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  • Mitch Ware

Episode 19: What to Expect During "Transition"

The physical act of dying is a tough thing to even think about, let alone talk about. When you find yourself in this situation with a loved one’s final weeks, days or hours approaching, it can be very scary. In this episode, Mitch discusses what the transition process is, how it works, and the peacefulness of the process. 

"As we start this transition, our body starts shutting down the lights in our organs, and it's a very carefully designed process. We were built this way. We were wired this way."


Hello and welcome to Living With Hospice. My name is Mitch Ware, and it is my honor to be your host today. Come on in. Grab a cup of freshly brewed coffee and I think hazelnut is the flavor of the day today. Pull up a chair and let's chat. Today we're gonna talk about something that is really pretty scary for almost everyone, and that is death and dying. Dying is a just a tough thing to even think about, let alone talk about. And when you find yourself pondering a situation with a loved one's final days and hours, well, it could just be scary. It's there's no other way to put it. If the flood of emotions that go through you are are sometimes just absolutely overwhelming, and that's okay, you're not alone to feel that way. In fact, those feelings are very common. They really are. Today I'm gonna share with you how peaceful death usually is, and I'm going to share my first hand experience reaching all the way back to my father's death in 1983 and the deaths of my mother in law, my father in law and, of course, my son and several others that I was honored to to be present. The thought of losing someone always brings up feelings of hurt, loss, fear, anger, effect. Most of us won't even let our minds go there because it's just it's just too painful. I recall when we first had Children first moved here to Grand Rapids, our kids were well, they were little. I don't think they were even in school yet in a high schooler in our community was killed in a car crash. The entire community was just crushed, and I recalled not even letting my mind go to that place where those parents must be the parents of that young 16 year old boy. I didn't even want to go there long enough to feel sympathy for them. I wasn't gonna let any of those thoughts about death and dying into my mind. I loved my Children so much I couldn't think about losing one of them. And that's how scary and sometimes absolutely debilitating. The whole notion of death and dying can be for us especially well, especially the death of our kids or our parents or our spouse or coworker, close friend or grand parents or whatever the thought of never seen that person again, at least not in this life. Never talking to him again there, holding her hand, never laughing with him again, never crying with him again. Well, it's just too much to bear, and that's common. That's most people. Aside from not having that person around anymore, there is the physical process of death that comes to mind the process that takes place when someone dies again. Another subject we just don't even want to think about. My perception of death and dying back in the day was kind of like somebody getting eaten by a grizzly bear or or a shark. Remember when Jaws first came out? One of the worst ways to die was being eaten by a shark. Might my experience with death and dying and my image of death end of the dying process was just pretty much formed by Hollywood, and my being very naive, well, deafened? Dying to me was just lots of pain and fear. Anguish, probably lonesome nous, overwhelming. Physically, mentally, emotionally. Well, that's Hollywood, and I guess if you do get eaten by a bear or shark jumps out water into your boat, Yeah, that's Ah, that's probably not too far off. Then it probably is very painful and and scary and all that. But here's what I found. The first person I saw pass away was my father. When I got to my dad's death bed, he was unresponsive. My mom, my brother, my sister and I were all gathered there, and we knew that his time was short and all of a sudden he asked us to help him get out of bed. His eyes were this really bright blue right then, and he looked directly at me and said, Mitch, son, help me Get up, Please. My oldest brother and sister jumped in real quick said, No, Daddy, you need to stay in bed. You need to rest. My brother offered him some water, the which he smiled and said, Thank you, my brother, then reminisced. You know, I remember Dad when we were kids working alongside you and in the hot summer sun, how we would always enjoy taking a short break and having a nice glass of cold water. And Dad said, Yep, and I'm always made the best ice tea, didn't she? She let it steep in the sun. We all smiled and kind of chuckled. He then laid back in the bed and we began to sing some of the great old gospel hymns that were, well, we were raised singing. Probably some of you were, too. Dad loved to sing those songs, and I really can't tell you how long it was, but we sang and saying seemed like it was really only minutes. But it could have been a couple of hours, I suppose. And then there was this incredible