Let's talk about death

Death is a vast mystery, but there are two things we can definitely say about it. It's inevitable and its timing is unknown. Unfortunately we seize on the latter as an excuse to put off facing death directly. Yet the longer we postpone facing death, the more we fear it.

According to mystics and sages from all the great wisdom traditions, denial of death deprives our life of true meaning. Far better to make friends with dying by reflecting on what death might actually feel like and what happens to the mind and body after you die.

Dr Katherine Clark is a staff specialist in palliative care at Royal Prince Alfred Hospital, Sydney. She knows all about the common symptoms experienced by people on their deathbed. "Of course, each person's death is unique," she says. "So you might see only some of these symptoms or none of them."

According to Clark, a person in the last stages of life will typically sleep more. Even so, loved ones are encouraged to keep talking to them. "There's research based on electroencephalograms (EEGs) of people's brain waves that indicates hearing is the last sense to go."

Breathing patterns change too. A dying person may take shallow and quick breaths or slow and laboured ones. They may also make gurgling noises, sometimes referred to as the "death rattle". In fact the sound is caused by air passing through mucus pooled in the person's pharynx, which they're unable to shift through coughing.

Equally distressing to onlookers is Cheyne-Stokes breathing. This is characterised by periods of up to 45 seconds of no breathing at all, followed by deeper and more frequent respirations. It occurs as vital organs are deprived of oxygen and waste products build up.

Hallucinations, agitation, loss of appetite, changes in bowel and bladder function as well as in skin temperature and colour are experienced as oxygen flow to the brain decreases, vital organs shut down, muscles relax and blood moves away from the extremities.

Finally there's the moment of death itself, when the heart stops beating and breathing ceases. Death was once defined as meeting these criteria, but the development of cardiopulmonary resuscitation (CPR) and prompt defibrillation forced a rethink. Doctors now turn to 'brain death' where a definition of death is required.

Let's talk about death