How do we support the body, mind, and soul of a dying person?
We want to know how to tell if our loved one is in pain so we can get them the right pain medications. We ask what we can do to make a loved one more comforted and comfortable. We need to know the signs that a person is dying.
I wrote this blog several years ago but have just updated the content. I hope that you find some of your answers here.
This post is also available in audio form through Soundcloud.com. By clicking the icon below you can listen to the audio version of the post or download the audio version.
I originally wrote this post at the urging of four young adults who sat vigil at their mother’s death bed. They were completely unprepared for what they were faced. They contacted me for suggestions on what they could do to comfort their mother. At the time, their mom was dying from cancer, only had a few hours left to live, and she was rarely conscious. They asked me to text them a checklist of things they could do during the night to help ease her transition to death. After their mother died, they asked me to share the checklist I wrote for them with all of you.
I offer the following suggestions for things you can do while sitting vigil at the death bed of someone you love. This is not an exhaustive list of what can be done to comfort a dying person, but it is offered as a starting point.
1. Pain Management: Work with the doctors, nurses, hospice professionals, or end-of-life doulas to assure that your loved one has all the pain medication and muscle relaxant they need to be comfortable.
What are some of the signs that tell you the dying person is uncomfortable physically or in pain? The person may keep shifting around in the bed trying to get comfortable, or they scrunch their face up into a grimace, or their limbs contract in a muscle spasm. These are just some of the signals that they are experiencing pain.
Running a temperature. When someone is dying from cancer, for example, their body can run a high temperature, and with those temperatures there can be seizures. In these cases, the patient may also need medications to relax their muscles.
Dehydration. Muscles often contract during the dying process from the lack of oxygen going to muscle tissue or from dehydration. Painful muscle spasms can occur during the death process. That is why doctors may order a pain medicine, like morphine, be given to a patient along with a muscle relaxant like Ativan. Because you are sitting vigil, you might notice signs of pain before any of the medical professionals do, so write down your impressions of the person’s pain or comfort level and note the time, then share those notes with the doctor, nursing staff or hospice provider. If you are not familiar with hospice or how to obtain hospice services for your loved one, please see What is Hospice? How Do I Get It?
2. Physical Comfort – the mouth: When a person is in the final stages of dying they are usually breathing through their mouth. The mouth dries out quickly and that is physically uncomfortable. It is helpful to swab the mouth and gums regularly with a glycerin swab to keep the mouth moist. You can also apply a non-wax based lip balm on their lips so the lips don’t dry and crack. It is suggested that you keep a good supply of glycerine swabs with a cup of water to wet them in before use and a good lip balm (again, not wax based) at the bedside and use them at least once or twice an hour. Swabs are intended for one use, then throw the swab away and start a new one soaking in water for the next use.
3. Clean the Body While Sitting Vigil: Gently wash the face, neck, arms, hands, feet, and legs of the dying person with a lukewarm damp cloth if they are feverish, or a warm damp cloth if they are cold. After cleansing, apply a light moisturizer to their face, hands, arms, legs, and feet. This keeps their skin feeling clean and soft, and gives them the gift of touch through massage of hands and feet. This is giving them the gift of feeling physically cared for in the process of their death.
4. Peaceful Environment: Keep the room quiet, lower the lighting if you can, ask people to speak softly, no loud noises, no harsh lights, and just as importantly, no harsh words in the room. Limit the number of people in the room at one time, numbers of people can get overwhelming for everyone involved – the person who is dying as well as the family keeping vigil.
5. Time Out: Let the person who is dying have time alone. This may be hard to do because you want to be with them constantly, but they need time and space alone to transition. Please, take short breaks from the death bed vigil. You need the breaks as well to help you sustain yourself through the vigil. You could take a walk outside and get fresh air, take a shower to help wake up, change clothes, talk with a friend, eat a healthy meal, go for a short run or workout, or meditate or pray in a quiet space.
