Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.
Hearing and vision may decrease. There may be a gradual decrease in the need for food and drink. Your loved one will say he or she doesn't have an appetite or isn't hungry. This is the body's natural response to the dying process.
End-of-life transition refers to a person's journey to death, especially in those with a terminal diagnosis. This process occurs differently for everyone. For some, it takes days or weeks; for others, it occurs rapidly. Partnering with a trusted medical team during this time can limit pain.
What happens in the 24 hours before death? Someone who is close to death will spend most of the time asleep. They may not be able to communicate when they are awake because their senses are failing. However, they may still be able to hear, so speak to them normally.
The first organ system to “close down” is the digestive system. Digestion is a lot of work! In the last few weeks, there is really no need to process food to build new cells. That energy needs to go elsewhere.
Depending on the nature of the illness and your loved one's circumstances, this final stage period may last from a matter of weeks or months to several years. During this time, palliative care measures can help to control pain and other symptoms, such as constipation, nausea, or shortness of breath.
In general the first step is to explore your gender identity. This can include any combination of internal self-reflection, connecting with community and support groups, or working with a therapist who has expertise in gender identity issues. This process could take anywhere from months to years.
Transitioning is a process that can take anywhere between several months and several years. Some people, especially non-binary or genderqueer people, may spend their whole life transitioning and may redefine and re-interpret their gender as time passes.
These can be visualised on the change curve. The stages are shock, anger, acceptance and commitment. People's initial reaction to the change will likely be shock or denial as they refuse to accept that change is happening.
Brain activity supports that a dying patient most likely can hear. Even if awareness of sound cannot be communicated due to loss of motor responses, the value of verbal interactions is measurable and positive. Patients appear comforted by the sounds of their loved ones (in person and by phone).
Hours Before Death Symptoms
In the final hours of life, your loved one's body will begin to shut down. Their circulatory and pulmonary systems will slowly begin to fail. This may lead to falling body temperatures, but may also cause sudden outbursts.
They Know They're Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.
It is normal to have less energy as you approach the end of your life. You may find you need help to do things you usually do for yourself. You may also need to rest more. Tiredness and weakness can make it harder for you to focus or take part in what is going on around you.
During the final stage of dying, disorientation and restlessness will grow. There will be significant changes in the patient's breathing and continence.
Speak to the family as often as possible. Take time even during resuscitation to sit down and talk to the family. The truth must be said, but it should be introduced gradually. Offer administrative help to the family and do not leave a single family member alone.
Your loved one may become restless and pull on bed linens or clothing, hallucinate, or even try to get out of bed, due to less oxygen reaching their brain. Repetitive, restless movements may also indicate something is unresolved or unfinished in the person's mind.
Even when vascular collapse is the primary event, brain and lung functions stops next. The heart is the last organ to fail.
Gasping is a brainstem reflex; it is the last respiratory pattern prior to terminal apnoea. Gasping is also referred to as agonal respiration and the name is appropriate because the gasping respirations appear uncomfortable, causing concern that the patient is dyspnoeic and in agony.
The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage. Though the active stage can be different for everyone, common symptoms include unresponsiveness and a significant drop in blood pressure.
Physical signs
Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
It is best to think of the decedent's belongings, paperwork, and assets as “frozen in time” on the date of death. No assets or belongings should be removed from their residence. Their vehicle(s) should not be driven. Nothing should be moved great distances, modified, or taken away.