Apologia for these journals:
They are not about taking care of a relative with moderate to severe Alzheimer's/senile dementia.
For an explanation of what these journals are about, click the link above.
For internet sources that are about caring for relatives with moderate to severe
Alzheimer's/senile dementia, click through the Honorable Alzheimer's Blogs in my
links section to the right.
I want to mention...
...one of the journals to which I link in the Honorable Alzheimer's Blogs section to the right, Alzheimers - The Carer's View has picked up after a fairly long absence. Although her care recipient, her mother, died some time ago, she decided to continue filling in the details of her story, including insightful observations and ruminations. It also contains some interesting short essays on circumstances encountered when caring for someone and some evocative posts on how her feelings about her mother and caring for her evolved through and after her journey. I'm ashamed to admit that, after a few unproductive visits, I assumed that she'd decided not to continue her blog, so I didn't get back to it until some days ago. Good reading, definitely worth a second look. For those of you who remember what seemed like her last post, she actually picked up the threads in earnest a few months later and continues to this day.
If it wasn't obvious, last night was one of my Broken Sleep nights.
It wasn't because of grieving, or anything connected to the effect on me of my mother's death. Because yesterday was an unusually physically strenuous day and I haven't had one of those, well, since December 8, 2008, at 0709, after relaxing and eating dinner I decided to pop a significant dose of ibuprofen to ward off any shoulder and back strain I might have provoked shoveling snow and take a nip-it-in-the-bud nap. I awoke a couple of hours before midnight, channel surfed for a bit, read some (I'm trying hard to get through our next book club book, which is entertaining but not particularly interesting), took a short walk in the amazing snow-reflected light of the 3/4 waning moon, wrote the immediately previous post, then, still full of energy and feeling good, decided to figure out if there was another way to access information about the dying experience on the internet.
I started simple, googling "dying". Bingo! It seems that the search terms I used which led to writing this post was not the most productive phrase. "Dying" led me to "dying process", which yielded much better results. Although not exhaustive, since I'm pretty well satisfied with my results from reading Chapter Fifteen of The Tibetan Book of Living and Dying, I'm listing some links that might be of interest to those of my readers who are approaching, encompassed by or surviving the experience of accompanying someone through dying. The following links are not, by the way, in any particular order:
- The Zen Hospice Project has an interesting page which summarizes much of what the The Tibetan Book of Living and Dying particularizes.
- Although the home page for the website Crossing the Creek is chiefly an advertisement and ordering site for the author's book, he includes two essays from the perspective of an outspoken, highly experienced Hospice RN.
- The first essay explains why even the most experienced Hospice RNs are sometimes reluctant to talk about their experiences with the dying and what the differences in dying perspective are between those of us who confront the dying rarely throughout our lives and those who specialize in working with the dying.
- The second essay is a short, sweet statement on behalf of the value of negative emotions, most importantly the fear of death.
- Dear Death (which no longer has an index page so the aforementioned will have to do) is a fascinating site that covers death from a wide variety of angles. It's interesting to click into several pages listed along the left side of each page. The page that introduced me to the site, though, was an acutely clinical review of death, which, curiously, closely follows the Tibetan Buddhist description of death about which I wrote. Check out the site's favicon.
- The author of this essay which appears at Toward the Light is a self-professed medium. This site exists overwhelmingly to support and discuss N[ear]D[eath]E[xperiences]s. However, the essay to which I linked, while containing a description of the author's NDE, also gives some very interesting insight into what it is like to approach death, states of mind that become available to someone who is dying and suggestions for enhancing the environment of the dying one to support these processes. Although written from the point of view of someone who gives plenty of spiritual weight to the process of dying, it also contains intriguing practical insights into the beginning of the journey.
- Dying Man's Daily Journal is written by a man who has been aware that he is dying for some years. I know, sounds absurd, but this journal, I think, is of interest because this man spends each day very aware of being on the other end of life, something most of us rarely do. He almost never mentions death, but it is obvious that, having been labeled as "dying" due to certain physical problems, he cherishes life more acutely than before his prognosis and spends daily time contemplating what life means when lived in the knowledge of ...the valley of the shadow of death...
- Here is yet another page from another Buddhist Hospice Site, this time in New Zealand. It is a fine, sympathetic, highly readable elaboration of the more esoterically technical passages I quoted three posts previously.
- About.com offers a surprisingly varied area regarding the dying process, all of which is available progressively from this page, although I was introduced to the area through this page. This section is a fairly thorough, practical explanation of what one caring for a dying person will confront, what the dying one is experiencing when certain symptoms occur and what palliative care can be rendered, if necessary. At this site I also clicked through to a few pages on grief. I was surprised to learn from this page that the words "grief" and "mourning" harbor distinctively different technical definitions. This page gives a brief but fairly complete overview of the grief process. Much to my amusement, even though the grief pages stress that grief is an individual experience, there is a section entitled "Abnormal Grief". This section, though, doesn't assert that certain types of grief are, for instance, morally wrong, but simply delineates grief experiences that surface for "only 3 to 25 percent of loss survivors". It's an intriguing section to read.
