Dying and Death in a Collapse Situation, by Irish Eyes

Many Americans have never experienced the death of someone close to them, and our current system of dealing with death makes sure that family and loved ones have as little contact as possible with the dead, and often very little with the dying.  Our culture reacts to the topic of death much like the Victorians reacted to the topic of sex.  We avoid even using the word “died” or “dead”, preferring euphemisms such as “passed”.   With the more widely spread use of hospice and palliative care teams, families are learning that helping their loved ones through the dying process can be a rich and healing time.  However, the dying process is still rather reminiscent of childbirth 30-40 years ago, when fathers and other family members were shut out, and the mothers in labor were left to labor alone and in pain, or drugged.  Too often the dying find themselves in similar situations, isolated from family and away from home.

Contrast the process of dying in our not so distant past, and in current non-westernized cultures, with that of many American families today.   In the past, the family would be responsible for caring for their loved one through the dying process, preparing the body for burial, sitting in vigil with the body as everyone told stories and remembered the person, and finally committing the body to the ground with prayer and other important rituals.   Now, often due to anxiety about the whole process, the family often chooses to have the person die in the hospital, be whisked away by funeral home personnel to be attended to.  Cremation avoids the uncomfortable issue of being in the presence of a dead body, and if cremation isn’t done, the body certainly must not be seen as that might be too “creepy”.

Those readers who saw the movie Places in the Heart may remember Sally Field’s character tenderly washing and preparing the body of her husband for burial.  Indeed, this was the norm not so long ago and continues to be the norm in non-westernized cultures, where caring for the dying and the dead is a way for the family to perform the final actions of kindness and respect for their loved ones.

What happens when it all comes down and we must, of necessity, figure out what to do with the dying and the dead?  In the past, there was a process which was taught elder to younger.  Now we are cut off from that wisdom and must sort out how to manage a painful and devastating situation.  We must learn again about the dying process, how to help our loved ones and ourselves through this final transition, and what to do afterward.  Caveat- none of this is offered as medical advice, and trained medical persons should be consulted when they are available.

Preparing to care for the dying:

As hard and sad as the topic of dying is, we must prepare for managing these situations in a collapse situation, and help our loved ones, and ourselves through.   There may be no option to simply call the doctor, funeral home, our pastor or priest, or the ambulance.  Preparing emotionally and spiritually is the vital first step.  Then, we can make the practical preparations.  You’ll want to assemble a comfort in dying kit, much as you would assemble a childbirth or first aid kit.  Here are some steps:

  1. If possible, collect medications ahead to assist with pain and anxiety such as liquid morphine and ativan, and learn how to use them safely.
  2. Constipation can increase pain and overall discomfort. Make sure you have laxatives, stool softeners and enema supplies.
  3. Adult diapers or continence supplies can be comforting to both the dying person and caretakers.
  4. Lotions for skin dryness, and lip balms
  5. Small mouth sponges for comfort during dehydration
  6. Include pads for beds such as Chux
  7. Sometimes in the dying process the body’s ability to clot blood is impaired, leading to bleeding through the mouth, nose, rectum and skin.  This can be very distressing to both patient and caretakers.  Having dark colored sheets and towels set aside in your kit can help.
  8. Nitrile gloves, N95 masks and eye protection in the event that the illness is contagious.


Preparing to care for the caretaker

Walking with someone through the dying process, as hard as it is, can also be a powerful, deep, and rewarding experience.  It is truly a privilege to help someone through the passage of death and into their new lives, free from their weary physical bodies.   Grief can be like a tsunami, running us over and we feel as though we will drown in our sorrows.  Helping someone we love in practical ways, praying with them, and holding their hands gives us strength as well.  How do we try to get ready for this experience and get through it?

  1. Grow strong in your faith.  Pray, read scripture, recall God’s promises
  2. Take breaks. You cannot help someone else over the long haul if you exhaust yourself.  Arrange for practical care in shifts.
  3. Don’t forget to eat
  4. If you can’t sleep, try to rest
  5. Share your own sorrow with others and reach out for help
  6. Gather your own resources in terms of Bibles, prayer books, and other things which comfort you.
  7. Don’t keep children away, but do explain to them what is happening at a level of their understanding.  Children are comforted by being included and made useful, such as fetching things.  Children become anxious when they are not told anything and often their worries about what is going on are worse than the truth. 


What Happens in the Dying Process and How to Support the Dying

A very wise teacher once told me that the dying need two things, comfort and company.  They also need honesty.  It will become obvious to them and to you that they will die from their illness or injury.  Pretending is easier, but it also denies them the dignity of acknowledging their time is short.  It keeps the dying from being able to talk about their own fears, make their own plans, talk openly with their loved ones, and reconcile with God and old enemies.  Follow their lead as they come to their own recognition of mortality, but try to be brave and allow the hard conversations to happen.

