At death's door

4th in a 12-part series

Erin Jordan thought it would be something like you see in the movies. Not with violins and perfect lighting, of course, but peaceful at least. She thought her little boy would fall asleep and just not wake up. She prayed, in fact, for a death like that.

She wishes she had known in advance, she says, what would really happen: that near the end, Zack would lose his appetite and it would be OK, better even, not to try to get him to eat; that at the very end he might have a seizure, bleed through his eyes, gasp for hours.

Knowing what to expect as Zack died at the age of 6 not only would have taken some of the fear and confusion out of the process but might have made dying easier on Zack himself, says Jordan, executive director of Candlelighters for Childhood Cancer.

How each person dies is as unique as the individual who is dying, but knowing that certain events are typical can help a family prepare for the inevitable, says Dr. Jane MacPherson, an expert in family and palliative medicine and medical director of IHC Hospice.

Chris Christie, who was widowed in 2000, says the metaphor people might understand is Lamaze. He and his wife, Judy, took the birthing classes before their first child was born. "They told us how the body was working, and that was helpful." When his wife was dying, understanding how her body was shutting down was useful, too, he says. "I didn't have false hopes. And I increasingly knew how precious life was."

"In our society, very few people have been in the presence of someone dying," says Dr. Greg Miller, staff physician at CareSource, an inpatient hospice facility in Salt Lake County. When they do come face to face with it, they often aren't prepared, so they sometimes try to intervene in ways that needlessly prolong life.

In some ways, the most predictable aspects of dying are a reverse of the beginning of life. A newborn baby sleeps a lot and progresses from liquids to solids. Breathing is irregular, even raspy, as any parent who has laid awake listening can attest. The tiny person is weak, dependent on others. And unless someone dies abruptly, the completion of life's cycle revisits those traits, MacPherson says.

With chronic illnesses the body shuts down in very typical ways. As Miller says, "nature has been doing the dying process for a long time and has built in some standard symptoms."

Appetite and, later, thirst dwindle, then disappear. This is particularly hard on the patient's loved ones, who tend to feel they're harming the patient by not encouraging or forcing him to eat and drink. This is especially hard on parents, says Jordan.