Peaceful Passages: Writing a Natural Death in Fiction (Part 1)

Does your character know what to expect with a natural death? Is it painful? How long does it last? What are the signs death is getting close? Did you know the death rattle is not the last breath a person takes? Do you need a timeline for your story, with some real-life examples? I have got you covered. Learn about all of this and more in today’s episode. 

Transcript

Does your character know what to expect with a natural death? Is it painful? How long does it last? What are the signs death is getting close? Did you know the death rattle is not the last breath a person takes? Do you need a timeline for your story, with some real-life examples? I have got you covered. Learn about all of this and more in today’s episode. 

Welcome to Writing Rural with Alley, the fiction writer’s weekly inspiration station for rural life and lifestyles, from historical to post-apocalyptic, helping you bring your rural stories to life! I’m Alley, and this is episode #88, Writing A Natural Death (Part 1). Stick around to the end to find out all the ways things could possibly go wrong. 

A quick disclaimer, I am in no way shape form or fashion a medical anything. This is not medical advice, death advice, or any other kind of advice. This is solely for the purposes of fiction writing, and nothing else! 

Welcome to the Halloween episode. As many of you know, the last few years, but especially the last few months, have been rough in our family, with several deaths. I have been at more deathbeds than I wish, and thankfully all of them from natural causes. That’s to say, I have some experience with this, and will be passing it along while it is still fresh in my memory. 

For any family or friends listening or watching, that is your cue, that I might talk about my family, and if that bothers you, you might want to skip this one. For everyone else, I will do my best not to cry, but no promises. With that said, let’s get into this. 

Now, this topic is impossible to talk about without talking about hospice, and the wonderful caregivers that work for them. If you do not know, hospice is what a person who has a terminal illness and is not expected to live more than six months is placed on. This is a team of caregivers. Doctors, nurses, therapists, chaplains, and we can’t forget the call center people holding everyone together in the same loop. 

On quick note, remember, all deaths will be a little different, and no two are the same. I know that same is true for pregnancies, but trust me, they are not the same. Also, each person will think, feel and react differently to each death. A single character will feel differently about two different deaths, just as many characters will feel differently about the same death. 

An example is that when my mother died, all of my brothers were devastated, cried, and wanted to talk at her memorial service. However, I was dealing with postpartum at the time, and didn’t cry, nor did I want to talk. And yes, many of my family members have not forgiven me for that. I’m not complaining, just explaining, death is complicated. 

So, let’s go over some timelines. Up to a year, before death, a person is likely to start noticing unusual weight loss. I do not mean; they are working out, or on a diet, but unintentional loss that has no real explanation. In fact, this is actually the time it is most likely a person can find what is wrong with them, such as a cancer, and take action to try to keep from dying. That said, this is the number one sign people ignore until it is too late to receive treatment. Historically, and after the Apocalypse, it is unlikely there is a treatment. 

Other things in this time that people overlook until to late can include, but is not limited to, wounds that do not close or heal, difficulty breathing, shortness of breath, feeling pressure or upper abdominal pain, fainting, dizziness, unexplained weakness, headaches that do not go away, sudden loss of vision or even blurry vision without injury, confusion or changes in mental status (though, that is likely noticed by someone other than the person dying), persistent vomiting or diarrhea, coughing or vomiting blood, fevers that will not go away, and more. 

One to three months before death, there are some new changes. The person can seem to withdraw from the world around them. In both my father, and in-law’s cases, they just didn’t reach out as often, and were not as chatty as they normally were. One was a very talkative person, and the other was a story teller, and loved to laugh. Both had a noticeable reduction in this. When they do talk, it is very common for them to want to talk about the past and reminisce about old times.

There will be a reduced appetite and thirst. This can manifest in several ways. For my mother, she had nausea and vomiting. Keep in mind, she was on chemo, but it lasted longer than her normal chemo effects. My father couldn’t eat as much. Either he said he was full, or nauseous. My in-law just ate less often, and smaller amounts when he ate. I have known others that only wanted sweets. One other thing I noticed, is that several of them had tastes changes, making food taste bland, and unenjoyable. Many of these happened years or even decades before covid was even a thing. 

Another is that weight loss is very common at this time. Partly from a slow down in eating, but definitely more than you would expect for only a slowdown in food intake. And let me say, that arm wasting is very common at this time too. So common, that I have rarely met a person who didn’t have this sign, and I grew up going to nursing homes every day as my parents both worked in them when I was young. 

There is an increased risk of infection at this time. In fact, this is so common that roughly 13 to 20% of natural deaths have infection as a contributing factor. That is one and two out of every ten deaths. However, globally there are estimates that it is as high as 1 in 7 deaths. This will be more likely in a historical or post apocalyptic setting. 

Pain and nausea can increase during this time. Many times, it is just uncomfortable feelings that over the counter can take care of, or in history, a cup of willow bark tea. However, some diseases are much more painful, and will require help to control the pain. Some of these can include colon or rectal cancer. 

The desire to sleep also starts to increase in this time. Sometimes it can look like naps, others just falling asleep wherever they are. Going to bed earlier, and getting up later are common. If this is a child, they might just want held to sleep or to snuggle with the parent.

