Death is a subject many of us avoid discussing, but it’s a part of life that we all have to face at some point. Sometimes, the more you know about a certain subject, the less frightening it becomes. Here are 10 things you may not know about dying.
1. Dying Is Often a Process
There are numerous causes of death, and many of them are instant. But for people who know death is approaching — whether from sickness or old age — there are certain signs. These signs include slowed breathing, a drop or weakening of the heart rate, a drop in blood pressure, and a change in skin color, says Zachary Palace, MD, the medical director of the Hebrew Home at Riverdale, part of RiverSpring Living in Riverdale, New York. This process, and the order in which the symptoms occur, may be a little different for everyone.
“In general, in the time leading up to death, usually the person will become pale because of a drop in blood pressure,” he says. “The fingers may get cold or turn blue. If you feel the pulse, it will be weak, and then they start to develop an irregular type of breathing, and that’s a sign that things are pretty ominous.”
2. When Breathing Slows, Death Is Likely Near
Dr. Palace explains that there may be gaps between breaths, during which it seems like the person has stopped breathing for 15 to 20 seconds. He says families often worry at this point, but he assures them it’s a normal part of the dying process.
3. There Are 2 Stages of Death
The first stage, known as clinical death, occurs when a person’s heart stops beating. About four to six minutes later, brain cells start to die from the loss of oxygen, and biological death occurs, according to the American AED CPR Association, which certifies people in first aid, cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and more.
While it’s sometimes possible to resuscitate people during clinical death, it is not possible during biological death.
4. CPR Isn’t Always as Effective as It Is on TV
Shows like ER and Grey’s Anatomy have led many to believe that CPR can save most people’s lives. In one study, 95 percent of 500 emergency department patients had gotten most of their information about CPR from TV shows, and more than half believed the CPR success rate was 75 percent.
The reality is different, however, and especially so for people with chronic illnesses. According to the American Red Cross, overall survival rates average about 10 percent for out-of-hospital cardiac arrests, and 21 percent for in-hospital cardiac arrests. Although high-quality CPR can save many lives, it can also have a negative effect on a person’s health and quality of life. The study authors stressed the importance of discussing the potential risks and benefits of resuscitation with your medical provider and loved ones, particularly when it comes to end-of-life care.
5. Hearing May Be the Last Sense to Go
It is widely believed that hearing is the last of the senses lost before death. One study showed that the auditory systems of hospice patients responded similarly to those of young, healthy control subjects just hours before the end of life. “[Hearing] is the most passive sense,” says Palace, explaining that when death seems imminent, “We encourage families to talk and share their last thoughts, love, and support with their loved ones, because even though the blood pressure is dropping and they’re fading out, they can hear what we’re saying.”
6. You May Urinate and Defecate
When we’re alive, our brain is constantly sending signals to tell different parts of our body what to do. At death, these signals stop, and our muscles mostly relax. “The neck of the bladder and the sphincter are in a constant state of contraction, so when there’s no more neural signals to the bladder or bowels, then they relax,” Palace says. “So it’s not uncommon just after death for urine to come pouring out or for someone to defecate.”
7. Morphine Is Used Only to Ease the Pain Associated With Passing
Palace says the biggest misconception he hears is that morphine is given to patients to induce death. He says this couldn’t be further from the truth. “Obviously, physician-assisted suicide is not legal in most states, so morphine is not given to help hasten the end,” he says.
When people are dying, Palace explains, blood pressure drops and less oxygen gets to their organs. The body responds by gasping for air in a futile attempt to increase the respiratory rate. Doctors refer to this as air hunger. “That gasping is very difficult for families to see, as it obviously looks painful, and that’s where the role of morphine comes in,” Palace says. “The proper dose of morphine relieves the sense of air hunger, so they’re breathing more calmly and more comfortably.”
8. The Body as a Whole May Be Dead, but Certain Parts Within Are Still Alive
The brain is the first organ to begin to break down, and other organs follow suit. Living bacteria in the body, particularly in the bowels, play a major role in this decomposition process, or putrefaction. This decay produces a very potent odor, known as the smell of death. “Even within a half hour, you can smell death in the room,” Palace says. “It has a very distinct smell.”
9. There May Be a Scientific Explanation to the Notion of Your Life Flashing Before Your Eyes
When a person dies in a movie or television show, it’s a common trope that they see memories from different periods of their life flash before them. It turns out there may be some scientific truth to this phenomenon. In one study, researchers described a case report of a dying man who appeared to experience a sudden flash of memory mere seconds before his heart stopped.
