What happens at the end of life?

People who have survived a near-death experience tell very different stories about their experience of being 'dead'. Although many describe moving towards a bright light and a very welcoming environment which they find hard to resist, others describe sinking or floating into nothingness.

The last weeks

It can be hard to understand how cancer can kill you. In the early stages of having cancer, your body's own immune system, together with any treatment you are receiving, can keep the cancer under control. As new cancer develops, your doctors will have suggested treatments such as radiotherapy or chemotherapy to help your body fight the disease. However, eventually the cancer grows so rapidly that it takes control. The cancer gradually uses up all your energy, leaving you exhausted and no longer able to fight. No matter how much you eat, you begin to lose weight. Your appetite for your favourite foods disappears. When this happens, just trying to carry out ordinary daily activities such as getting up and dressing make you feel exhausted. Your muscles shrink and you become weaker. Eventually, just staying awake becomes too much of an effort and you find you spend more of your time sleeping or drifting in and out of consciousness. The majority of cancer patients are unconscious when they die.

As with all other seemingly healthy people, there is a small risk that you may die suddenly. However, a gradual decline is much more common. Because of this uncertainty, it is always better to do important things such as getting your affairs in order sooner rather than later. Then you can relax and enjoy the time you have left.

The last few days

In the later stages of cancer, several different organs may be affected. Cancer in the liver can cause swelling and discomfort in the upper abdomen; the patient may also become jaundiced (yellowness of the skin, eyes and urine). Cancer in the lungs can cause cough and breathlessness. Cancer in the abdomen can cause kidney failure or blockage of the bowels. When any of these changes is severe enough to prevent the normal body functions, the result is a build up of toxins. Cancer in the brain can cause headaches, confusion and unsteadiness. Any of these can cause you to become drowsy, then drift into a deepening coma.

At times you may become confused, and not recognise your loved ones, or hear or see things which are not there (hallucinations). This is usually much more frightening for your family and friends than it is for you. The drowsiness and hallucinations are usually partly due to the build up of toxins, partly to your profound weakness and partly to the medication you need to keep you comfortable. At this stage food and drink are not necessary as your body is no longer able to benefit from them. Moistening your lips or mouth are all that is needed.

Occasionally a dying person remains aware and able to talk right up until very close to the end, and can have a meaningful conversation with loved ones. However, this is the exception rather than the rule, and you should say all the important things much earlier - repeating them if you have the opportunity.

Even though you are unconscious during the final hours or days of life and will not be able to respond to your loved ones, it is likely that you will still be aware that they are there with you and you may be able to hear what they are saying. This will be very reassuring and comforting for you. For most people, the final moments of life are very peaceful, with a gradual slowing and irregularity of breathing, before it stops. With some people this seems to take a long time, while others slip away quite quickly.

If you practice a faith where the moments leading up to death and the actual moment of death are vital for your future, this time needs to be spent as peacefully as possible. It is therefore important that those who are looking after you are aware of your needs, and that they understand that you will not want to be disturbed in any way for some time before or after death.

The staff in hospital or hospices will try to find out what is appropriate for people of different cultures in their final hours, but it may be easier if you or your family make staff aware of your needs. This will allow them to make arrangements for your spiritual or religious adviser to visit if you feel that this is helpful, and to ensure that your body is treated in the appropriate way after death.