You've seen it on television: A doctor shines a bright light into an unconscious patient's eye to check for brain death. If the pupil constricts, the brain is OK, because in mammals, the brain controls the pupil.
When you're in bright light, it shrinks to protect your eye and keep light out. When your pupil shrinks (constricts), it's called miosis. If your pupils stay small even in dim light, it can be a sign that things in your eye aren't working the way they should.
Brain death (also known as brain stem death) is when a person on an artificial life support machine no longer has any brain functions. A person who's brain dead is legally confirmed as dead. They have no chance of recovery because their body is unable to survive without artificial life support.
Signs of brain deathThe person shows no reaction to pain. The eyes don't blink when the eye surface is touched (corneal reflex). The eyes don't move when the head is moved (oculocephalic reflex). The eyes don't move when ice water is poured into the ear (oculo-vestibular reflex).
Shortly after death, due to relaxation of muscles, including the iris, the eyes will dilate (pupils grow larger). However, with the onset of rigor mortis, the pupils constrict. They may be unevenly dilated or constricted, and may even appear oval.
Pressure that builds inside your brain after a head injury, stroke, or tumor can damage the muscles in your iris that normally make your pupils open and close. One or both of your pupils can become fixed in the dilated position and can't react to light. If that happens, you should see a doctor right away.
Doctors sometimes refer to more pronounced mydriasis, when the pupils are fixed and dilated, as “blown pupil.” This condition can be a symptom of an injury to the brain from physical trauma or a stroke. The opposite of mydriasis is called miosis and is when the iris constricts to cause very small or pinpoint pupils.
Dilating drops cause vision to be blurred for a period of 4 to 8 hours and induce photophobia, lack of accommodation, glare, and decreased contrast threshold and high-contrast visual acuity. For elderly patients whose vision and mobility are already compromised, these visual changes can be dangerous.
It's uncommon, but it can be difficult to watch when it happens. Instead of peacefully floating off, the dying person may cry out and try to get out of bed. Their muscles might twitch or spasm. We squirm and cry out coming into the world, and sometimes we do the same leaving it.
While the dying person may be unresponsive, there is growing evidence that even in this unconscious state, people are aware of what is going on around them and can hear conversations and words spoken to them, although it may feel to them like they are in a dream state.
Now UBC researchers have evidence that some people may still be able to hear while in an unresponsive state at the end of their life. This research, published recently in Scientific Reports, is the first to investigate hearing in humans when they are close to death.
Here are end-of-life signs and helpful tips:
- Coolness. Hands, arms, feet, and legs may be increasingly cool to the touch.
- Confusion. The patient may not know time or place and may not be able to identify people around them.
- Sleeping.
- Incontinence.
- Restlessness.
- Congestion.
- Urine decrease.
- Fluid and food decrease.
What not to say to someone who is dying
- Don't ask 'How are you?'
- Don't just focus on their illness.
- Don't make assumptions.
- Don't describe them as 'dying'
- Don't wait for them to ask.
Share on Pinterest Glassy eyes are often caused by strain. Tears lubricate the eyes, which become dry when there is limited or no tear production. Dry eyes can take on a glassy appearance. This is often the result of too much time spent looking at a computer screen, but it can also result from eye surgery.
The first organ system to “close down” is the digestive system. Digestion is a lot of work! In the last few weeks, there is really no need to process food to build new cells.
Five Physical Signs that Death is Nearing
- Loss of Appetite. As the body shuts down, energy needs decline.
- Increased Physical Weakness.
- Labored Breathing.
- Changes in Urination.
- Swelling to Feet, Ankles and Hands.
And particularly when you're human, you are more likely to die in the late morning -- around 11 a.m., specifically -- than at any other time during the day.
Reality: Pain is not an expected part of the dying process. In fact, some people experience no pain whatsoever. If someone's particular condition does produce any pain, however, it can be managed by prescribed medications. Myth: Not drinking leads to painful dehydration.
Your loved one may seem to be working hard to breathe -- even making a moaning sound. The moaning sound is just the sound of air passing over very relaxed vocal cords. This indicates that the dying process is coming to an end. Feel your emotions.
There are physical signs of dyingBlood pressure gradually goes down and heart rate gets faster but weaker and eventually slows down. Fingers, earlobes, lips and nail beds may look bluish or light gray. A purplish or blotchy red-blue coloring on knees and/ or feet (mottling) is a sign that death is very near.
Sleeping moreSeveral months before the end of life, a dying person may begin to sleep more than usual. As you get closer to death, your body's metabolism falls. Without a steady natural supply of energy, fatigue and tiredness easily win out.
Tips for Talking with Someone Who is Dying
- Tip # 1: Follow the dying person's lead.
- Tip #2: If possible, be clear that you know the end is nearing.
- Tip #3: Deal with regrets by saying, “Please forgive me.”
- Tip #4: Free yourself of hard feelings by saying, “I forgive you.”
- Tip #5: Appreciate the person's legacy by saying, “Thank you.”
They could have:
- Different sleep-wake patterns.
- Little appetite and thirst.
- Fewer and smaller bowel movements and less pee.
- More pain.
- Changes in blood pressure, breathing, and heart rate.
- Body temperature ups and downs that may leave their skin cool, warm, moist, or pale.
Social Withdrawal. Your loved one may begin to have a desire to decrease her social interaction. As the body shuts down, the dying person may lose interest in people around them. They will stop talking, interacting and keeping up with the conversation.
It can sometimes appear that people choose the moment to die. For example, people talk about someone hanging on until a relative arrives at their bedside, or until a special anniversary or birthday. A person who is confused, drowsy or unconscious may also wake up and be able to say a final goodbye before dying.
This difficult time may be complicated by a phenomenon known as the surge before death, or terminal lucidity, which can happen days, hours or even minutes before a person's passing. Often occurring abruptly, this period of increased energy and alertness may give families false hope that their loved ones will recover.
Eye contactEye contact is so intense that researchers have even used it to trigger feelings of love. So, if your partner is looking deeply and comfortably into your eyes, it communicates a lot about their desire. “Deep eye contact, or holding your gaze for at least four seconds, may indicate feelings of love.”
For those without a diagnosed mental health condition, avoidance of eye contact could be related to shyness or a lack of confidence. Looking someone in the eye while speaking can feel uncomfortable for those without a lot of practice making conversation or who tend to prefer not being in the spotlight.
Some studies show that intense eye contact can actually stimulate sexual arousal. People like feeling seen and understood. Intense or prolonged eye contact helps people feel seen and can make them feel confident and even aroused. Not only can eye contact heat things up, but it can also make sex more intimate.
The eyes can also reveal much more complex phenomena: they can convey whether we are lying or telling the truth. Our eyes can also serve as a good detector for what people like. To accomplish this, it is necessary to look at pupil size in combination with where someone is looking.
If someone looks down and to the left they are accessing their feelings and when they look down and to the right they are having an internal dialogue with themselves. If someone says they were at a certain place at a certain time and you don't believe them you can always ask them a question about it.
However, the best way to decipher a person's true emotions is by looking at the rest of his face. For example, narrow eyes and tight lips indicate anger. If someone is uncomfortable with something you have said, he will often use a body language tactic called eye blocking.