- Finally, I was surprised (although I probably shouldn't have been) to discover that the search phrase I entered led not only to information on the human process of dying but, as well, the process of pets dying. I clicked into a couple because I am good friends with someone who provided compassionate, at home hospice care for his dying cat and, as she has recently been relating in her journal and her twitter account, Dethmama is providing hospice care for her beloved pug, Opal. Truth is, the very few sites I clicked into were nothing compared to the direct experiences to which I have been and am privy, above, and through The Yellow Wallpaper, specifically these one, two, three posts. One site discovered through my search, though, offered a poignant tale of a lesson in grief I thought some of you might enjoy learned from the young companion of a beloved dog euthanized by the vet who wrote the essay.
I spent the bulk of the light part of the day, today (make that yesterday, officially), shoveling snow.
Aside from being difficult and invigorating, it brought me in closer touch with one of my neighbors to my southwest, across the street. The neighbor and I have occasionally, over the years, greeted one another and exchanged a few words when simultaneously collecting our mail. Our front windows afford a direct view of the front of her house, her property and her carport. Mom and I spent a fair amount of time noticing when she was out (and, when she wasn't), commenting on her company and the presence of maintenance vehicles, discussing the landscaping improvements she applied to her property, trying to remember what her name was...typical front porch stuff but, since we weren't on a front porch but behind walls, I rarely interacted with her, my mother only once when she was walkering our driveway and our neighbor was retrieving her mail (her mailbox is on our side of the street). On the few occasions when our neighbor and I ran into each other we exchanged names, although, from meeting to meeting we never remembered the other's name. She had noticed Mom and knew that we lived together and that I cared for her. One visit occurred because we both noticed we'd gotten other people's mail, we met in the middle (so to speak) while checking for the appropriate houses then, when neither of us found anyone home to receive misdelivered mail, discussed the advisability of slipping mail into the correct mailbox. We decided against it because, as she pointed out, it is against the law to tamper with anyone's mailbox.
Today while I was in the middle of shoveling my extremely long driveway, we met again as our mail deliverer worked her truck through the slush left by the snow plow along the sides of our street. She, the mail lady and I conversed for a fair amount of time. I realized that I hadn't gotten a chance to let either know that Mom had died and I knew they would both be interested. I thought I would be okay relating this information but found myself choking up as I informed them. Both were sympathetic and comforting.
After the mail lady headed up the street, my across-the-street neighbor and I continued chatting about the amazing two and a half day snow storm we'd just had, the difficulties of delivering mail in this part of town (the mail lady told us that she'd gone through three sets of chains, yesterday) how clear and bright it was today, how we both hoped the sun, if nothing else, would clear most of this overwhelming batch of snow away before our next predicted snowfall, this Saturday, and how beneficial it is to shovel snow off one's driveway before another snowfall. She had, as well, been watching the serial spin-outs two nights ago occurring between both of our houses and we laughed about some of the antics some of the drivers tried to get themselves further up the hill before finally giving up and swirling into my driveway.
In due time I went back to my shoveling and she returned to her home. She has a shorter, steeper driveway than mine and owns an old Toyota Corolla that, I knew, would falter on the level of snow blanketing her driveway if she needed to get anywhere. Although, overtly, she appears determined and physically able, there is something frail about her. I considered that she might appreciate having her driveway shoveled, in case she wanted to make a supply trip or two before our next snowstorm. I speared my snow shovel upright in a snow bank and turned to head across the street to her house to ask her. She was heading across the street toward me.
"You said you're strong, is that right?" she asked pumping her arms at the elbow, Popeye style.
"Yes. Taking care of my Mom really developed my strength."
"Could I hire you to shovel my driveway?"
I laughed. "I was just headed over there to ask you if you wanted me to shovel your driveway."
I surveyed her driveway, determined that it would take about a half hour to clear and started to work. She stayed outside, bundled up in a lawn chair. We chatted as I worked.
She has a disability, one of those that isn't apparent on the surface but affects her joints and makes it difficult for her to do strenuous work, spend much time sitting in a car, etc. She is having groceries delivered tomorrow and was concerned that her delivery guy wouldn't be able to make it up her driveway, thus would give up before completing the delivery. "I tried to clear some of my driveway yesterday," she said, "but I wasn't able to do much."
I'd seen her out there, yesterday, when I got the "bright" idea of attempting to clear my own driveway using my truck, which didn't work...I foundered the truck in a snowbank on my front lawn when I was attempting a turn to "shovel" up the drive. She had been so bundled up when she was working on her driveway, and, as well, was using a digging shovel rather than a snow shovel, that I thought one of our common neighbors had been working on her driveway.
No, she confirmed, it had been her, and, she admitted, she hadn't done a very good job. She was amazed that it had occurred to me that she might need help. "You didn't know that I'm disabled, did you?"
"No, I had no idea; but, since I thought someone else was working on your driveway, yesterday, I figured that clearing it was, well, not something you were prepared to do."
During the rest of the time we talked about all kinds of things: The new president; she's a long time immigrant from Europe so we compared notes about what it's like to learn to live in the states when one is a young adult; we compared notes on the commonality of owning Toyotas and having people knock at our doors asking if our cars are for sale; the importance of being bilingual; how beautiful our area of Prescott is; how wonderful it is to live in an "old style" neighborhood.
When I finished her driveway she again mentioned payment.
Without thinking, I heard myself say, "You don't need to pay me. This is the neighborly thing to do. You know, for years, because I was so involved with my mom, I haven't been able to be very neighborly. Now that I can, I think it's time I started."