A mental thing that can happen at this time is the sense of euphoria. I’m a Christian and believe there is a reason for that. Others believe that it is the natural body chemistry changes that happen at this time. At the same time, others can feel a sense of dread. I repeat the same causes as the last one. However, the part that some people struggle most with is that dying people can feel both of these at the same time. This is weirdly common at this stage, and frankly, to be expected. That said, many people feel different from what they expected as the time draws closer, and that can be distressing to them. 

In the weeks before death (one to two weeks), the person will be sleeping more. In fact, they are likely to be sleeping more than they are awake. This is very normal, and not a cause of alarm. In fact, in every case I have seen, this felt natural, and seemed relaxing to both the person dying and their caregiver. That said, some people can be saddened by this, as they will realize that it is likely they are getting closer to death. 

Other things that are common are an increased confusion. This is believed to be because the body is shutting down. Keep in mind each person is different, and some people will be lucid, and present the whole time. Congestion is common at this time. 

Also, there will be a greater decrease in their food intake. I have seen some with an appetite of a newborn once a day. Whatever they want is perfectly fine, and food and drink should not be forced if they do not want it. This is also the time they might start to have problems swallowing. Food and drinks might have to be thickened so they do not choke. I find most people have a honey consistency that is the easiest at this time, but not everyone is the same. 

Some of the physical changes are a lowering body temperature. While some people will have a fever, those who don’t will have their temperature go down. Thier hands and feet will become cold to the touch. The person may or may not notice this. 

There can be skin color changes in the hands, feet, lips, nose, ear, toes, and well, pretty much anywhere a person would worry about getting frostbite. The colors can look blueish, purplish, grayish, or just seem off. These can be all over the area or in blotches. 

Weakness and fatigue are common at this time. Many people will be in bed, unable to get out. I have also had one person who had this issue, but still managed to swing an IV pole at my head and climb over the bed railing while I was trying to call the nurse in to help because she ripped the IVs out. While most will be in bed, there are some that can surprise you! 

Sudden leg and arm movements, or jerkiness, if you will, are common. They do not need a history of this. It can be twitches, or larger movements. Usually looking like they are restless and trying to get comfortable. If they do not show any other signs of discomfort, then it is unlikely that this is caused by discomfort. 

Talking less is common. Some people don’t talk more than a few words during this time. My father was one of these people, but he still loved to hear you talking. Side note: It is believed that hearing is the last thing to stop when people die. That means it is likely that they can hear you long after they can no longer reply, and is the reason, talking to people can help ease their signs of discomfort, as most people do not want to be alone. 

Other things that happen in this time, is lowered blood pressure, incontinence (or the lack of bladder control), constipation, or nausea. Irregular breathing that can be faster, slower, or even speed up and slow down is common, too. Increased sweating can start during this time, and is more common the closer they get to death. 

Pain can become more of an issue. Now, let me be clear here, death, at least natural death, is not painful. Our bodies are naturally designed to die, just as they are to be born. What can be painful are certain diseases. Some of these include ALS, Parkinson, or any kind of disease that can obstruct the bowels. My mother fell into this category as she died of colon cancer. 

In my mother’s case, as with most cases, hospice workers were able to keep her pain under control. She, as some people do, was worried about becoming addicted to pain meds, since morphine is a common drug choice. There is no need to worry about this, as first, this isn’t long term as they are dying, and second, it helps control pain. No one wants to die in pain. Historically, some people just died in pain, and others choose to end things themselves or their family members did. I am not saying that is right or wrong, just stating it happened. 

A common question asked by caregivers of non-verbal, or unconscious people (because some diseases like Alzheimer’s leave people like this) is how do you tell if they are in pain? There are a few signs. Things such as restlessness, or agitation, can be a sign. Groaning a lot, flinching, or guarding when touched are other signs. 

At this time, terminal secretions start to happen. This is what we call the death rattle. Yes, I was shocked to learn this, as I thought it was the last breath, but it is not. In fact, this can start about two weeks before the death. To not get technical, the body will still be making saliva, but the brain will not be triggered to swallow it as it had before. This leaves the person having to breathe over or around the small amount of saliva they would have swallowed. This makes a gargling rattly sound that it got its name from. 

In modern times, there is medicine to help with this. It is something we chose for our loved one as they were distressed that they felt like they needed to spit something out and could not. The terminal secretions medicine helped, and they were able to relax better. 

Other none medicine ways to help is to place them is with a bit of an elevation in bed that moves or with pillows to prop them up. Another way is to roll them on their side, and let them drool out of the side of their mouth.

In the days before death, there are a few common things. First (that we will cover) is visioning. This is when the person is lucid, (that means they are of sound mind) and they see, and often hold conversations with their dead loved ones. Many times, they say they are told about the family that misses them, and the family member they see will be back to get them for a trip. This normally brings them peace, and they are happy about it. In fact, this happened in all but two of the deaths I have been at. This is not considered a hallucination. That is a distinction that is very important to know. 

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This episode has grown much longer than I expected, and since I have much more to say, I will finish this episode next week. 

Thanks for listening! Until next time, happy wordsmithing.