How can I tell when someone is about to die? I have had practice, especially over the 15 years I have worked full-time in palliative care. It is not so much a science as an art. You try to find evidence to prove your diagnosis. A person has become less active. They need to rest or sleep more. They have become less mobile. They are eating less. They are losing weight. They are losing their interests. They are engaging less with the world around them. This might be what we see in the months preceding death.
In the weeks all of the above continues, and there is an overall diminishing of a person. They may be physically shrinking before your eyes. Cheek and other facial bones become more prominent. Their movements may slow down. Movement of limbs, movements of bowels. The body’s functional ability becomes impaired. This could lead to loss of balance and falls. Falls could lead to minor injuries like skin tears or bruises, or major injuries such as broken bones. The appetite worsens even more. Sense of taste and smell may fade, as the body starts to fade away.
I often talk about the spark leaving people’s eyes. In Māori, they talk about the Mauri or life force of a person. Which could be a synonym, maybe spirit or soul could also fit. Mojo could be another. The sign of an energised being, a sign that life is still there to be lived. No matter how physically frail a body may become the spark can hang in there for a while. It can be hard to describe exactly what it is.
Maybe a description of what it is not is the way to do it. The person has lost their inner brightness and it has been replaced by dullness. Their eyes have a matte finish rather than the usual shine. The focus of the eyes is no longer sharp, they seem to be looking through you rather than at you. As if they are staring into another plane of existence, something that the rest of us are not privy to. The eyes may have dried out because all of the tears have run out. Too much crying has been done and the body has no reserves to spare. The eyes which were previously mirrors to the soul no longer reflect as the soul prepares to leave.
Anima, the Latin animating principle is about to leave. It has passed through security and customs. It has made its way to the departure lounge. It is waiting patiently for the boarding call. No one can say for sure when the call will come. Some people can’t wait any longer and have asked for assistance in this most final of journeys. I am not here to judge people for the choices that they make in their life. I am here to try to help with quality control. I can’t affect what will happen to life itself, but I can affect the quality of the experience.
Does the spark only weigh 21 grams? Is this the same spark which lit the fire of what became a person? The flames were fanned until they grew into a fully-fledged adult, able to leave the nest and fly away on their own journey. Like the big bang caused the universe to expand, a person grows from one tiny cell into a being comprised of many billions of cells. And is that why the person shrinks as they head towards the final light? The reverse of the great expansion, the great contraction until even the life-giving spark is about to leave. The Transformers fought for the All-Spark, the cybernetic life-giving force. Are spark plugs still needed in electric cars? What vehicle will you ride in for your final journey? Will the funeral director allow you to take it for a test drive?
I have many questions but few answers. I try my best to prognosticate as closely as I can. I am often wrong both ways. Too short or too long, I have no way of telling how it will be. I always would rather people come to visit too early, rather than too late. It’s about giving people opportunities to see who they want to. In preparation for the final disconnection. Closure of relationships, some of which are life-long may be done. I don’t want there to be any surprises as the end approaches. I need to signal ahead of time what direction things may be taking. I am not the driver but am a navigator. I am here to help point out the checkpoints along the way. “Watch out for the pothole up ahead. Hard left after the fence.” My job is to make the final journey as smooth as possible. To make sure that the others along for the ride are not shaken up too much. I can’t take away all of the (e)motion involved, that would be out of my scope of practice.
“The spark is gone.” Death may follow soon. Everyone dies in their own way at their own pace. The loss of spark may be just one step in the dimming of a person’s overall light. Everything starts to fade away as a person dies. Their skin can start to look translucent as they shrink away from us. The sun is setting, and soon there will be darkness. Rest in peace fellow human.