Signs of Dying

Inspired by Dr. Jose S. Pujalte’s article in yesterday’s issue of Manila Bulletin, I tried to remember my mother’s journey towards death. Death is something that people don’t normally discuss. It’s weird. It’s morbid. It’s a no-no. But it’s the reality of life, we all die.

It was November 2008 when I urged my mother to go to the doctor to have her blood sugar checked. I was checking on her every now and then through text message because I wanted to know if she was suffering from diabetes. Two weeks prior to her check up, she had a seminar in Baguio and when she came back home, she complained of aching lower back and numb legs. My mother confirmed to me through a phone call that the test result showed that she had diabetes. She was crying and I told her that there is nothing to be worry of.

We had her treated for diabetes and even hired a Physical Therapist to help her feel better. Her doctor said that osteo-arthritis sometimes go with diabetes. To cut the long story short, we learned about her breast cancer in April 2009 and a week after that, she expired.

Had I known earlier or had I seen the signs earlier that she would soon leave us, I would have stayed by her side 24/7. I thought that her last confinement at Bataan Doctors Hospital where the Angel of Death fetched her was just another confinement. No big deal, she would eventually get out of the hospital and we would all be home happy. I think this is what each and everyone of us in the family has thought of: had we known that that would be her last confinement, we would all gather around her and together, we would be by her side in her journey to the afterlife.

Signs of Death According to Dr. Jose S. Pujalte

Pre-Active phase. The terminally ill are sometimes not told by well-meaning (but misguided relatives) that they have but a few months to live. Yet the dying knows that he or she is and behavior becomes uncannily universal. The pre-active phase of dying can last from weeks to months. These are observed:

Withdraws from social activities to spend more time alone or at home.
TRUE: My mother, who was sociable, closed her world to her friends and preferred to stay alone. We thought she just wanted a full rest.

Becomes concerned with finances, insurance, or wills.
TRUE: My mother told me her worry about my youngest brother’s education. I told her that she should not worry because I would be here for my brother.

Seeks out estranged relatives and friends.
TRUE: My mother was never the type who would severe ties with anyone. Her issue with this relative dated back four years (prior to her death) ago over some family issues. She was ecstatic when this relative visited her at the hospital and she even called me up to inform me about the good news.

Begins to talk about dying.
FALSE: She never thought she would die soon.

Loss of interest in eating and drinking.
TRUE: I thought it was just her fear of vomitting.

Increased anxiety.
FALSE: Mama kept her poise up to the last time.

Increased periods of lethargy or sleep.
TRUE: We thought it was because of the drugs she was taking.

Recovery from infections slows down or wounds, if any, no longer heal.
TRUE: We thought it was due to her diabetes.

Increased edema (usually swelling in the extremities).
FALSE: Not much swelling.

Apnea or temporary periods when breathing stops either when awake or asleep.
FALSE: I don’t know. No idea.

Shows interest in speaking with a priest or pastor or imam.
FALSE: It never occurred to her that she would die soon.

May remark that he/she is beginning to see dead friends and relatives.
FALSE: She said she often dreamed about her mother who passed away four years earlier.

Active phase. The active phase of dying is, of course, much shorter and may take days to a few weeks. These are common observations:

Breathing is labored and irregular – sometimes slow then fast and shallow – the respiratory system is clogged with secretions and fluid builds up in the lungs (congestion).
TRUE: But I was not with her when she had breathing difficulties.

Person may state that he/she is dying soon.
FALSE: She was still fighting up to the very end.

Difficulty swallowing food and drink.
TRUE: She had her food taken through a tube.

Movement is slow and person prefers not to move.
TRUE: We thought she was just resting.

Hands, feet, arms, and legs are cold to touch.
TRUE: But we thought it must be the a/c.

Skin becomes mottled purple or blue.
TRUE: We thought it was just the a/c.

Urine becomes dark.
TRUE: We thought it was due to lack of fluids.

Incontinence, both urinary and bowel.
TRUE: We thought it was due to lack of solid food intake.

Dropping blood pressure.
TRUE: And we thought it was a good sign. =(

Marked fluctuations in behavior from agitation to hallucination to serenity.
FALSE: She was still poised up to the last minute.

Eventually, in the final stage, loss of sight, taste, smell, feeling, and hearing.
TRUE: But we were so dumb to realize it. Or maybe the signs were there but we were all in denial stage.

I would forever be grateful to my Dite Letty for helping us take care of my mother. Without her, all of us in the family could have lost our sanity by the sudden turn of events.

I have moved on with my life without my mother but I still terribly miss her.