What happens when you die?

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

More posts by Christiane Fux All content is checked by medical journalists.

Dying is part of life. But what does the news of having to die soon do to a person? And what happens when the last hours have actually come?

There is no certainty in this world except that everyone has to die at some point. Still, death is one of the last taboos in modern Western culture. For most people today it doesn't come suddenly and unexpectedly, it comes slowly.The reason for this are the advances in medical diagnostics and treatment. One advantage is that it makes it possible to reconcile oneself with life and death, to deal with unfinished business and to say goodbye.

Psychological dying process - phases

The death researcher Elisabeth Kübler-Ross divided the psychological dying process into five phases. However, these are not seen as successive stages; the dying person can also switch between the individual phases several times.

Denial: The patient does not want to admit the fact that he does not have much longer to live. He suppresses the news, denies it, perhaps believes it has been mistaken, and still hopes to be saved.

Anger: The patient rebels against his fate, feels anger at God, at the doctors, at everyone who is allowed to go on living. This can also lead to aggression towards the relatives.

Negotiating: The patient tries to negotiate with fate, making promises in case he is allowed to live on for a while.

Depression: the patient loses his last hope. He says goodbye to life, dreams, goals and people - everything that is dear to him and dear to him. He mourns the opportunities and experiences that he has missed over the course of his life. He regrets mistakes.

Acceptance: In the best case, the person concerned accepts his fate and makes up with it.

Physical dying process - signs

People also change physically before death. The process can also be divided into different phases:

Rehabilitation phase: The disease is progressing, but the patient may recover from an acute symptom and can still lead a self-determined life to a large extent. This phase includes the last few months, rarely years before death.

Terminal phase: the sick are bedridden and become increasingly weaker. The symptoms increase. This phase can begin months to weeks before death.

Final phase: This phase describes the actual dying process. The body functions gradually cease to exist, the consciousness of the dying person turns inward. Death occurs within hours, at most days.

The dying phase

Dying is a part of life and as such should be honored and - if possible - shaped. Palliative care professionals report that for the majority of people with life-shortening illnesses, death proceeds peacefully. In the last days before their death, most of them withdraw strongly. Your perception is turned inward. They are exhausted and sleep a lot. The body is already shutting down the metabolism. Most dying people no longer need to eat, and a little later, many of them lose their thirst. This is a natural process that is not associated with agony - on the contrary: forcing liquid or even food on the dying, unnecessarily burdens them and disturbs the gradual glide over to death. This phase of dying is primarily about making the dying process easier - for example, relieving pain and shortness of breath.

What relatives can do

Most people wish not to die alone. Relatives can do one thing above all else: be there. However, some people find it easier to detach themselves from life when they are alone. If your loved one dies while you are not in the room, do not blame yourself. You can assume that it was easier for him that way.

Do not try to get the dying out of their inward-looking posture in their final hours, but accept their withdrawal. Realize that this does not mean that the dying person is no longer aware of his surroundings. Meet him in this phase with loving care and respect. Even if your grief is great, try to let go on your part and make the dying person feel that it is okay for them to leave.

In addition, there are a few things you can do to make the last few hours easier for the patient. Many dying people have difficulty breathing. Slightly straightening up the upper body and fresh air in the room can make it easier to breathe. Let the nursing staff advise you on this.

Liquid should always be offered, but not imposed. Often the dying can no longer swallow properly. Then just wetting the lips and mouth brings relief. Some dying people still like to suck on ice cubes - preferably from their favorite drink.

Gentle touch can bring peace, security and well-being to the dying person. But stay sensitive. Sometimes caressing can be too much and uncomfortable. Calm music and pleasant scents can also penetrate the dying person and do him good.

Dying process - signs of imminent death

Little by little, the organs cease to function. This is accompanied by a number of characteristic symptoms. It is important for relatives to know these in order to be able to accept them as part of the natural process of dying. Check with the medical nurses or doctors about the various stages of the dying process so that they are no longer terrifying.

Breathing: The breathing when dying changes, it becomes shallower and more irregular. Some dying people suffer from shortness of breath and develop what is known as gasping for breath. Shortly before death, what is known as a "terminal rattle" occurs very often. It occurs because the dying person can no longer swallow or cough and therefore mucus collects in the airways. This is difficult to bear for the relatives. The burden on the patient himself is - provided he does not suffer from significant shortness of breath - less than it appears from the outside.

The face: In people who die, the face and facial expression change in characteristic ways. Doctors speak of a "Facies hippocratica". Eyes and cheeks sink in, the nose appears pointed. The chin and tip of the nose are whitish and cold. The reason for this is the increasingly poor blood flow and the slackening of the muscles. The skin of the face is pale, especially around the lips and nose. This so-called "death triangle" is a typical sign of imminent death.

Brain and nervous system: The brain function also decreases more and more when you die. The perception becomes worse, the consciousness becomes cloudy. The autonomic nervous system is also impaired. This can manifest itself in vomiting, intestinal obstruction or incontinence.

Restlessness: Some patients experience restlessness in the last hours of their lives. You move your feet back and forth, tugging on the bedspread. This can be alleviated with appropriate medication.

Hands and feet: As you die, the blood increasingly withdraws from the extremities. As a result, hands and feet become cold and turn bluish. Sometimes it collects in the skin of the feet and lower legs and forms dark spots there.

The internal organs: digestive tract, kidneys and liver gradually cease to function as you die. The associated poisoning of the body by metabolic products can lead to drowsiness and clouding of consciousness, but also itching, nausea and water retention.

The heart: The heartbeat slows down and becomes irregular when you die, the blood pressure drops. If the heart finally stops, the body cells are no longer supplied with oxygen. After a few minutes, the brain cells die - the person is dead.

For the relatives, the time of death means an exceptional emotional situation: the grief mixes with the relief that it is over. Even if you are not religious, it can help you to celebrate this moment with a symbolic act. Light a candle in memory of the deceased. Or open a window so his soul can fly away.

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