As I walked back to continue working on my driveway I realized, yeah, that's right! During those years when I wasn't able to exchange neighborly favors Mom and I were, even so, the recipients of some wonderful acts of neighborliness. During years when I couldn't get to yard maintenance, my neighbor to the east, when he was weed-eating his own yard, would work his way through the eastern front of our yard. There were times when I'd put the garbage out on Tuesday night and before it was picked up the next day some health crisis would occur and Mom and I would head down to Phoenix. When we returned a few days later, some one or more of our neighbors would have pushed our emptied bins to our carport and piled our newspapers on our stoop. Our neighbor to the west, the gardener, before she died and her companion, who has no interest in gardening, fallowed out her plots, would keep us supplied with sweet, vine ripened tomatoes and spicy arugula for salads. One of our neighbors two houses down, when my mother was still driving, happened to be out one day when my mother slammed the back driver's side fender into our retaining posts while trying to back the car into our driveway. He sprinted over with a mallet and popped the dent out of the fender.
We've never been chummy with our neighbors, here, but neighborliness in this part of the country has a distinctively independent Western edge...one with which I am, and my mother was, very comfortable. You keep a casual eye turned toward your neighbors, allow them to live in your thoughts as they do across the way, on the other side of the boulders, behind that stand of Ponderosa. If you notice they need a hand and if your hand is available, you offer it.
I'm a little sad thinking that it is my mother's death that is allowing my hands to be more available to my neighbors, but I'm excited, too. My mother was a neighborly soul. It is from her I learned that when returning a borrowed or left-behind dish, you always return it full of something good. When we noticed that our front yard was a great place for turning around on this narrow, climbing street, we made sure all obstructions to this were pushed back. We watched with pleasure during the spring, summer and fall as walkers and cyclists stopped to rest beneath the shade of our indigenous, fast growing perfectly situated deciduous tree. We were delighted and intrigued when dog walkers lingered in our yard. We often devised subtle landscaping plans that would render our yard more inviting: A vine covered arbor close to the street for more shade; some weather proof chairs for older walkers and enough of those so that if Mom was up to it, we could sit outside and people watch; salt licks to encourage more deer visits; a couple of bridges across the wash to encourage access. We didn't get around to any of them while Mom was alive. Her neighborly spirit remains, though, and she taught me well. Now's as good a time as any to extend my hands and our hearts to our neighbors.
Come one, come all! There's a new carnival in town!
You're forgiven for not noticing; that's how new it is. I stumbled across it because, much to my surprise, a post of mine was featured in the premier edition and one of my readers, the next host for the carnival, in fact, Dethmama of Dethmama Chronicles, clued me in about the presence of one of my posts. The carnival is called Palliative Care Grand Rounds. The aforetyped link will lead you to its newly established home page. This link will take you to its premier edition hosted by Christian Sinclair, MD, at Pallimed.
It's a good one, especially for those interested in, well, here, let me quote the opening paragraph to Volume 1 Issue 1:
Welcome to the inaugural edition of Palliative Care Grand Rounds, a monthly blog carnival bringing you the best and most interesting blog posts about hospice, palliative care, death and dying, grief, quality of life, communication in the medical arena, and anything else that strikes the fancy of the host that month.You tell me: Who doesn't that include? This month's edition is divided into four sections according to the type of blogger posting the articles. I'm continuing to work my way through the posts. It's full of curious and thought provoking information. Some tidbits: A post about how often and under what circumstances patients remember the names of doctors attending them in hospitals; what it's like to receive messages from the dead; at the moment I'm listening to a song about euthanasia.
I recently asked Dethmama if she was planning a theme. She says, "I'm not going to have a theme for the carnival... PCGR is so new that I don't want to discourage anyone from contributing by limiting the topic. So like Christian says anything to do with death, dying grieving, caregiving, palliative/hospice, etc." The field's wide open, folks...spots available for any ride you want to offer. Keep in mind that the first edition of the carnival was constructed by hand by Dr. Sinclair, who trolled the web looking for appropriate posts. Dethmama is expecting to have to do much the same. Wouldn't it be great if she had so many submissions for the second edition that she didn't have to go looking?
Finally! My kind of snow!
Snow started falling a day later than predicted: Saturday instead of Friday, and in fits and starts. The delay and the initial amount disappointed me. I figured, as with all the other promised snows this season, we might get a thin frosting that would ice the crumbs down then disappear in 12 hours. It snowed enough on Saturday, though, for a legitimate blanket to survive the night. Sunday morning it began in earnest, continuing through last night. I figure, judging by the thickness of the blanket against a granite boulder in the front yard, that we've gotten over eight inches, maybe even closer to ten. A month and a half after Christmas I'm finally living in a Christmas card, again. It was a gray sky snow. A branch bending snow. A sound muffling snow. A chain snow that most people here, yesterday, had to negotiate without chains. It caught my neighbors by surprise. Going-home vehicles had trouble, yesterday evening, making it past my driveway. My home is right at the point where a gentle slope becomes a determined climb. Many of the slipping cars angled themselves, with difficulty, into my driveway to gain purchase for a turn and headed back toward town. This morning an endless, thick slab of snow covers everything except cracks where the branches of evergreens, leafed and needled, have carved smooth, rounded cracks in the slab.
Miscellaneous note: It is with some difficulty that I am using "my" to describe this house, this home, rather than "our". I'm making a conscious, labored effort, to habituate to referring to it as "my" house, "my" home. It isn't that I wish to lose the sense that it is "our" home. It will always be "our" home. But, for practical reasons, it seems to me as though, in normal conversation and thought, the concerted use of "my" might help me lose the continued sense of absence that engulfs me every time I reenter "our" home. It's one of the few structured grief therapies to which I am consenting.
