Mystery and Reality of Death and Dying Being with Dying Knowing the signs and symptoms of active dying can be very helpful when we accompany a friend, relative or patient in their final stages of leaving the body after a sickness or due to old age. Most questions arise about this stage of active dying and how to perceive and guide the dying person’s process when they return to the ground of being. Often there are anxieties that centre on questions like “What will my death be like?” or “How exactly will I die?” in the person approaching death. Relevant medical information, assurance of compassionate palliative care and the continuous presence of friends during the dying process can relieve much of this anxiety. Often the time of death is preceded by an apparent coma, in which many things happen below conscious awareness. It is a great challenge to develop the spiritual guidance and inspiration, the vision and knowledge that can speak of the peace in surrender, and guide each other there. Active Dying Towards the end of our life-in-form, we enter a phase called active dying that proceeds over a period of time between a few days to a few hours. The disease is causing a dramatic decline, our physical existence is approaching its end, and fatal processes are progressing rapidly. This may be the most important time in the dying process, in that it is the gate to the divine, or even to enlightenment, as Osho often says. We can observe specific details in this decline. Signs precede death in most people, indicating the slowing down of their bodily systems, but there is no particular order in which these events occur. Usually, for the overwhelming majority of people the signs consist of a series of physical changes that are not medical emergencies and do not require high-tech medical intervention. What may be abnormal in living is normal in dying These physiological changes are the natural way in which the body prepares itself to die. They require most of all the common sense acts of human compassion: wiping the brow, wetting the lips, turning the body and keeping it clean, speaking gently, truthfully and comfortingly. The physical signs occur with simultaneous shifts in consciousness, being, and identity. We assume that consciousness enters form in a somewhat physiologically prefigured vehicle of manifestation. In addition to the biological systems well known to Western science, this vehicle of manifestation, the body-mind, includes bio- energy fields that subtly surround and interpenetrate the body. It also includes the powerful mind as well as the other constituents of our experience which are known in Buddhist psychology as the skandhas: sense organs, feelings, the capacity for perception and memory, unconscious tendencies, and consciousness itself. These are the subtle components of life-in-form: the organisational structures of ego identity allowing for survival and functional autonomy. Tibetan Buddhists teach that All of these components… dissolve when we die. The process of dying is complex, in which groups of related aspects of our body and mind disintegrate simultaneously…. Each stage of the dissolution has its physical and psychological effect on the dying person and is reflected by external physical signs as well as inner experiences. How the body prepares itself for the final stage of its life The first physical symptom of approaching death is an obvious decrease in the intake of fluids and nutrition; the body can no longer metabolize these substances. In fact, current medical science suggests that artificial nutrition and hydration actually make the process of dying more uncomfortable.The physiological systems, even at a cellular level, are coming to an end. In medical terminology, this is referred to as apoptosis, from the Greek for “a falling away from life.” Cells typically follow a metabolic pattern of development, maturity, and death. As we near death on an organismic level, physiological systems become less complex. There appears to be a progressive and system-wide cellular implosion when cells, sensing subtle changes in themselves, enter the natural process that ensues when they are no longer needed in continued bodily development. It has been suggested by A. H. Almaas that one of the central tasks of the self is to “digest” or “metabolize” the experiences presented to it at each phase of development. In the light of trans-personal psychology, the “food” the being is receiving at this stage in the process of life is “spiritual food,” which is now being metabolised so as to create an evolving psycho-spiritual identity and consciousness. There is a clear increase in weakness and fatigue. The person may no longer be able to move at will, not even to adjust his or her own position in bed. The eyes can sometimes open and focus and there may even still be some conversation. A dying friend had been unresponsive for many hours, as he had slipped into another realm of existence; at one point, surprisingly, he whispered, “Ahhh, so this is how it is.” The amount of time spent sleeping increases dramatically. In the process of dying, the person often goes through the sleep/wake patterns of infancy and very early childhood. These are normal changes that are due in part to changes in the metabolism of the body and in the body’s inability to oxygenate itself. Blood toxicity levels rise as the body functions less and less efficiently, urinary output changes, and electrolyte patterns lose their order. All of this affects various and interrelated brainstem centres responsible for sleep patterns, including the locus ceruleus. The locus ceruleus is the principal