piece that just washed over all of us. We experienced something that we'd never, ever felt before, not even close and is our dad took his last breath. We just lingered there. We cried for ourselves for our loss. And yet we all knew in her heart of hearts that Dad had transition to a better place. Dad's transition and by the way, transition is the word that we use in the hospice world to mean dying are actively dying and dying. When Dad transitioned, he knew we were there. He knew we loved him. We knew he loved us. The medical team was managing his pain. He was comfortable and he died very peacefully. It was an honor to be there with him. It was a blessing to see how peaceful it was when he passed away and it took really, it took the fear of physical death away from all of us. When I think about the body actually dying, I think of a big old house full of kids and lots of activity. And all of a sudden it's time to go out for pizza. Mom says, Kids, get your coats and let's go Dad says, All right, everybody in the car, Kids, We're all cheering. They drop whatever they're doing. Grab their coats, race out to the car. Mom's right behind putting her coat on as she goes. Dad behind. Mom looks back at the house and sees every cotton picking like in the house is on Well, so he goes back in, goes room to room, shutting off all the lights, the computers and televisions of video games. No, he does all that for he goes back out to the car. That's what's happening in our bodies. As we start this transition, our body starts shutting down the lights in our organs, and it's very carefully designed. We were built this way. We were wired this way. Here are the lights that we see that are being turned off a few days, maybe a week or so before someone passes away. There's a there's a loss of appetite. As a body shuts down energy needs. They just decline. Food is fuel for our bodies. As a transition starts, we move around less. We need less fuel. We need less energy. You know, people can live over a week without food. You can offer some soft foods, things easy to swallow or used like a food meal replacement. Drink like, um, what's that one? Insure Eventually, your loved one will lose the ability to swallow and again the body's way of shutting the lights off. It's important to keep their mouths and in lips moist during this time. So I suggest having a wet cloth or or something they're sponge to use. Depending on your loved one's condition, you might want to try to have a maybe even something like a Popsicle available to dab on their lips or let them having their mouth if they're able A second like that gets turned off is we see an increased physical weakness as circulation diminishes and a decrease in food yields. Less energy to do routine things like lifting her arms toe, help change clothes or even be able to sit up on the side of the bed and or roll over on their side. So don't try to do too much at any one time with them. This is no longer about being efficient. It's about comfort. So go slow. Spread these little tasks out. If you have to over the day, find the humor in the situation, smile and laugh together in a sure, um, it's okay if it it's okay. If we can't get this awful, we'll do it later or we'll do something else. We're not in a hurry. It's all good. As the kids would say. Another light gets turned off is our regular breathing we go into. It's called a labored breathing in our final hours. Have you heard the term air hunger? It's a term used when people think they're not getting enough air, and they try harder and harder to breathe. The body's telling the heart and lungs that it needs more oxygen, and this can produce an anxiety. Another change of patient can experience is chain strokes breathing, which is loud breathing with a distinctive pattern to it. Deep, rapid inhalations that slowly decrease, followed by a pause of not breathing like apnea . Caused by unstable ventilatory control as the heart and our brain starts to shut down, morphine can be used to treat this air hunger as it decreases. The heart's urged to have more oxygen. Have you heard the term the death rattle I'm sure you have? It's fairly common now, near the very end. Excessive excretions that's moisture in the mouth and throat can create this kind of, ah, gurgling sound, and it's kind of scary. The hospice nurse cangive a patient some medicine that dries up those secretions and makes breathing easier and less alarming Again. All of this is evidence that the body is systematically turning the lights off. It's all part of the body's way of transitioning into passing away. The fourth light that gets turned off is or your nation. We'll see some changes in our loved ones. Urination. This is usually a surprise. The most people dehydration from decreased aural intake with lower blood pressure leads to decreased renal function. Well that means decreased urine output and eventually renal failure. Urine will become concentrated. It's sort of ah, brownish reddish in color. Maybe, I guess, resembles like like iced tea. Well, T In general, it may have a very strong odor to Also, patients who normally have bladder or bowel control issues may lose that function that bodily function during the dying process, and