Coaching

There may be a brief stage in which the process of losing vision is troublesome to families. Patients may appear to be "looking right through you." This often feels spooky to families. The "look," as some hospice workers call it, is often accompanied by predeath visions. Patients at this stage may be on a different wavelength, as discussed in the section on altered states in Chapter 7. Families may project all sorts of meanings onto this look - "He's ignoring me or mad at me." It may help to explain this process (without necessarily trying to explain why, in fact, patients experience different wavelengths).

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Most dying people then close their eyes and appear to be asleep. From this point on dying is very mysterious, and we can only infer what is actually happening. My impression is that this is not coma, a state of unconsciousness, as many families and clinicians think, but something like a dream state. Hearing and touch often seem remarkably preserved, suggesting some degree of consciousness.

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If people ask me how I know this, it is from the many cases in which a loved one, holding a dying person's hand, has said "I love you" and received a soft hand squeeze. In reassuring a dying person who has anxious respirations by saying "You are doing fine," the breathing pattern may slow and becomes peaceful. Families are thus encouraged to comfort their loved one with words and touch.

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