The Hospice Chaplain called yesterday. It was, again, awkward, at first, talking with her, but she is gently persistent and I so appreciate her calls that I work hard to craft a legitimate conversation. Once we warmed up our conversation lasted well over an hour. Without the more natural connection, for me, anyway, of pen to paper or fingertips to keyboard, I had more trouble, than I do writing here, telling her that grieving is, at the moment, getting harder instead of easier. She picked up on what I was trying to express, though, and helped me verbally clarify some of what I've been experiencing. The most significant aspect is that the mental fog continues without cease, muffling productive thought and action. I'm "hanging on for the ride", though, and grateful that I don't have to cut it short or interrupt it with the normally essential work of surviving. Toward the end of our conversation she congratulated me on sticking with it, regardless of the difficulty. She intimated that refusing to turn away from the grief ultimately opens one's heart (she speaks from experience on this, by the way) and often brings additional clarity. "I hope so," I told her.
I can't remember how we got into it, but part of our conversation involved the process of dying; what it feels like, what the dying one experiences. Previous to talking to her I had assumed that it's impossible to know unless one is going through it. I tend to regard "almost dying" experiences as not legitimate death experiences, since the person who "comes back" hasn't died. As well, of course, I'm aware of the scientific explanations of what happens neurologically when one dies and how Western science has linked much of the physical deterioration of dying to the states often described in "almost dying" experiences.
She asked me, though, if I would be interested in literature that described the process of dying from the inside out. "Yes," I said. I'm intensely curious about what my mother might have been experiencing through the hours she was dying; especially since she indicated her unusual, unexpected discomfort to me, a discomfort about which I commented, day before yesterday, after reading a post at Dethmama's journal.
The Hospice Chaplain told me she and one of the Hospice RNs with whom I'm acquainted (the one who subbed for our regular Hospice RN when he was off) would get back to me with material references. For the meantime she mentioned The Tibetan Book of Living and Dying as one reference, talked about how she vaguely recalled that it contained a description of "dissolving of the elements". Sounds pretty esoteric, I thought, but intriguing. That, I figured, would be an easy reference to seek out, since I own a copy of it. I'd read it through some years ago but have almost no memory of the book, let alone anything specific about the process of death. Funny how you don't retain what you don't need at a particular time!
The Hospice Chaplain also mentioned researching the internet, which was what I did first, assuming that The Tibetan Book of Living and Dying would contain less clinical explanations. The internet exercise was unproductive. Aside from snippets of "NDEs" (Near Death Experiences], versus what I label, in my mind, Approaching Death Experiences, I was only able to find two references, both of which ultimately skirted the descriptions in which I was interested. The first is a much linked to and quoted article published in October, 2007, in NewScientist that describes what, exactly, kills people under a variety of lethal circumstances. It is so prolifically quoted that, six pages into my search, various links to the article continued to overwhelm links to any other pertinent information on the web. It is so popular that an edition of The Water Cooler Diaries has been devoted to verbally summarizing the article. Although the article contains some information about what various death experiences might feel like, only one, drowning, has a fairly detailed explanation (with which my experience concurs). The rest mentions, offhandedly, statistics like seconds or minutes of viability after the lethal act and the method of oxygen deprivation, which is what kills most people. The title of the article is the exact phrase I used in my internet search, which surprised me, but the title was misleading. There is lots of interest in the death experience but not a lot of reliable information which, I suppose, is not surprising.
[Added 3/4/09 as I was reading through the post for the first time since I wrote it: I forgot to mention, there is also a detailed description, in this article, of what it is like to die by fire.]
The second internet resource I found is the full text of a book entitled The Natural Death Handbook. Chapter 2 contains multiple descriptions of dying folks, famous and obscure. The catch is that all the descriptions are from the outside looking in, curious but still not what I was looking for. I decided to abandon the internet.
When I found my copy of The Tibetan Book of Living and Dying I leafed directly to the chapter entitled The Process of Dying and discovered, seven pages into the chapter, some cogent descriptions of certain physical experiences noted through the ages by Tibetan doctors and observers of the dying and the dying, themselves. Between the covers of metaphysical metaphor I found a surprisingly detailed, hauntingly physical analysis of what my mother probably experienced through her last three to four days as she was dying. It is so fascinating to me and seems so accurate that I've decided to quote pertinent passages, below, and describe how I interpret these passages using what I observed of my mother's experience of death. Since I'm not interested in challenging copyright, I'm mentioning, here, that my edition of the book is copyrighted as of 1993 by Rigpa Fellowship; I'm also invoking the copyright instructions on the opposite side of the title page which allow "brief quotations embodied in critical articles and reviews."
Although I will be quoting the metaphysical explanations of what happens as one dies, note, also that the metaphysics is accompanied with clear explanations of physical processes. Keep in mind that much of what seems like metaphysical description to our Western sensibility is considered to be a legitimate technical vocabulary in Eastern thought, bringing to mind exact delineations of physical areas and processes. As well, the chapter lays out a specific event line. As I was reading it seemed to me that my mother's event line differed but, as I compared what I was reading with what I reported and recalled, it turns out only one event, the one hallucination she had of which I am sure, was out of sync. In cases where I have reported events as my mother experienced them in this journal I'll attempt to find and link to them. I'll quote in this color and typeface. My comments will be in my typical typeface and color.