site for brain synthesis of norepinephrine (noradrenaline). The person very often appears uncommunicative, unresponsive, and even difficult to arouse. Those who have been able to share verbally, even non-verbally, with me throughout this stage have indicated something of the profound changes they are undergoing in their own deep interior, while to outside observation they appear to be “depressed”, withdrawn, or only sleeping. This is, in fact, the quality of “positive depression” of the Nearing Death Experience, a deep turning inward to access beyond. Other signs and symptoms signalling the coming end of life in the body One has been called “terminal agitation” which manifests itself as restlessness. An observer may witness restless and repetitive motions such as the limbs shuddering or the hands pulling at bed linen or something else. This happens rather frequently and has been attributed to decreased circulation to the brain and other metabolic changes, including increased blood acidity. Those who work with the dying observe that this can often be calmed with interventions in the energy-field, such as conscious touch or Reiki. Music that uses alpha and theta brainwaves, or the antiphonal music of the Christian tradition of death preparation, may be calming and fosters the entrance of consciousness into deeper dimensions. Practices of meditation or prayer previously agreed upon by the dying person that reflect his or her own spiritual vision, Atisha´s meditation or simply being silent and breathing with the dying person, are in my experience deeply calming. Often, this seeming agitation can be calmed by the soft, reassuring voice of a beloved or by placing a hand under the hand of the dying person. Closer to death, the dying person may manifest “disorientation”. The person may seem confused as to time, place, and identity. My observations are that the person is in the process of integrating a new structure of time, place, and identity on deeper levels of consciousness, and has already transcended the level of consciousness of the mental ego and imagined separation. Much of what happens during this stage of dying is without words and very difficult to verbalise. The observations are of subtleties, moments of profound connection and essential being, inarticulate gestures, looks, emanations of light from the body. Even if words are found, they cannot convey my deep conviction that psycho-spiritual transformation is occurring, that one is in the presence of grace. Often I have seen people open their eyes, focus on something that I am not perceiving, and smile in deep openness and radiance, with no fear whatsoever. There is decreased urination and often incontinence of both bowel and bladder, as the muscles involved in those systems begin to relax. Ischemia, decreased blood flow and therefore decreased oxygenation, limits the functioning of various organs and systems. All available bodily energy is switched to maintaining the essentials: the lungs and heart. Often other systems fail first: the liver, the kidneys, the pancreas; their decreased function leads to their ultimate breakdown which in turn puts additional stress on the already faltering circulatory and respiratory systems until these also cease functioning and the death of the physical body occurs. The slowing of the circulatory system manifests itself particularly in the colour changes we can observe in the dying. The person’s arms and legs may become discoloured. Often, there is dark mottling on the entire underside of the person’s body lying in bed as blood gathers due to gravity. Fingers and nails become bluish, or cyanotic, due to diminished oxygenation. Although it is not uncommon for fever to be present, hands and feet often begin to feel cooler to the touch. This is considered a normal indication that circulation is conserving itself to function only at the core, supporting the most vital organs. With focused attention over many hours, we observe that the skin colour of a person very close to death may change to one that is almost translucent or opalescent, with a slight radiance. This radiance appears to occur with changes in the energy field around the body. Attending to the energy field and changes in it involves very subtle perceptions for which our language has few or no words but can be noticed. I describe the closeness of physical death as perceived in the energy field as an intensification of the field. I notice increased heat in the area of the heart and head, decreased energy in the limbs and lower torso. The radiance I can subtly perceive with my eyes sometimes appears to pulsate as the dying person surrenders more deeply into the process and is carried farther into realms that I call sacred, Grace, Spirit, Divine. Breathing pattern changes when a person is actively dying This period can last from minutes up to several days, depending on the way a particular consciousness manifesting itself through a particular body dies. Subtle and not so subtle differences in pattern become apparent. Often, a pattern referred to as “Cheynes-Stokes breathing” emerges. In this pattern, shallow, rhythmic breaths are followed intermittently by periods of no breaths whatsoever for as long as a few seconds to over a minute, followed by faster and deeper breaths. I once worked with a curious woman who had done extensive research on the dying process. As she was very close to death, she returned her consciousness briefly to this realm of being, noticed her own breathing pattern, and whispered, “Oh, this must be Cheynes-Stokes.” She closed her eyes, returned to wherever she was, which we will know