Introduction to Dying.


The Labor of Dying

A dear friend in her 90s tells me "We all need help coming into the world, and most of us need a little help going out from it."

In The True Work of Dying, Jan Selliken Bernard and Miriam Schneider open Chapter 4 ("Midwives and the Labor of Dying") with:
"Of all the similarities between the paths of birth and death, perhaps the most important and striking is that both birth and death involve physical labor. During these labors, our bodies and souls are pushed to their limits and beyond."

One kind of dying is a sudden collapse into death, and here the labor of the death itself is short.

The other kind of dying is slower, taking hours or days or weeks, and can appear (according to Bernard and Schneider) as these three stages, which are described in full in their book:

Stage I: Preactive labor, the "beginning" of physical death

This may last for days or weeks.

Physically, the person will eat and drink less. Breathing may alter. Body temperature and sleep cycles may fluctuate. Sensitivity may increase to the surroundings.

Emotionally, one may center increasingly on all but a few. One will be concerned to have a chance to finish business with one's family and friends. Strong emotions (including grief, anxiety, anger, or depression) may occur.

Stage II: Active labor, the transition phase of dying

This may last for hours to days.

Physical changes increase. The skin may start to cool and mottle, beginning at the toes, the fingers, and gradually working toward the center. With increased lung congestion, breathing becomes difficult. The ability to communicate fades, and one loses the ability to control bowels and bladder.

Emotionally, one may have increased anxiety and some fear. Others relax and accept the changes calmly.

Stage III: Death

This is the moment of death.

The hearts and lungs stop. Breathing stops. The skin turns grey.

The main physical symptoms that may cause some people discomfort during their labor of dying, and which their medical support team can alleviate, are (after Bernard and Schneider, citing The Oxford Textbook of Palliative Care):

Supporting the Labor of Dying

How can we support someone who is working on the Labor of Dying?

In The True Work of Dying, Bernard and Schneider write:
"The guideline of what to provide will always be,
Does the action provide relief?"

Bernard and Schneider list supportive measures that are helpful for the one who is dying, in addition to the medical and hygiene support. A sampling is here:

Atmosphere "Move slowly, quietly, and gently. Keep extra stimulus to a minimum."
Books "Many people enjoy being read to. Books that speak to their spiritual beliefs bring comfort and can help alleviate fear ... Hearing is still very acute even though it seems the dying one cannot hear you."
Family gatherings "Create a gathering of the dying one's choice of people. ... Make time for each person to be alone with the dying one. Be honest with each other about the sadness of letting go."
Loved ones "Honor the dying one's desire to see other people."
Massage "Always honor the dying one's boundaries and be guided by them."
Picture board "Have family and friends gather pictures of times shared together. Place them on a bulletin board near the bed where everyone can see them. As the death draws nearer, the board will provide comfort to everyone."
Quiet listening "Sit quietly, perhaps touching gently. Be honest about your own feelings of sadness or loss."
Room environment "A comfortable bed, medical equipment and supplies should be easily accessible, as well as personal belongings important to the person, such as a familiar blanket or pillow which will promote comfort. Caregivers should have the ability to adjust the environment to comfort."
Sound "Avoid disruptive or disturbing noises, such as television in the background. Choose music that brings comfort."
Therapeutic touch "This is done by a person trained in the art of therapeutic touch."

They also list the supportive measures that are especially helpful for the one who is passing through each phase of the Labor of Dying, and additionally list supportive measures for the caregiver(s). These are some:

Stage I: Preactive labor, the "beginning" of physical death

For and with the dying one:

For the caregiver:

Stage II: Active labor, the transition phase of dying

For and with the dying one:

For the caregiver:

Stage III: Death

For the dying one:

For the caregiver:

When am I Going to Die? One answer.

In The True Work of Dying, Bernard and Schneider write:
"A question that we are frequently asked is, When will the death happen; how much longer will it be? There is no one answer to this question because each person is unique. Each of us comes into the world with our own path to follow. We leave the world in the same way.

'When am I going to die?'
a patient once asked Miriam. She replied as quietly as he had asked,
'You will be telling us before we can tell you.'
This is the only way we are able to respond to that much-asked question."

The Books

Bernard & Schneider's The True Work of Dying.
Buy 'The True Work of Dying'

A compassionate book for those that help the dying and those that are preparing to die. Their special contribution is to compare what happens to the mind, body, and spirit during the process of dying with what happens during birthing.

"Just as a baby grows to maturity within the mother's womb and must leave, so will the body mature to its end and once again leave its place of shelter."

See also our book log entry.

Callanan & Kelley's Final Gifts.

Albom's Tuesdays with Morrie: an old man, a young man, and life's greatest lesson.

See also our book log entry.

This is a useful book for any visitor (whether relative, friend, or Hospice volunteer) to someone who knows they are dying. In particular, the book takes you through the lesson that the author learned in each of the 14 weeks while he visited his dying professor, Morrie Schwartz. This was what they talked about on the successive weeks:

  1. The world.
  2. Feeling sorry for yourself.
  3. Regrets. ["Sometimes, in the mornings, ... that's when I mourn. I feel around my body, I move my fingers and my hands - whatever I can still move - and I mourn what I've lost. I mourn the slow insidious way in which I'm dying. But then I stop mourning. ... I give myself a good cry if I need it. But then I concentrate on all the good things still in my life. On the people who are coming to see me."]
  4. Death.
  5. Family.
  6. Emotions.
  7. Fear of Aging.
  8. Money.
  9. How love goes on.
  10. Marriage.
  11. Our culture.
  12. Forgiveness.
  13. The perfect day.
  14. And on the last week they say goodbye.

Maybe a dying person wants to talk about such things. Maybe not. But if we don't offer them the opportunity to talk now, when will we?

Doka's Living with Grief: Children, Adolescents, and Loss (2000), edited by Kenneth J. Doka, published by H.F.A. (Hospice Foundation of America).

A collection of essays on practical approaches to helping our youngsters to cope with loss and grief. Includes 'Eight Myths About Children, Adolescents, and Loss' to show that:

  1. "Children grieve at any age."
  2. "Children and adolescents experience a range of losses."
  3. "Much as we like to protect children from loss, it is impossible. ... We can teach and model our own ways of adapting to loss id we include children and adolescents rather than exclude them."
  4. "Children and adolescents should have the choice as to how they wish to participate in funeral rituals."
  5. "No one gets over significant loss. Children, like adults, will learn to live with the loss, revisiting that loss in different points in their development."
  6. "Most people, including children, are resilient."
  7. "There is much value in openly communicating with children and adolescents. But there is also great value in using approaches that allow the child or adolescent other creative ways of expression."
  8. "Families do have a critical responsibility [to help children and adolescents deal with loss] But is is a responsibility shared with other individuals and organizations."

Sweeney's God said "Ha!".

Other Bibliographies:
Project on Death in America (PDIA); with PDIA Caregiver Bibliography: Transforming the Culture of Dying.


Categories of suicide:

Approximately 30,000 suicides per year in the U.S.A. or about 80 per day.

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