The Intimacy of Death: This will be graphic

By: Michael Amesse

Those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that this moment is neither frightening nor painful, but a peaceful cessation of the functioning of the body. — Elisabeth Kubler Ross

We tend to think of Death as a singular moment when the soul leaves the body and human conciousness fails one final time; when the heart stops beating, the senses stop sensing, and conciousness stops… well… being concious. Death is then seen as this ultimate second where all things come to a halt.

From my experience, death happens over time. It comes in chapters with defining moments which happen in the span of months, weeks, days, hours, and seconds.

But this article is not going to revolve around my own personal opinions on death and I will do my best to paint a clear and true picture of what it means to care from someone who is dying.

Physically, the body knows it is dying and will do some pretty strange things.

Skin breakdown occurs and bloody, oozing sores will open up anywhere that isn't constantly being treated. Essentially the body will stop providing resources in order to keep the skin from breaking down because it simply isn't a priority. As you can imagine, this leads to the possibility (and sometimes inevitability) of infections. These infections can ultimately be the final straw as they move throughout the body causing damage and even more breakdown as they go. The body doesn't bother trying to fight these infections and decay can start well before the body is technically “dead”. I once had a patient with a large protruding tumour coming from atop her head which would spilt through the skin. Once the body finally gave up trying to repair it, we had to wrap her head in a scarf just to keep flies from laying eggs inside her skull. There were times we would go to clean the wound out to prevent (further) infection and we would end up picking maggots out of her tumour.

Our mouths are gross on a good day. So what happens when the body gives up trying to take care of itself? I'm glad you asked! The human mouth is usually one of the fastest healing parts of our bodies. It can take a lot of trauma and bounce back rather quickly. That said, it is a breeding ground for all sorts of bacteria. It is extremely common for a person who is dying to have a dry mouth. Dry mouth do not heal well. Dry mouth smell awful. Mix those two with the sweet, metallic smell of coagulated blood and no amount of Mentos can mask that odour. It smells like old blood mixed with whatever antibiotics and chemicals are coming in and out of the body. Imagine a trash-can on a hot, humid day, full of blood and spoiled breakfast sausages and mix that with a slurry of chemically sweet smelling antibiotics. So we do our best to keep the mouth clean, but you don’t want to irritate the mouth causing more bleeding and if the person is unconscious or unable to swallow, you don’t want them to choke on whatever you clean the mouth with. We use these soft little pink swabs for cleaning teeth with a solution of fluoride mouthwash and water. They are also used for feeding boost milkshakes by dipping the sponge in the drink and touching it to the lips (mostly so they have something else to taste other than their own mouth rot).

Everybody poops. Even the dying. Not everybody has the physical or mental aptitude to do this process on their own. Especially the dying. As mentioned, the body essentially stops caring so food breakdown and absorption comes to a swift and problematic halt. Mix that with the medicine and treatments patients receive and you have the perfect recipe for some ferocious bowel movements. Considering the patient usually cannot get up to use the bathroom or signal they have to use the bathroom in the first place, the intestines will expel whatever and whenever they want. Obviously this means that every time the body decides to go, we inevitably are there in moments to clean up. When a patient is laying on their back and they have a moment of incontinence, a lot of the stool will run between their legs. Cleaning out a vagina that is full of stool while trying to change a bed from underneath them is a difficult process. Genitals have lots of little nooks and crannies and folds which are easily irritated and difficultly cleaned. On top of this, the bowels may just simply leak constantly. This is especially true for patients with bowel cancers. With bowel cancers, rarely will you see actual stool but what you will get are large, foul smelling blood clots mixed with mucus and their disintegrating colon (mixed with medicine obviously).

The mind of the dying can go through some interesting changes and experiences as well. Obviously it is impossible to give a 100% accurate and subjective account of what happens unless you are the one going through death, but objectively observations can still be made. Considering the body is undergoing extreme dehydration, malnourishment, (usually pain) and general trauma, hallucination can definitely occur. Mix those factors in with a patient with Alzheimer’s, dementia, or a urinary tract infection (can cause hallucinations as well) and you have the makings of an unimaginable trip. Since my job is to make the patient as comfortable as possible, I find putting on some nice, quiet music and dimming the lights can help with some of the paranoia that they may experience (especially if i have to clean stool out of their genitals). Essentially you want to find the right balance in between sensory deprivation and over-stimulation which is not an easy task in a hospital setting. It is amazing how hard a dying woman can hit if they have a sudden burst of strength while you clean her vagina.

We don’t like dealing with families. Its not because we are not sentimental or compassionate enough. We can relate to them and we absolutely understand the pain they are going through. Now that you have a better idea of what it is like taking care of the dying, how do you think it would make you feel to see someone come into the room and start doing these things to your family member or friend? The things we do are not pretty but we do them for a reason. Sometimes we will get entire families overlooking everything you are doing to their mother or father, horrified by what they see. People tend not to realize that dying isn't always pretty until they watch us clean their loved ones genitals or rinse their rotting bed sores. Families also have a tendency to think miracles are going to happen and that we can magically make the patient live, but the fact is, at that point we are just doing damage control.

If you have made it this far in my writing, I understand if you are shocked or even horrified by how I make the whole process sound. To others, I may seem crass, unattached, or even disrespectful and I can definitely see why.

I love what I do. Before all of this, my goal is to make people as comfortable and happy as possible. I am a people- pleaser by profession. Everything we do for the dead and dying in my work is for them. We will hold your hand and sympathize with your pain as we help you pass.

All in all, when you watch people die on a day to day basis, you see death differently. You come to realize that it is not a magical moment full of last words and peace. Chances are, your last breath will not be peaceful. You will probably kick, choke, and gurgle until you fall unconscious, leaving an already smelling and rotting corpse in your wake. Death is not pretty and is certainly not glorious. We think that our last moment is what our whole lives have been working its way towards, but I would argue that the death is a process. The moment we are no longer able to control our conciousness, the first time we are no longer continent and a sympathetic stranger in hospital blue scrubs must clean us up, when we can no longer swallow more than a few licks of vitamin milkshakes, death comes in many moments.

I don’t fear death so much as I fear its prologues: loneliness, decrepitude, pain, debilitation, depression, senility. After a few years of those, I imagine death presents like a holiday at the beach. — Mary Roach

I am a 23 year old male, a registered PSW/PCA, working at a popular teaching hospital in Ontario, Canada. I have a wide range of care-taking experience in hospital settings, mostly working with palliative cancer patients and ICU’s.