Doctors took brain scans of the 87-year-old patient, who was in the hospital after a fall caused bleeding in his brain. Although he died of cardiac arrest, the scans kept running after his heart stopped and revealed a burst of brainwave activity associated with memory and dreaming that lasted approximately 30 seconds. The researchers hypothesized that this flash of activity could be memories replaying from his life.
10. Consciousness May Continue After Death
Researchers have long been trying to understand what happens to the mind after death. One study of cardiac arrest patients may provide some answers. The research included more than 550 patients from U.S. and British hospitals who received CPR after their hearts stopped beating. Fewer than 10 percent of those studied recovered, but of these survivors, 4 out of 10 recalled some degree of consciousness during CPR.
Some described having lucid experiences, including sensations of separation from their bodies, observing events without pain, and a meaningful evaluation of their relationships and actions. The researchers also observed brain patterns in scans linked to thought and memory up to an hour into CPR. “This is the first large study to show that these recollections and brain wave changes may be signs of universal, shared elements of so-called near-death experiences,” said the senior study author, Sam Parnia, MD, PhD, director of critical care and resuscitation research for the division of pulmonary, critical care, and sleep medicine at NYU Langone, in a statement.
The Takeaway
Some causes of death are instant, but when someone dies due to old age or illness, the signs develop over time, such as changes to the skin’s color and a dropping heart rate.
There are two stages of death: clinical death, when the heart stops; and biological death, which occurs four to six minutes later, when the brain cells start to die.
Lesser-known facts about death include the fact that CPR is not as effective as it is on TV, hearing may be the last sense to go, and you may urinate or defecate just after death.
There may be scientific evidence to support notions about life flashing before your eyes and consciousness continuing after death.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Bandolin NS et al. Perspectives of Emergency Department Attendees on Outcomes of Resuscitation Efforts: Origins and Impact on Cardiopulmonary Resuscitation Preference. Emergency Medicine Journal. October 2020.
Vicente R et al. Enhanced Interplay of Neuronal Coherence and Coupling in the Dying Human Brain. Frontiers in Aging Neuroscience. February 21, 2022.
Parnia S et al. Awareness During Resuscitation – II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest. Resuscitation. July 7, 2023.
Simran Malhotra, MD, DipABLM, CHWC, is a triple board-certified physician in internal medicine, hospice and palliative care, and lifestyle medicine, as well as a certified health and wellness coach. She is currently practicing part time as an inpatient palliative care physician at Medstar Health after serving as the palliative care medical director at Franklin Square Medical Center in Baltimore for a little over four years.
Dr. Malhotra completed her internal medicine residency at Medstar Franklin Square Medical Center, where she also served as chief resident in 2015. She completed her fellowship in hospice and palliative medicine at Johns Hopkins Hospital in 2016. She was named Top Doc in Palliative Medicine in 2019 and 2020 by Baltimore Magazine.
On a personal note, she is a BRCA1 previvor with a strong family history of breast and female reproductive cancers, and underwent a risk-reducing bilateral mastectomy and total hysterectomy in 2020 at 32 years old. After learning about her own genetic risk of cancer, and grounded in her professional experiences in palliative care, she founded Wellness By LifestyleMD, a platform where she works with and educates women at high risk for cancer with or without genetic mutations on the powerful impact that positive lifestyle changes can have on their quality of life and even longevity.
In addition to being a diplomate of the American College of Lifestyle Medicine, she completed the T. Colin Campbell plant-based nutrition certification in 2019, the CHEF culinary coaching certification in 2020, and the WellCoaches health and wellness coaching certification in 2022. She is a member of the ACLM women’s health member interest group and serves as the co-chair of the breast cancer subcommittee.
Malhotra has been featured on several blogs and podcasts, where she has shared her unique perspectives and experiences from palliative care as well as from being a genetic mutation carrier who is passionate about using lifestyle as medicine.
Ashley Welch has more than a decade of experience in both breaking news and long-form storytelling. She is passionate about getting to the crux of the latest scientific studies and sharing important information in an easy-to-digest way to better inform decision-making. She has written about health, science, and wellness for a variety of outlets, including Scientific American Mind, Healthline, New York Family, Oprah.com, and WebMD.
She served as the health editor for CBSNews.com for several years as a reporter, writer, and editor of daily health news articles and features. As a former staff member at Everyday Health, she covered a wide range of chronic conditions and diseases.
Welch holds a bachelor's degree from Fordham University and a master's degree from the Craig Newmark Graduate School of Journalism at the City University of New York, where she studied health and science reporting. She enjoys yoga and is an aspiring runner.
