What happens after death?
Many people wonder. What are the procedures? What should I expect? Perhaps knowing a bit about what may lie ahead may provide some comfort and take away some of the fear that is often associated with the unknown.
When I arrive at someone’s home as a continuous care nurse, I introduce myself to family and then receive report and account for narcotics with the previous nurse. After the previous nurse leaves, I take some time to chat with family, hear their concerns or advice on caring for the person, and then start my general assessment and take vitals; blood pressure, temperature, respirations.
Many times on a night assignment, family may go off to other rooms to sleep, as oftentimes a patient’s bed has been moved into the center of the house so that even if unresponsive, they are able to hear the goings on of family life.
It is not unusual for an imminent person, someone very close to dying, to have very shallow breaths which may also have long, or short periods of not breathing, called apnea. But there will come a time that slight changes occur that would alert me that death is near, and if at all possible hastens me to alert family members to come to the bedside. I step back in the room now to allow the dying person to become surrounded by those that love them. Loved ones will generally hold their hands, cry and stand witness as the last breaths are taken. It is at this time that I step forward to confirm death and note time.
The immediate period following death is for family. It is a private time to say their goodbyes. The time spent with a person after death will be as long as that family needs. There is no rush, time is given to absorb the new reality. No matter how much someone has adjusted to and accepted the idea of death, the reality is like a punch in the stomach. It takes your breath away. Tears are shed, grief is vocalized, calls are made. During this period I will place a call to my hospice team to report the time of death and request a chaplain or social worker to come if family had expressed a need for such services. The hospice team will now cancel future continuous care shifts, notify all doctors, contact bereavement staff, and alert the equipment department so that future arrangements can be made to remove hospice equipment, beds, commodes, etc which are all visual reminders of the disease. All medications are then destroyed by me and witnessed by family member present.
When family tell me they are ready, the next thing to do is post mortem care which involves bathing and dressing the body. Occasionally family members may want to assist which is always fine and welcomed. Family will choose clothing, sometimes one outfit to leave the home and another to be brought to the funeral home for viewing. After post mortem care, the family will again be offered the opportunity to spend some time with their loved one.
*In cases where families are not present, such as at a nursing home or hospice house, calls are made whenever possible to alert family members of changes so that they may have the chance to be present at death. If death comes quickly and that is not possible, persons listed as contacts are notified of the death and given the opportunity to come in and view the body.
**If a funeral home has not been chosen at this point, then family are now making calls to make arrangements. Nursing homes and hospice care centers may provide a list of local funeral homes but are not allowed to make recommendations. Take note that nursing homes and hospice care centers will have a time limit protocol, amount of hours that will vary as to how long the body may remain at their facilities, as they are not permitted or prepared for long term storage of the body.
After what may be an hour or longer, the family, when ready, will direct me to call the funeral home. The funeral home generally sends one to two people to transport the body back to their establishment. When the funeral home transporters arrive they will answer any questions and again give family private time with their loved one before removing the body. I am present throughout this process as it unfolds offering support, information and direction. I will work to remove trash, remove bed linen and arrange equipment as needed in hopes of relieving some burden on family.
The body will be completely covered when removed from the home and nursing home setting by either a body bag or wrapped coverings. In the hospice house setting which I worked, faces of the deceased were left uncovered as they were taken out of the building, and all staff would stand and bow heads as the transported body passed down the halls.
In the home setting, once the body has been removed by the funeral home, it is time to say my own goodbyes, leaving the hospice bereavement team and the funeral director to now follow up.
An interesting account of old an new funeral procedures can be read here. The beautiful painting featured on the post cover is titled ‘Ophelia’ by the artist John Everett Milais.