blog a patient may go back and forth through them or stop and turn around all together. The stages generally accelerate with each successive stage taking less time than the stage beforehand.
The second stage of active dying is dissolution of Water. This stage is, from a biologial perspective, exactly what it sounds like. In this phase the fluids of the body dry up, including the saliva and other body fluids. This is the phase where patients generally start to turn inward and pay less attention to the world around them. Much like with the loss of weight and hunger in the Earth phase, these patients are generally not thirsty.
It can be helpful to moisten the mouth with wet gauze at this point, but it is generally not helpful to force hydration with syringing water or administering fluids under the skin or into the vein.
This phase we generally don’t see much happening on the outside, however we know from human hospice this phase usually involves rich internal experiences. Many people report making contact with dead friends and relatives during this stage regardless of medications that they are taking or not.
The other thing that can happen at this stage is the final bloom. A patient may rally all their strength for a final day of play, walks, or suddenly want a large meal. This may appear that the patient is recovering, but usually after this final expenditure of effort the process continues.
The next stage is dissolution of Fire. Fire is the element that powers digestion, metabolism, and internal heat in Tibetan Buddhism. During this stage the digestive functions stop completely, which may not be evident if a patient already stopped having appetite and was not being force fed. You may also see diarrhea, regurgitation, or simply a final bowel movement.
The loss of internal heating capacity leads to a cooling of the extremeties and cold breath is often noticed at this point. At this stage breathing shifts to short inhalations and longer exhalations, this is normal and does not usually indicate a problem breathing.
It is very important to keep the environment around the dying patient quiet and restful at this point. At this stage we no longer expect the patient to respond to their name.
The final stage is dissolution of Wind. As you might expect, this stage has a lot to do with breathing. This stage is often quite fast lasting usually only a few minutes. During the stage the pattern of progressively shorter inhales with longer exhales will intensify until breathing ceases completely. Twitching of the limbs and stretching out of the limbs and spine may also occur at this time. Usually there will be some stretching of the spine in a gentle backward arch which may include lifting of the head.
When assisted by hospice, this process is generally peaceful and can be a rich spiritual experience for all involved.
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