The book prescribes a proper position for dying:
Traditionally the position generally recommended for dying is to lie down on the right side, taking the position of "the sleeping lion," which is the posture in which Buddha died. The left hand rests on the left thigh; the right hand is placed under the chin, closing the right nostril. The legs are stretched out and very slightly bent. On the right side of the body are certain subtle channels that encourage the "karmic wind" of delusion. Lying on them in the sleeping lion's posture, and closing the right nostril, blocks these channels and facilitates a person's recognition of the luminosity when it dawns at death. It also helps the consciousness to leave the body through the aperture at the crown of the head, as all the other openings through which it could leave are blocked.
My mother spent most of the last four days of her life in this position, but reversed. This is the position in which she slept for the last several years. Her eccentric modifications were that she did not rest her right hand on her right thigh, but tucked it under her left ear on top of her left hand. Her left nostril was often effectively blocked in this posture, either by her hands or her pillow. It was securely blocked through her last night.
My feeling, over the last nine months of her life after discovering that she had lung cancer, the tumor being in her right lung, was that this position favored her right lung in such a way as to allow deeper breathing. Up through the last few days of her life I don't think her left lung required favoring.
Curiously, my mother was a Leo and I often referred to her, in deference to our kitties, as an honorary cat, so I'm intrigued that the reverse of her usual sleep position is called "the sleeping lion". Also, during her last night of life, aware, from The Literature, that it is often a good idea to reposition the bedridden, we tried arranging her on her right side. She found this even more uncomfortable than her usual position and unacceptable. I'm curious to know, now, what, according to Tibetan dying theory, she was blocking by lying in the reverse of the recommended position for dying. I'll definitely be looking for this as I reread the rest of the book. I'm making a mental note, as I type, to report back, should I find anything.
Added 3/4/09 as I was reading through the post for the first time since I wrote it: Something I've been meaning to add as I've thought about this post: I'm aware, and was hyper-aware during my mother's last days, that it is recommended by hospice/palliative care professionals to alter positions so as to prevent discomfort and bedsores. During my mother's last hours, though, trying to reposition her was physically and emotionally harrowing for her. I tried, anyway, but, as a team we were unsuccessful. At any rate, her skin was in great shape, the only bedsore she's ever developed was under the care of the hospital and rehab facilities, despite my constant oversight and reporting and help, but that had healed before she came home from her last rehab stint and, until a few days before she died, she was active enough and so well cared for that other skin conditions didn't crop up, except for her usual bruising.]
The Outer Dissolution: The Senses and The Elements
The outer dissolution is when the senses and elements dissolve. How exactly will we experience this when we die?
The first thing we may be aware of is how our senses cease to function. If people around our bed are talking, there will come a point where we can hear the sound of their voices but we cannot make out the words. This means that the ear consciousness has ceased to function. We look at an object in front of us, and we can only see its outline, not its details. This means that the eye consciousness has failed. And the same happens with our faculties of smell, taste and touch. When the senses are no longer fully experienced, it marks the first phase of the dissolution process.
This post describes my mother scratching at her makeshift night stand and picking at my pants during the last three hours of her life, immediately after I awoke to medicate her again. It also describes her reaction to sound, which I now realize she may have been hearing but no longer discerning. I think the scratching and picking at things is explained by a diminishment of her ability to see clearly.
I also find it interesting that Western medical descriptions insist that the sense of hearing is the last to go. In this description, while gross hearing may remain, "ear consciousness", which is clearly interpreted to mean the ability to discern what one is hearing and attach meaning to it, is one of the first senses to fade.
Added 3/4/09 as I was reading through the post for the first time since I wrote it: I just realized, as I was rereading this section, that my mother's glasses lay on that makeshift night stand. I wonder, now, if she was reaching for them in an attempt to improve her ability to see; perhaps she may have had it in mind, as well, to arise, which was objectively beyond her ability by that time. I didn't think to realize this or ask her, at the time, but, at any rate, as soon as I entered the bedroom, she calmed down and appeared to want nothing but my company.]
The next four phases follow the dissolution of the elements: [of which there are five: earth, water, fire, air, space; each corresponds to various physical parts and processes; they also correlate with spiritual "parts" and processes]
Our body begins to lose all its strength. We are drained of any energy. We cannot get up, stay upright, or hold anything. We can no longer support our head. We feel as though we are falling, sinking underground, or being crushed by a great weight. Some traditional texts say that it is as if a huge mountain were being pressed down upon us, and we were being squashed by it. We feel heavy and uncomfortable in any position. We may ask to be pulled up, to have our pillows made higher, or for the bed-covers to be taken off.
My mother lost her physical strength two days before she died, very dramatically, during this episode of incredible pain. From that point on she was only able to uphold herself, and then only barely, for a brief period on Sunday morning when she decided she'd like to spend some time in the living room, eat a bit and watch one of her favorite Christmas movies. Even though she was sitting, it was necessary to prop her from falling to her left with several pillows of various sizes and one of her wedges strategically placed between her, the arms and the back of the wheelchair. We were both surprised at her sudden and complete loss of strength. I remember thinking that it was as though her Puppet Master had let loose of the strings attached to her waist so that she was no longer able to keep her trunk erect. Once this depletion of strength occurred, she didn't fight it. Now that I think of it, this was unusual for her on one level; it was her MO, when not feeling "up to par", to work at correcting the situation. At another level, her lack of struggle was perfectly appropriate: Once she realized (and it rarely took long for her to come to this realization) she was in the grips of a force stronger that her will, she always relented, assuming that the easiest way through a difficulty was to go with it until she emerged out the other side. [Should I capitalize that, "the other side", I briefly wonder, considering that I'm describing my mother's death? Nah, no need. When she was dying, I'm convinced she thought she was actually working her way through to "the other side"..."of this cold".]