In the natural process of dying by illness or disease, there are some consistent signs and symptoms which can be recognized.  To use a natural pregnancy as our example, the mother and her doctor or midwife may be aware that labor is going to start soon even if they don’t know exactly when.  They may note symptoms such as increased Braxton Hicks contractions, an extra burst of energy, loss of the cervical mucus plug, change in the position of the baby etc.  Likewise, there are signs and symptoms that someone is in the process of dying, even if it’s not known exactly how long that will take or how soon it will happen. 

Early Stage Changes and Symptoms

Decreased appetite or no appetite.  This is the body’s way of gradually shutting down systems.  In certain cancers, blockages of the stomach or intestines can cause pain and discomfort during eating and avoiding intake helps with comfort.
What to Do
Don’t force food, but allow the person to choose their own intake
Experiment with textures, sometimes liquid or very soft food is more easily tolerated

Even if the person refuses food and water, they may welcome a small sponge soaked in water to moisten their mouth and a balm to keep lips from becoming uncomfortably dry.

Increased fatigue and weakness and increased in sleeping.  Some of this may be connected with decreasing intake, but some may be related to decreasing oxygenation and failing organ systems.
What to Do
Allow the person to rest and sleep as they need to. Don’t attempt to wake them up or stimulate them to stay awake.

Assume the person can still hear you, even if they appear to be sleeping.  Speak gently and softly to let them know you are there and what you are doing e.g. changing bed linens.

Withdrawal from others and from usual activities and interests.  It is normal for the dying to begin a process of being more internally focused.  This does not mean they don’t care for you or necessarily want you to go away.
What To Do
Follow the lead of the person in determining whom they want to have around.

Decrease the stimulation in the room e.g. keep the noise down and avoid too many persons in the room at once.

Loss of bowel and bladder control.  As the muscles begin to loosen and relax, a person may not be able to avoid accidents.  The decreased appetite experienced by many may decrease bowel and urine output. 

What To Do
Keep the person as comfortable as possible, changing out soiled or wet garments and bedding.

A pad under the person may keep the bedding cleaner.

Try to take a matter-of-fact attitude with the person, who may be embarrassed or feel humiliated by this loss of function and independence.

Itching.  This may happen as a result of kidney failure, or with dehydration

What To Do
Lotions may relieve itching briefly
Benadryl may offer some relief.

Increased pain.  As some disease processes progress, pain will increase at the same time as the person’s capacity to manage may decrease.

What To Do
You’ll want to try to anticipate ways to help with pain ahead of time by stockpiling medications if possible.

Explore methods such as gentle massage, warm and cold compresses, and position changes.


Late Stage Changes and Symptoms

Mental confusion.  This may be related to decreased oxygenation of the brain, or to changes in the brain itself e.g. with metastases of cancers to the brain.  Fevers with infections may lead to delirium and hallucinations.  People who are confined to one room may become confused when they lose track of routines to mark times/days.  This symptom, known as “sundowning” can become worse in the evening.

What To Do

Keep the shades or curtains open so that the person can tell if it is day or night.  This helps keep them oriented.

Gently orient the person when you enter the room, telling them who you are and where they are.

Some may talk of seeing and hearing long departed loved ones, or angels, or may see things you aren’t able to see.  Don’t try to argue with them or convince them they’re wrong.  Simply listen.

Even if they seem asleep, assume they can hear you.  They may enjoy hearing scripture read or passages from favorite books..  Pray with them.

If the person becomes agitated, don’t restrain them or try to reason with them.  Simply continue to quietly and gently respond with reassurance.

Towards the end of the dying process, some individuals seem to have a burst of clarity, become brighter and engaged with others, are able to say goodbyes.  This period may last a short time or for a day or two.

Swelling of extremities such as feet and ankles.  This may be caused by the kidneys failing or lack of circulation.  There is little to do and this is generally not uncomfortable.

Labored breathing and gurgling sounds during breathing. Breathing may become very fast or shallow.  Breathing may stop for a few seconds to minutes, only to have the person suddenly take a large gasping breath. This may be very distressing to others but usually does not mean that the person is in distress or is uncomfortable.

What to Do
Allow secretions to come out of the mouth, wiping them gently.

Suctioning secretions (assuming this would be available) can sometimes increase the secretions and isn’t recommended.

Coolness in fingers and toes, mottled bluish coloration.  This means the circulatory and respiratory systems are shutting down.

How Do You Know When A Person Has Died:

  1. No breath or pulse able to be detected
  2. Pupils dilated
  3. Jaw may be relaxed and mouth slightly open
  4. Bowel and bladder release
  5. Skin is cool to the touch and pale to bluish in color.


Before burial (if this is possible for you in a TEOTWAWKI situation), wash and dress or wrap the body.  Coffins will be a luxury in many situations but bodies may be buried without one.  The public health implications of where you locate your cemetery is a whole other article, but obviously beware of contaminating water sources and bury the dead deep enough to discourage animals from digging.

May God give us the strength to manage these hard and sad tasks with His grace and love.