My Beautiful Boy

It hit me the other day, Ian is dying. As this hit me...I sat there wondering how it is possible that it is just hitting me...Ian is dying. Ian has been dying, slowly over time, slowly over time. I am not sure what brought me more to this realization yesterday, but it hit me right in the face, SMACK. 

I decided to look up the signs of death. According to caring.com, there are 10 signs death is near. These signs of approaching death are specific to the natural dying process (apart from the effects of particular illnesses the person may have). Not all symptoms show up in every person, but most people experience some combination of the following:

• Loss of appetite - Energy needs decline. The person may begin to resist or refuse meals and liquids, or accept only small amounts of bland foods (such as hot cereals). Meat, which is hard to digest, may be refused first. Even favorite foods hold little appeal. How to respond - Don't force feed; follow the person's cues even though you may be distressed by a loss of interest in eating. Periodically offer ice chips, a popsicle, or sips or water.Use a moistened warm cloth around the mouth and apply balm to the lips to keep them moist and comfortable.
• Excessive fatigue and sleep - The person may begin to sleep the majority of the day and night as metabolism slows and the decline in food and water contribute to dehydration. He or she becomes difficult to rouse from sleep. The fatigue is so pronounced that awareness of immediate surroundings begins to drift. How to respond - Permit sleep. Avoid jostling the person awake. Assume that everything you say can be heard, as the sense of hearing is thought to persist, even when the person is unconscious, in a coma, or otherwise not responsive. 
• Increased physical weakness - A decline in food intake and lack of energy leads to less energy, even for activities like lifting one's head or shifting in bed. The person may even have difficulty sipping from a straw. How to respond - Focus on keeping the person comfortable. 
• Mental confusion or disorientation - Organs begin to fail, including the brain. Higher-order consciousness tends to change. "Few conditions leave people hyperaware when they're dying," says palliative-care physician Ira Byock, author of Dying Well. The person may not be aware of where he or she is or who else is in the room, may speak or reply less often, may respond to people who can't be seen in the room by others, may seem to say nonsensical things, may be confused about time, or may act restless and pick at bed linens. How to respond - Remain calm and reassuring. Speak to the person softly, and identify yourself when you approach.
• Labored breathing - Breath intakes and exhales become raggedy, irregular, and labored. A distinctive pattern called Cheyne-Stokes respiration might be heard: a loud, deep inhalation is followed by a pause of not breathing (apnea) for between five seconds to as long as a full minute, before a loud, deep breath resumes and again slowly peters out. Sometimes excessive secretions create loud, gurling inhalations and exhalations that some people call a "death rattle." How to respond - The stopped breathing or loud rattle can be alarming to listeners, but the dying person is unaware of this changed breathing; focus on overall comfort. Positions that may help: the head slightly elevated with a pillow, sitting up well-supported, or the head or lying body tilted to the side slightly. Moisten the mouth with a wet cloth and moisturize with lip balm or petroleum jelly. If there's a lot phlegm, allow it to drain naturally from the mouth, since auctioning it out can increase its quality. A vaporizer in the room might help. Some people are given oxygen for comfort. Br a calm, physical presence, stroking the arm or speaking softly. 
• Social withdrawal - As the body shuts down, the dying person may gradually lose interest in those nearby. He or she may stop talking or mutter unintelligibly, stop responding to questions, or simply turn away. A few days before receding socially for the last time, the dying person sometimes surprises loved ones with an unexpected burst of alert, attentive behavior. This can last less than an hour or up to a full day. How to respond - Be aware that this is a natural part of the dying process and not a reflection of your relationship. Maintain a physical presence by touching the dying person and continuing to talk, if it feels appropriate, without demanding anything back. Treasure an alert interlude if and when it occurs, because it's almost always fleeting. 
• Changes in urination - Little going in (as the person loses interest in food and drink) means little coming out. Dropping blood pressure, part of the dying process (and therefore not treated at this point, in tandem with other symptoms), also contributes to the kidneys shutting down. The concentrated urine is brownish, reddish, or tea-colored. Loss of bladder and bowel control may happen late in the dying process. How to respond - Hospice medical staff sometimes decides that a catheter is necessary,  although not in the final hours of life. Kidney failure can increase blood toxins and contribute to a peaceful coma before death. Add a bed pad when placing fresh sheets. 
• Swelling in the feet and ankles - As the kidneys are less able to process bodily fluids, they can accumulate and get deposited in areas of the body away from the heart, in the feet and ankles especially. These places, and sometimes also the hands, face, or feet, take on a swollen, puffy appearance. How to respond - Usually no special treatment (such as diuretics) is given when the swelling seems directly related to the dying process. (The swelling is the result of the natural death process, not its cause).
• Coolness in the tips of the fingers and toes - in the hours or minutes before death, blood circulation draws from the periphery of the body to help vital organs. As this happens, the extremities (hands, feet, fingers, toes) become notably cooler. Nail beds may also look more pale, or bluish. How to respond - A warm blanket can keep the person comfortable, or be or she may be oblivious. The person may complain about the weight of the coverings on the legs, so keep them loose.
• Mottled veins - Skin that had been uniformly pale or ashen develops a distinctive pattern of purplish/reddish/bluish mottling as one of the later signs of death approaching. This is the result of reduced circulation. It may be seen first on the soles of the feet. How to respond - No special steps need to be taken.

NOTE - THESE GENERAL SIGNS OF IMPENDING DEATH CAN VARY IN SEQUENCE AND COMBINATION FROM PERSON TO PERSON. IF A PERSON IS OF LIFE SUPPORT (RESPIRATOR, FEEDING TUBE), THE PROCESS DYING FOLLOWS CAN BE DIFFERENT. THE SIGNS OF DEATH LISTED HERE DESCRIBE A NATURAL DYING PROCESS.

Thinking back to the last few days, I realized this hit me because of a conversation I had...a hard conversation but a good one to say the least. Through this conversation I realized a few things and wanted to find out more such what signs of the dying process. When someone begins the dying process it doesn't mean that it is today, it doesn't meant that it is tomorrow or it doesn't mean that it is in a couple of weeks or months, although it could mean that. Looking at the signs above, Ian has started some of them...he goes back and forth with his eating, some days he will eat one meal and that would not even be a meal for you and I, sometimes we have the excessive fatigue and sleep, and occasionally the social withdrawal, the smiles are not there as often and neither is the sparkle in his eyes. 

One of the other things I realized through this conversation is when someone dies their physical presence is no longer with us but their soul is. According to Chabad.org, the soul is the self, the "I" that inhabits the body and acts through it. Without the soul, the body is like a light bulb without electricity, a computer without the software, a space suit with no astronaut inside. With the introduction of the soul, the body acquires life, sight and hearing, thought and speech, intelligence and emotions, will and desire, personality and identity. Realizing this has helped me with my journey in acceptance and being "okay" with the process.

Remember treasure, dream and live.