The reason, as well, that for most of her last night I continually tried to pull her up on the bed and place pillows further underneath her was that she indicated that she was not comfortable laying completely flat. No matter how many times I tried, though, to accomplish some elevation for her upper body, she'd slip down, and I'd try again. I attributed this, again, to that loss of Puppet Master control at her waist. It was as though she was crumbling into her lower body.
A sensation of falling or being crushed under a heavy weight could also explain her scratching at the nightstand. There was a period, too, during her last night, when she was picking at her covers. I asked her if she wanted me to remove them. She did. I did. As I've mentioned previously, she was, indeed, "uncomfortable in any position".
Our complexion fades and a pallor sets in. Our cheeks sink, and dark stains appear on our teeth. It becomes harder to open and close our eyes. As the aggregate of form is dissolving, we become weak and frail. Our mind is agitated and delirious, but then sinks into drowsiness.
Her complexion didn't fade, there was no pallor nor did her teeth stain until immediately after death. Her cheeks didn't sink, before or after death. When I was at her bedside her eyes didn't close until after she took her last breath, although, in the last few hours I assumed she was not focusing on anything outside of herself. For the most part she didn't display any overt agitation or delirium in her last few hours, although picking at the nightstand and my pants earlier in her last hours certainly qualifies as both. I think it's possible that my presence calmed any agitation she might have been experiencing and allowed her to accept any delirium. For much of the time I was physically in touch with her, as well, either with my feet snuggled against her belly, holding her hand, petting her, or all three at once. Whether any of this overtly registered, these may have had much to do with her lack of obvious agitation and delirium. As well, of course, she was obviously withdrawing, in what I interpreted as a fierce attempt to rally forces to breathe. She may very well have been doing "other internal things", as well.
The only drowsiness I witnessed was the closing of her eyes each time I left the room; when I gathered medication, ice chips or collapsed for a few hours sleep much earlier in the evening. She obviously, though, wasn't sleeping, as each time I returned her eyes (rather, the one eye that I was able to see, her right eye) opened and blazed and, as well, when I awoke earlier in the morning just before medication time she was awake and working at the nightstand.
These are signs that the earth element is withdrawing into the water element. This means that the wind related to the earth element is becoming less capable of providing a base for consciousness, and the ability of the water element is more manifest. So the "secret sign" that appears in the mind is a vision of a shimmering mirage. [One note, here: The material in this chapter that precedes the section I'm quoting explains, fully, the relation of each element to specific physical and spiritual parts and systems. I'm not quoting these correlations, here, in order to attempt some modicum of brevity and, as well, in a concerted effort not to obviously impinge upon copyright.]
Each element section concludes with a corresponding image that is believed (and, perhaps has been reported) to accompany the segment of the dying process one is experiencing. Although I will never know, it's intriguing for me to imagine that my mother was experiencing spontaneous imagery related to each segment of her experience. You'd think, of course, that these images might be different in different cultures, considering that the images the brain manufactures for us are based on what we witness during our lives. However, the images described in this chapter are so fundamental that I consider it possible that these may be universal visions.
We begin to lose control of our bodily fluids. Our nose begins to run, and we dribble. There can be a discharge from the eyes, and maybe we become incontinent. We cannot move our tongue. Our eyes start to feel dry in their sockets. Our lips are drawn and bloodless, and our mouth and throat sticky and clogged. The nostrils cave in, and we become very thirsty. We tremble and twitch. The smell of death begins to hang over us. As the aggregate of feeling is dissolving, bodily sensations dwindle, alternating between pain and pleasure, heat and cold. Our mind becomes hazy, frustrated, irritable, and nervous. Some sources say that we feel as if we were drowning in an ocean or being swept away by huge river.
The water element is dissolving into fire, which is taking over in its ability to support consciousness. So the "secret sign" is a vision of a haze with swrling wisps of smoke.
Most of the above happened on cue for my mother, with some interesting exceptions:
- Her nose didn't seem to run, mainly because of the rush of air through the cannula. However, it crusted incredibly, a sure sign that her nose actually was running. I spent a fair amount of time during her last hours moistening this crust and picking her nose. When I began doing this she tried to move my hand away in protest, but I explained to her that her nose was clogging so quickly that I needed to do this in order to make sure oxygen delivery wasn't blocked. She relaxed. I cleared her nose as gently as possible, of course, but, well, picking one's own nose isn't exactly a gentle process, let alone someone else's.
- There was no apparent eye discharge, although, after her death I did notice a slight crust on her eye lashes. It was, however, no more or less apparent than the eyelash crush with which she normally awoke.
- Her lips neither drew nor paled, although this may have been due to the oxygen supplementation.
- She drooled, a lot. The drooling began sometime Saturday afternoon. A couple of times she expelled what I assumed to be stomach contents, although this process was so easy for her that I hesitate to call it vomiting. It appeared to happen without observable stomach volition. The weeks previous I had, luckily, bought several extra pillows. We used every single one as I changed cases and pillows to make sure she was able to lay her head on a dry surface.
