Signs of Passing – How Imminent Is Death?

In this era of “dying harder” how can we know when our loved one is ready to pass? In most cases death can be seen as an eight-stage process.

In Sacred Passage, Margaret Coberly, RN,  describes the eight stages of dissolution as the “most enriching and psychologically helpful Tibetan Buddhist teaching about death and dying…The precise nature of the teachings provide an easy-to-read map through the unknown territory of dying and can easily be used by westerners who may want to broaden their understanding about the dying trajectory…”

1. Earth dissolves into Water. The mind is now starting to separate from the body. The dying person experiences a feeling of powerlessness and deep heaviness that feels like sinking. He or she complains about weakness and exhaustion. The eyes may roll back and the person experiences mental turmoil. Caregivers may notice that the person actually feels heavier during transfers or when moving in bed. Caregivers can help by elevating the patient’s head, eliminating heavy covers, providing reassurance in clear and direct speech and avoiding emotional heaviness and anxiety (as well as needless conversation) at the bedside.
2. Water dissolves into Fire. Initially the feeling here is of drowning, but it is quickly replaced by dehydration, heat and parchedness. The person may likely withdraw and lose interest in worldly affairs. Her perception of pain may decrease and she will have difficulty swallowing. Ice chips made of water or juice and a damp cloth on the neck or forehead will help. The caregivers should protect the dying from confusion and fright, at the same time informing upset friends and relatives that the dying person is not rejecting or turning away from them, but naturally turning inward.
3. Fire dissolves into Wind. Initially a feeling of being consumed by fire is replaced by a feeling of being very cold. Digestion and respiration weaken. The extremities mottle and the person may require extra clothing. Ordinary consciousness becomes very dim, the mind becomes even more unfocused and the person may not even recognize family members. At this time it is important to avoid disturbing the dying person’s mind. Keep a positive mental outlook at all times around the dying.
4. Wind dissolves into Space. Respiration becomes slow and rattled. A profound silence envelops the dying. According to western medicine, death has occurred. The dying person is no longer aware of external forces. Visions arise according to the predominant mental tendencies. It is important at this time to do Readings from texts to guide the dying and explain what is happening or speak softly to the dying person, urging him to move onward and merge with the peace, happiness and light (or any religious figure or symbol) that is beckoning.
5. The final 4 stages of dying involve dissolution of the ordinary mind and the subtle mind. We need not describe these here except to let the caregiver know that for a period, the dying person is still going through dissolution and that an awareness of some sort exists. Tibetan Buddhists let the body remain undisturbed for 3 or 4 days to let dissolution occur. This is usually impossible for westerners, but it is important to handle the body with care: avoid jostling, and keep a meditative atmosphere.

Here is another description of the symptoms of transition, and a more clinically oriented article: recognizing the dying process.