ourselves someday, and died peacefully. The dying person may also have periods of rapid, shallow, panting breathing. Occasionally, there is a moaning on exhalation. Although either of these sounds may engender horrible fantasies in those present, this does not necessarily signal distress on the part of the person dying; it is due to the sound of air passing over deeply relaxed vocal cords. The person may develop gurgling sounds coming from the lungs as those tissues begin to fill with fluid. Again, this may be very distressing to hear. Those of us who work with the dying and observe them during the times they are making these noises notice the many evidences of their deep relaxation. I think that when these noises are there, the consciousness of the one dying is already far removed from the body, in a much more enveloping dimension where the mind-body is only a facet in one´s awareness. Often, the only bodily movement apparent at this point is the pulsation visible in the carotid artery and the irregular rising and falling of the chest. On a more subtle level, of course, changes in the person’s energy field can be perceived as it intensifies, expands its previous parameters surrounding the gross physical body, and often begins to rise up through the chakras, or energy centres, receding from the lower extremities and strengthening near the heart and head chakras. For those who are aware of these subtle cues, these are clear signs and symptoms that death is close. Similarity to Near-Death experiences Internally, in terms of physiological changes that we cannot see, much is occurring. It is reasonable to assume the physiological changes that occur in the near-death experience, occur up to a point in similar fashion in the Nearing Death Experience. After all, we have reports of the near-death experience from those who have evidenced a flat electroencephalogram (EEG), which implies that brain activity has ceased, as well as the cessation of breathing and reflex actions, all of which are among our primary medical measures of death. A great deal is taking place in the anterior portion of the brain stem. It is here that the vital functions of the body are regulated and controlled, particularly breathing and heart rate. These areas, deep within the tissues of the brain and therefore well protected, are particularly sensitive to changes in both blood pressure and oxygenation, signalled either directly or by circulating peptides. They register threats to the delicate ecosystem of the living, breathing body. These areas are connected through intricate feedback mechanisms with the autonomic nervous system. Changes in the autonomic nervous system The autonomic nervous system, as discussed, goes through changing dynamics that correlate with experience of the transpersonal realms, in particular with the experience of visions and archetypes, especially the image of the Clear Light, as mentioned in the Tibetan Bardo process. The autonomic nervous system works through the balance of both the sympathetic and the parasympathetic nervous systems via the locus ceruleus. The locus ceruleus, interestingly, is located near the pineal gland, viewed in Indian yogic systems as the outward manifestation of the crown chakra, or energy centre. It is through this chakra as well as through the third-eye chakra, connected with the pituitary gland that many yogic systems of meditation teach to expand beyond the consciousness of the body. Observations point to the speculation that it is somewhere in this region of the body, the higher energy centres, both gross and subtle, where transformative experiences have significant physiological correlates, revealed in both the “near-death reflex” and in sophisticated meditative techniques. The autonomic nervous system effects its changes from this area, controlling both the sympathetic and the parasympathetic nervous systems. The sympathetic nervous system is that ever-vigilant aspect of this protective mechanism that swings into action when the organism is threatened. Sourced in the body’s thorax region, it regulates the appropriate blood pressure, pulse, blood oxygenation, breathing, and heart rate commensurate with the threat. The parasympathetic nervous system, rather than being located in the midpoint of the energy system of the body, is sourced simultaneously from areas near both the lowest and the highest chakras. Typically, the parasympathetic nervous system reacts to the vigilance of the sympathetic nervous system by providing a balance of deep relaxation, produced through a vasodilation in the peripheral circulatory system, leading in the extreme to cortical ischemia. At the point of the extreme systemic stress of the body failing and dying, the reflex connection between the two interrelated subsystems is lost. Within the dying process, death ensues. During the period of the near-death reflex, the mind-body also experiences the release of beta-endorphins and other neuropeptides. The inner experience is a profound relaxation of the entire body, so profound that any awareness of the outside world disappears. This is a state so out of ordinary waking consciousness that it is only known in deep sleep, Stage IV anesthesia, death, or certain deep and stable contemplative states far into trans-personal dimensions of consciousness. In the near-death experience, in the deepest stages of meditation, surrender and inner silence, and we can reasonably presume in the Nearing Death Experience as well, this state is also characterised by bliss and tranquility.
Posted on: Wed, 17 Dec 2014 10:50:42 +0000
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