- Thinking back on it, I'm sure that she lost control of her tongue and her mouth and throat became sticky and clogged. The symptoms are what predicated my concern here, that, at her next scheduled medication dose she would no longer be able to swallow acetaminophen crushed in cherry jam.
- Her nostrils did not appear to cave in, but this may have been because of the cannula and the flow of oxygen and, as well, my constant attempts to keep her nose clear of crust.
- Her ability to feel thirst was surprisingly present during her last 9 hours of life. I was astonished at how much liquid she willingly consumed Sunday morning when she was up in the living room. As well, throughout her last few hours she sucked at straws, eye droppers and spoons full of water or ice chips. It wasn't until her last hour, I think, that the ice chips slid out of her mouth before they melted.
- I never detected any kind of an odor that I would consider peculiar to her death. This may have been, however, because, during her last hours of life, I noted that I could almost watch her skin drying on her arms, imagined this to feel uncomfortable and slathered her arms, several times, with a thick, very fragrant spicy lotion.
- I cannot attest to whether, as my mother's senses dwindled, she experienced serial flashes of primal sensations. She may have, as, at one point about an hour before she died she indicated that she wanted me to cover her back up, which I did, then, a bit later, made an attempt to push the cover back, again, which I immediately understood and accomplished for her.
- I wouldn't be surprised if her mind was "hazy, frustrated, irritable, and nervous." Her labored breathing, despite it's regularity, was a clear indicator of all these. Whatever else she might have been mentally experiencing, I cannot guess.
Our mouth and nose dry up completely. All the warmth of our body begins to seep away, usually from the feet and hands toward the heart. Perhaps a steamy heat rises from the crown of our head. Our breath is cold as it passes through our mouth and nose. No longer can we drink or digest anything. The aggregate of perception is dissolving, and our mind swings alternately between clarity and confusion. We cannot remember the names of our family or friends, or even recognize who they are. It becomes more and more difficult to perceive anything outside of us as sound and sight are confused.
I did, indeed, notice her arm that was available to me cooling. Although I'm sure I didn't record it, I also noticed, as I attempted to feed her ice chips, that her breath was very cool. I assumed it was from the ice chips. Obviously, too, she stopped being able to swallow before she died.
Kalu Rinpoche writes: "For the individual dying, the inner experience is of being consumed in a flame, being in the middle of a roaring blaze, or perhaps the whole world being consumed in a holocaust of fire."
The fire element is dissolving into air, and becoming less able to function as a base for consciousness, while the ability of the air element to do so is more apparent. So the secret sign is of shimmering red sparks, dancing above an open fire, like firelies.
I can only hope that she envisioned fire as she cooled. She hated to be cold, or cool. As well, she loved fires. I hope the spiritual blaze was hearty enough for her to die in a sense of heated comfort.
I wonder if these final visions are tweaked according to individual character. I, for instance, would love to die envisioning a glossy, multifaceted glacier, feeling a blast of icy wind in my face.
AirAh! That felt good! Going through this description of dying and correlating it, point by point, to what I observed during the last days and hours of my mother's life has lightened me a bit. As I worked through the correlation I was able to remember how it was that I was never sure, until she died, whether she was dying, thus, I wasn't sure that I conducted myself appropriately to her circumstances. I can see, now, several clues, throughout her last hours, that she was, indeed, dying, regardless of whether she thought she was. Frankly, I'm glad I wasn't sure at the time. I think my confusion supported her staunch determination that she was not dying; thus, I did not fight her drive (which is a drive we all have, by the way, according to both of the Final books) to die in character. I'm also glad that I had no memory of having read this book, nor anything else that described the dying process. This allowed me to clearly and innocently notice things, rather than look for things. Reading through what I wrote over the last few days of her life, I did guess that she was dying, but, just as quickly, I'd second guess and, finally, decided just to ride the episode out and observe rather than label it. I'm sure part of the reason I decided to go with the flow of the ride rather than try to figure out the "future" significance of what was happening is that there had been many times in my mother's life during our companionship when I would anxiously wonder if she was dying "now", and, much to her consternation, ask her if she was.
It becomes harder and harder to breathe. The air seems to be escaping through our throat. We begin to rasp and pant. Our inbreaths become short and labored, and our outbreaths become longer. Our eyes roll upward, and we are totally immobile. As the aggregate of intellect is dissolving, the mind becomes bewildered, unaware of the outside world. Everything bcomes a blur. Our last feeling of contact with our physical environment is slipping away.
We begin to hallucinate and have visions: If there has been a lot of negativity in our lives, we may see terrifying forms. Haunting and dreadful moments of our lives are replayed, and we may even try to cry out in terror. If we have led lives of kindness and compassion, we may experience blissful, heavenly visions, and "meet" loving friends or enlightened beings. For those who have led good lives, there is peace in death instead of fear.
Her eyes, by the way, did not roll up into her head while she continued breathing. I'm assuming, although I didn't check, that they did so when she closed her eyes after her last breath.
