We are taking on a heavy topic in this time before Christmas as we explore the process of active dying, and I know many people are facing the realities of this process at this time of year as well. The good news is that there is help available. Of course there are death doulas and grief counselors who can help greatly with these emotions and thoughts that come up along the path and you should seek them out if you need someone to talk to. If you are just feeling a little down, or in addition to outside help, essential oils and aromatherapy can be a huge help.
If you are making a blend for a diffuser you can help everyone in the room feel lighter and calmer. Another great approach is to have a pot of strongly scented items simmering, especially this time of year. This can also help with humidifying the air if you have a wood stove or other drying heat source.
My recommended fragrances that are both uplifting, healing, and festive this time of year are blends that include a sweet citrus like clementine or wild sweet orange, an uplifting herb like eucalyptus or peppermint, and a spicy herb like cinnamon or clove. All three of these improve mood, move stagnant Qi (sad and depressed emotions are emotional forms of stagnation), and blended they have an excellent holiday smell.
Today we will approach the first stage of the active dying process. Certainly not all, but a lot of anxiety around walking the dying journey with a loved one can come from the lack of knowledge about the process that we generally have. The unknown is frightening, especially when you are concerned about a loved one potentially suffering.
The following information is taken in part from an excellent book written by an RN who is involved with hospice. The book is Sacred Passages by Margaret Coberly and I highly recommend it to anyone who is facing this journey themselves or with a loved one, or anyone who has curiosity about the process.
When we first start hospice or palliative care, the patient is usually not actively dying, and they can often continue with life as they have known it in the recent past for a period of time. A we approach the end of life with any patients including our furkids, we reach a stage where there are many changes occurring and veterinary care becomes more intensive as we adjust our treatments to meet the pet’s current needs. After this we usually see the beginning of a period where bodily processes and organs begin to shut down, this is the active dying process.
Tibetan Buddhism’s understanding of the dying process provides an excellent metaphorical framework to explain this stage in detail, and that is what we will be using. They understood this process of dissolution to be the reverse of the creation process. As in creation we progress from a subtle idea and energy into a physical body or other creation, so in the process of dissolution do we see a transition from a physical body returning to a subtle, insubstantial state.
The first of these stages is the dissolution of Earth. In the body, earth is represented by the most solid parts: bones, teeth, nails, muscles, and skin. In this phase the pet very literally becomes less solid as there is significant weight loss that occurs, even in patients who still have excellent appetites.
This can be a difficult phase because of the appearance of the pet. If you are undertaking a journey through natural death, you may want to get a document from your veterinarian stating that your furkid is receiving appropriate care to allay the concerns of any who feel their weight is a sign of neglect.
In this stage we will often see the dying individual lose their appetite. When this happens as a part of the dying process it can be very disturbing to those of us who have spent our lives feeding our fur children. Know that in the vast majority of cases when a dying individual stops eating, it is simply because they are no longer hungry. They are generally not uncomfortable or suffering from hunger and starvation, their body simply does not need further fuel and their digestive system often is no longer strong enough to handle or want food.
A patient at this stage will sometimes lose so much muscle and strength that they are unable to move. This is normal, and at this point often the patients no longer require turning or adjustments to keep them comfortable unless they are in a position where it is difficult to breath or this phase lasts a particularly long time. It is important to make sure they their head is in a comfortable position as they may not be able to easily adjust this for themselves.
Some other important considerations are that they may not easily blink on their own at this point, and they may not want blankets on their body. It can be helpful to keep lighting in the care space low to provide a relaxing atmosphere for the patient if they cannot close their eyes. We have learned from human hospice that many patients in this stage cannot bear the weight of blankets on their bodies. A good solution to avoid this discomfort while still providing warmth is to raise the general room temperature, or to use a low table or other structure over the patient and drape a blanket over the structure.
This and the following stages generally proceed as laid out, but we do sometimes see patients skip stages, move back and forth through the stages, and, although it is rare, it is possible for a patient to move through some of the stages of dying only to turn around and move back into living for a time again. Usually the stages progress as they will be laid out. The first stage is the longest of the stages and usually lasts a few days, though it can be longer or much shorter in some cases.
In the next installment we will cover the remaining three stages of the process.
If you want a consultation, or simply more information, please get in touch.
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