6. Fresh Air: Some cultural traditions call for a window to be open by a death bed, at least a small opening of a window to allow in some fresh air. It is believed that an open window in the same room as a death bed is needed to allow the souls of family members who have already died to come to retrieve the soul of the person who is dying, to take them into the next life. Others believe that if the room is closed, the soul will be trapped and unable to move on. Regardless of cultural or religious beliefs, fresh air helps everyone at the death bed because death comes with odors that are not pleasant and closed rooms get stale. If you can, open a window, at least a little bit, to let in air. Overly fragrant flowers are not helpful in a death room as the scent can be overwhelming, I suggest you clear them from the bed area or the room altogether. Set up a small fan to move air around. Keep the air in the room as fresh as possible.
7. Observe Religious or Spiritual Values: Religious and/or spiritual rites are important for many people as part of their dying process. Find out if the person who is dying wants a visit with a religious or spiritual advisor. Please do not wait until the last hours of life to ask this question because arranging such visits can take time. These visits could range from receiving the Anointing of the Sick (which may include Last Rites), or a religious person to pray with them, and/or to receive healing, or to resolve spiritual conflicts, or to receive counseling, or assistance with meditation. Reiki practitioners are also often available to offer healing energy work with the dying as well. Whatever the individual’s belief system is, please respect it. If the person who is dying asks for any form of a religious or spiritual or healing visit, please do whatever you can to make that visit happen for them.
8. Dying People Say They Want to Go Home: The dying will often say they “want to go home” even if they are already in their home. I have always taken this to mean that they want to leave their physical body, they are done suffering, and they want to move on to whatever dimension/realm they believe follows this physical life. But it can be disturbing to hear this over and over, especially if you are caring for them in their own home.
The person may also be trying to get out of bed, saying they need to “leave now” or “go home.” That can be unsafe as they usually cannot stand on their own. Instead of saying “no, you can’t get up” you can place your hand about 3-6 inches above the person’s shoulder so that they encounter your hand as they try to get up. That usually stops them from pushing further with their desire to get up. If they are demanding and thrashing to get up, ask for medications to calm them down so they don’t hurt themselves.
I had one man trying to get up from his bed to “go home” and I explained his legs would not hold him up anymore and if he tried to stand he would fall. He looked at me and said “No, no, no, no, no. That’s all everyone ever says to me.” I quietly said to him, “you have the choice to leave your body any time and go to a place where they only say yes.” And I kept reassuring him he could leave his body at any time.
Whether they are asking to “go home” or not, I recommend that you, and everyone else participating in the vigil, tell the loved one that you are all fine and they can leave to “go home” anytime they want to or need to go. I suggest you repeat that phrase during the course of the vigil, especially when you are leaving the room for an extended period of time. You could reassure them that whatever they may be troubled by, either a concern for their spouse or a child, or with their own unresolved conflicts, they can trust that all will be well, and they can let go of this life in peace.
9. Talk to Them: Keep talking to the person who is dying, even if they are in a coma, or read to them. There is a strong belief that they can still hear and are aware of all that is going on around them. Speak from the heart, from a place of compassion, or forgiveness, but don’t speak from anger – it is not helpful to you or to them to bring up hurts or past wrongs.
If anger is keeping you from visiting someone who is dying, please consider reading Anger Stops You From Visit to a Deathbed? Suggestions.
You can also read to someone who is dying, if they want you to or if they are in a coma. For suggestions on reading to someone who is dying, you might want to check out one of my most read posts What to Read to a Person Who is Dying?
If you want something funny to read, you can check out my post In Death, Laughter is Allowed! This post was cited in a USA Today article, FYI. It’s okay to laugh with the person who is dying, with family members and friends. Remembering the good times, or funny stories you shared with your loved one is okay to do. Remember the dying person’s life, not their death.
10. The Dying See Dead People: People who are dying often say they see a loved one who is dead. They may say they see friends or relatives long deceased standing or sitting in their room or by their bed, or tell you they had a long visit with a deceased friend or relative. If you hear this kind of statement, please don’t argue with them or tell them that person is dead and isn’t in the room. Whatever they are seeing, whether it is a dead spouse, or deceased siblings, or dead friends, you could reassure them that those loved ones are there for them, to help them move on. Hopefully, those visions are a comfort to them. Maybe their visions of being visited by dead relatives or friends at the time of their death can be a comfort to you as well.