The only vision my mother had of which I'm aware occurred out of the above sequence, a bit less than 12 hours before she died. Here's the description. My assumption, considering what MFS said about her, that she was "a pure spirit", is true, she lived, primarily, a life of unusual kindness and compassion [I know, I know, people say that about their mothers all the time, right? But, in regards to my mother, there are many, many, many people, both alive and dead, who would agree with this, including some extremely miserable, spiritually crippled characters.], is that whatever visions and hallucinations she had, they were overwhelmingly peaceful. I can report that she did not appear to "cry out in terror". For the last couple of hours she seemed completely immobile and withdrawn.
I can't resist a footnote to the above passage, though. I would, frankly, hope, that the description it contains of the hallucinatory hell that confronts people who have lived in "negativity" is actually not true, is simply an aberration of the lively human need to imagine revenge and punishment upon those who mistreat us. If I were in charge of designing the spiritual universe, I would see to it that especially those who haunted dens of iniquity in this life would be greeted, as they were dying, with refreshing visions of environments and people that immediately calmed the life long fears that caused them to live in and perpetuate misery. I mean, really, why not!?!? We have proof enough here on earth that iniquity is strictly the province of being human (well, at least I have enough proof of this). Why shouldn't fear and iniquity die as we die out of our humanity?
Okay, I'm done with the editorial portion of this post. To continue...
Kalu Rinpoche writes: "The internal experience for the dying individual is of a great wind sweeping away the whole world, including the dying person, an incredible maelstrom of wind, consuming the entire unverse."
What is happening is that the air element is dissolving into consciousness. The winds have all united in the "life supporting wind" in the heart. So the "secret sign" is described as a vision of a flaming torch or lamp, with a red glow.
Our inbreaths continue to be more shallow, and our outbreaths longer. At this point blood gathers and enters the "channel of life" in the center of our heart. Three drops of blood collect, one after the other, causing three long, final outbreaths. Then, suddenly, our breathing ceases.
Just a slight warmth remains at our heart. All vital signs are gone, and this is the point where in a modern clinical situation we would be certified as "dead." But Tibetan masters talk of an internal process that still continues. The time between the end of the breathing and the cessaton of the "inner respiration" is said to be approximately "the length of time it takes to eat a meal," roughly twenty minutes. But nothing is certain, and this whole process may take place very quickly.
Curiously, my mother's breathing for more than the last hour of her life and certainly through the last minutes of her life, although so labored that she looked and sounded like she was on a ventilator, remained rhythmic. I did notice, in the last hour, as I was breathing with her and studying each of her breaths, that her in and outbreaths measured about the same amount of time, which is unusual. Normal breathing has been described to me as 1/3 inbreath and 2/3's outbreath. I thought little of it, though, as I assumed it was indicative of her continued attempt to "get past this cold."
After her last full breath she had one final outbreath, a few minutes after she died, after I took out her cannula. I assumed this was the expulsion of oxygen concentrator build-up in her lungs.
Her eyes closed but a nano-second after her last breath. Her lips immediately turned blue. Her complexion immediately paled.
As to the cessation of "inner respiration" spoken of in the above passage, although I have no idea, my guess is that this took place rather quickly for my mother.
There is a bit more to this chapter, a section entitled The Inner Dissolution, which discusses the Primary Spiritual (my caps) process of dying, which happens after the physical and mental death just discussed. Although I find it interesting to contemplate, it isn't anything I can absolutely correlate to what I observed during my death watch of my mother, so I'm leaving it out. The section contains an intriguing description of spiritual death being the opposite of conception. There is also reference to the seven thought states resulting from ignorance and delusion which, at spiritual death, or, perhaps it would be more accurate to say, spiritual rebirth, are brought to an end. There is a section on the death of the three poisons: ...anger, desire and ignorance...all die, which means that all the negative emotions, the root of samsara, actually cease...
And where does this process take us? To the primordial ground of the nature of mind, in all its purity and natural simplicity. Now everything that obscured it is removed, and our true nature is revealed.
Sounds like heaven, doesn't it!?!
I think it's important to note that the reason I had no trouble with the metaphysical vocabulary of the Tibetan description of death is because of my familiarity with elemental metaphysics through astrology. The element of "space" (sometimes called "ether") was a relatively new one to me, having only recently encountered it in a PBS program, The Story of India. You'll notice, in the above citations, only four of the five elements are discussed in regard to death. Within the last section that I didn't cover there is a presumption that it is involved in the after-physical-death dissolution.
It is important, as well, to consider that any medications delivered to the dying one may alter and/or eliminate some of the symptoms of dying described above. There is one medication, for instance (which we didn't use) designed to silence the death rattle. It is not for the comfort of the dying, of course, but for the comfort of the living. Some medications, like morphine, for instance, may increase certain dying symptoms, like the sense of thirst and the drying out of normal bodily fluids, mucus, for instance. Some short circuit the experience of pain that is described in the passages above, thus, may also short circuit the experience of physical pleasure. Morphine, too, alters the body's response to air hunger, so, of course, would alter how the dying one breathes. This is not to say that I believe it is inadvisable or spiritually tainted to administer palliative meds as someone is dying. In fact, I'm glad we had them and would use them again if I was in the presence of someone who was dying and experiencing pain and/or shortness of breath and/or unusual physical discomfort that could be alleviated by the administration of medications (including herbs, etc.). Perhaps, in strict Tibetan Death Theory, medicating for dying symptoms might be spiritually problematic; I'm not sure of this, I'm just speculating. However, it isn't for me. I'm sure it wasn't for my mother, either.
All material, except that not written by me, copyright at time of posting by Gail Rae Hudson