eventually there will be no urine output. It all the fifth light that gets turned off is swelling and feet, ankles and hands. Various chronic illnesses contribute to edema and the swelling of our feet and hands. As the disease becomes unmanageable, fluid is not effectively pumped through the kidneys to be filtered and regulated anymore. Fluid is most evident in areas that are below the heart, like our ankles and her feet like it. If your bed ridden of our loved ones bedridden with hands and hips might swell as well. So those are the five lights that get shut off during this transition process, and it could start a week or so ahead of death with the lack of appetite. So if your loved one hasn't eaten in over a week, hasn't taken water for several days. Their feet and hands are beginning to swell. Their fingernails and toenails air purplish blue because their circulation is diminished, their breathing is labored and irregular. They are probably in their final moments on this earth. Are they in pain? No. Can they still hear you? Probably depending on the amount of medicine that they've been given. Can they still, since you're there, I think, absolutely. 1000 times. Yes, I feel like everyone I've been with. They knew I was there when they passed away. Let me leave you with a short story in the third week or so of my sons hospice inpatient care. He was becoming more and more on responsive. When he would get restless. We would occasionally give him a tiny drink of water with a nurse's supervision. Of course, through a hyperdermic needle into his parted teeth is, it was hard for him to open his mouth anymore. It always calmed him down. We would keep his lips moist with a sponge. We do our best to keep him comfortable. Across the hall from our son was an elderly Irish priest. He had dementia and memory serves me correctly. He had stage four lung cancer. And that's pretty much why he was there in the hospice in Patient Unit. He was a terrific guy. He stood about five foot nothing. Wade, maybe 100 and £25 soaking wet. He was always smiling. He always had a good story to tell. He often forgot that he was a patient there and thought he was out there ministering to people. On this particular Tuesday morning, I got up from the lazy boy and mats room, and I walked across the hall to visit with the priest. After a bit, a close family friend who had been with us all morning came into the priest's room and and, in a frantic voice, said, Quick, Quick, I think Matt's dying. Come quick. I got up, ran out of the room, only to be met by my wife at the door of our sons room there were tears pouring down her cheeks, She said he spared you, Mitch, he's gone. And I thought, No, no, no, no, no, no. That isn't our deal. And I rushed by her and I'm saying I promised I would be there for him with him. I promised. I got to his bedside where the rest of our family was standing and I said, Matt, it's dad. He took several more breaths. He hadn't left yet. He mumbled something and took several more breaths. I took his hand into mine as my wife took his other hand into hers, and we both leaned over to him and she said, Matt, if you see God go to him and he took another breath, and it was then that it dawned on me that the fight was over. 39 months. It was time to lay down our swords. I was holding his hand that hadn't moved him weeks due to a stroke that he'd had from all of the radiation that he'd had. I leaned closer to my boy's ear and said, Matty, if you see God run to him. And with that, he squeezed my hand twice, took his last breath and passed away. Is I still slightly opened? We're a beautiful blue. His face was relaxed. My wife reached up in and closed his eyes. The room was filled with such peace. Words fail like I can't even begin to describe it to you and we cried for our loss, and we prayed for God to take him from our arms to His, and we know he did. We sensed God's presence. I've never seen a passing that wasn't peaceful. My mother in law, my father in law, several of my patients. And of course, I guess I need to qualify this by saying my experience is limited to hospice experiences and those with my own family. But I believe leaving this world is nothing to be afraid about. And for those who are left behind, as long as you know what to expect, the body just naturally turns out the lights in each room as it prepares to shut down. And if you're a person of faith, as I am, you really have hope that there's something much, much better on the other side. I want to thank you for spending your time with me today. Death and dying is a tough subject, and I hope we were able to dispel some of the fears that you might have about being a caregiver and taking care of someone that you love. In those last days and hours. I really look forward to visiting with you the next time. In the meantime, I would love to hear from you. You can leave comments or questions on this platform that you're listening to this podcast on, or you can send us an email at our website. We love to hear from you. Please subscribe to us and share this podcast with your friends until next time. This is Mitch Ware for living with hospice wishing you a blessed day.

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