People who die from COVID-19 actually follow the same, usual pattern of dying; which is of becoming very tired, of not being able to stay fully awake, and then gradually a lapsing into unconsciousness.
During this difficult time we spoke with an old friend of The Art of Dying Well, Dr Kathryn Mannix. Kathryn is a palliative care physician and bestselling author of ‘With the End in Mind’.
Kathryn has provided many people with reassurance and comfort about what dying is really like, having spent her medical career working with people who have incurable, advanced illnesses. Starting in cancer care she then became a pioneer of the new discipline of palliative medicine, and has worked as a palliative care consultant in teams in hospices, hospitals and in patients’ own homes, optimising quality of life even as death is approaching.
Dr Kathryn’s words are taken from our podcast: Episode 18: Dying, Recovering and Caring during the COVID-19 Pandemic.
Drawing on your experience Kathryn, please could you talk us through the natural process of dying?
“That’s really important isn’t it – is the picture we draw in our mind of what dying might look like. And, how we can frighten and distress ourselves by imagining something like we saw on the television, in a soap opera, on a cinema screen.”
What is different with COVID-19?
“Well guess what, people who die of this virus follow the same, usual pattern, which is of becoming very tired, of not being able to stay fully awake, and then gradually a lapsing into unconsciousness.
“What’s different about the virus is that this happens quite quickly, that people who have been struggling for a little while but managing, will perhaps over a period of one to three days, very dramatically deteriorate, become less able to stay awake, be less able to talk to the people around them.
“And then they enter a phase that everybody enters towards the very end of their life, which is of being intermittently unconscious, and then unconscious all the time. And, once they are unconscious all of the time, the only thing that’s still switched on in their brain is the bit that drives breathing.”
If we were with the person, what would we see?
“Ordinarily what we see is reflex breathing cycles of breathing that’s sometimes deep, and then it becomes shallow, and then it becomes deep again. And sometimes slow, and sometimes fast, and then it becomes slow, and then it goes fast again.
“Because the lung infection with this virus makes people’s oxygen levels in their blood drop very low; people might be breathing 30 or 40 breaths a minute – but that’s quite rapid breathing – so it’s quite important to understand that they are now deeply unconscious – and this is simply a reflex, the body is breathing fast to just try and get the oxygen levels right in the blood, but the person themself is not feeling breathless, and there will be pauses, and then eventually there will simply be one breath out that just doesn’t have another breath in; they’re not drowning, they’re not choking, they simply stop breathing because their brain has stopped driving their breathing.
“So that very last part of being alive, the person is deeply unconscious as their breathing gradually stops happening and they are completely unaware of it. So if you’re imagining somebody who’s not with you because they’re at the other end of the country and you’re not allowed to travel or because they’re in hospital and you’re not allowed to be there, then the picture to paint is of unconsciousness, of slowing of breathing, of something that actually is quite peaceful, not at all like on television.”
If you’d like to hear more from Dr Kathryn Mannix please listen to our podcast: Episode 18: Dying, Recovering and Caring during the COVID-19 Pandemic.
Read more about what death is like.