11. Music: If you play music while sitting vigil, please do so quietly with no one talking over the music, and play it only intermittently. Please do not put the speakers right at the head/ears of the person who is dying. The person who is dying needs a quiet space, a tranquil space, to transition from their body, not a party with music playing and people talking over the music – unless they ask for such a party to happen!
12: Skype: Yes, I just said Skype! Video calling services, like Skype or its equivalents – like Google Chat or Facetime – offer an amazing tool to use if close relatives or friends cannot get to the death bed of someone they love. I recently advised a family preparing to sit vigil where two of the adult children were in foreign countries and could not make it back to be with their mother who was dying. The one child who was with their mother set up her own personal laptop and her Ipad and Skyped her two siblings into their mother’s room to keep vigil with her. Using Skype, all three of them could talk with each other, talk with their mother when she was conscious, and ask questions of the nurses.
According to the adult child who was present with their mother, Skyping her brother and sister in to share in the vigil at their mother’s death bed helped her tremendously because she did not feel alone and overwhelmed, and there was shared decision-making. Best of all, there was shared time during the moments their mom was conscious, and they all felt they experienced the death of their mother together as a family in real time – no one was left out.
I encourage you to think about the use of technology to bring everyone together to sit vigil and be included in the experience of the death of a loved one.
NOTE: Some hospitals and nursing homes do not have internet access in individual patient rooms. If you are going to Skype, please be prepared to create a hotspot using your phone or other mobile devices in order to use Skype or any other video conferencing service.
13. The Person Dying Abused Me. If the person who abused you or abandoned you is dying and you are asked to come to their death bed, please know you don’t have to if you don’t want to. This is your choice. If the person dying asks for your forgiveness, you have the choice to give that freely but no one can force that on you. I wrote a separate post that may be helpful to you, it’s called When Your Abuser or Abandoner Dies: How to Cope and I hope it helps.
After Death: Preparing the Body
Once your loved one has died, take time to sit with their body for your own process of letting them go.
Some people are comfortable washing the body in preparation for burial, others are not. Please know there is no right or wrong decision here. If you want to wash the body, then do so, slowly and with care, with the assistance of the nurses if they are available to you. If you do not want to do this, then ask the nurse or hospice provider at the house to wash the body before it is sent to the morgue or transported to the funeral home.
Pick out clothes for your loved one to be buried or cremated in. You can either dress the body or send those clothes with their body to the funeral home or cremation service. Don’t worry about shoes, they can go barefoot or with their favorite warm socks to the funeral home or cremation.
After Death: Feeling Relieved/Happy/Sad All At the Same Time
After sitting vigil and experiencing death, you may feel a degree of relief that your loved one’s suffering is over, and it is o.k. to feel that way. As much as you loved them and will miss them, you feel relieved that they are no longer suffering physical hardship or pain. Relief is a perfectly normal reaction to the death of a loved one who has been suffering.
One friend of mine went through a particularly grueling death process with his father, who suffered horribly for five years before he died. When his father died, he called me and said, “I can’t stop smiling! People are going to think I didn’t love my Dad, and of course, I did, but I’m just so happy for him that all of his sufferings are over. What do I do? Friends are coming over right now to mourn with us.” In this family they were all devout Christians, so I suggested he keep smiling and simply tell his truth by saying to mourners, “I’m happy because he’s with the Lord and his suffering is over.” Whatever your religious beliefs, or if you have no religious affiliation, it is usual and universal to feel a sense of relief when someone you love, who had been suffering, has died.
It’s also usual to feel some degree of euphoria at the end of a vigil, to have a sense that the universe is much larger than yourself. You have just been living in sacred space while attending your loved one in their death process. In many ways, this is similar to birth. This experiencing of death first hand is the essence of life, of existence in human form. Let yourself feel whatever comes up for you. It may help to journal or meditate about the experience, to write letters of thanks to those who helped in this journey, to cry and to laugh. Please let yourself feel everything from profound sadness to relief to joy after a vigil is over.
Again, these are just some suggestions for how to comfort a dying person while sitting vigil at their death bed, and some of the emotions you might experience in the hours or first days after a death. If you have been through the death of a loved one, if you have sat vigil at a death bed and have helpful advice to offer, please leave a comment to share with other readers – your thoughts are welcome here!