Many medical professionals say that there are actually two stages of dying – an pre-active and an active phase. The pre-active phase usually lasts anywhere from two weeks to a month while the active phase can be counted in just a few days. These guesses are an average because there are always exceptions, often dependent on an individual's will to live as well as a host of other factors.

Medical personnel who work in hospice situations have often been surprised by patients who they thought were in the active phase of dying only to last for a month or longer. Unfortunately, death has its own timetable so it can be hard to tell loved ones who want to say goodbye to be at the bedside at a certain time. You can use the following as a general guide to help you identify the phase your loved one may be in:

Pre-active phase

In the pre-active phase of dying, your loved one may withdraw from social interactions, denying most visitors or they may request their family members to visit so that they may settle things. Your loved one may become restless, agitated, confused and uncomfortable, changing positions with regularity.

A decline in appetite and thirst is common in the pre-active stage of the dying process as is increased sleeping period. They may express tiredness and may even state that they are ready to die. Their breathing will slow down in both sleep and wake periods and even have apnea issues. Slow recovery time from infections and operations is another sign of the pre-active stage.

Active stage of dying

Changes in breathing patterns such as slow inhalation and exhalation and even increased apnea issues are sure signs of the active stage of dying. Hallucinations are common and lucid moments decrease, with coma occurring many times. Fluid build-up in the lungs and edema in the body are common as are drops in blood pressure.

Incontinence or decrease of bodily output is expected and your loved one may not be able to take food or fluids via mouth any longer. Numbness and cold temperatures are often felt and reduced movement is expected.

There is really no rhyme or reason to the different symptoms of dying. Not everyone will exhibit each one. So when a doctor or other medical professional says that the end is near, you and family members may have to maintain a vigil so that your loved one will have someone with them when they pass on. Always remember that many times, your loved one may hear you talking to them and feel your touch even if they appear unresponsive. It is important to continue the dialogue and loving touches to give them comfort before they die.

Anger
Confusion
Denial
Despair
Disbelief
Guilt
Humiliation
Shock
Yearning

These emotions and more may be felt in no particular order and some of the listed emotions may not be felt at all or may be delayed until much later.

Expressing these feelings are normal and are all common reactions to experiencing a loss. Those going through the death may not be prepared for feeling these emotions or how intense they may feel them or how quickly their emotions will change.

These emotions may be so intense that you may question your sanity as they engulf you. The fact that you have these feelings is not only appropriate but also healthy for you to have and express. These feelings will help you to deal with the death and to come to terms with your loss.

A major loss like the death of a loved one will take time to process and to deal with. The pain of the loss may ease with time but you will never stop missing the person. You will remember them when you hear a song, or visit a store, vacation spot or event that you shared with them. Other people will remind you of the person you lost and you will feel the loss over again.

Mourning the death is normal and is what allows you to eventually accept your loss. Everyone mourns in their own unique way and no way is right or wrong. The grieving is the outward expression of loss and there are physical expressions as well as psychological ones.

These normal feelings must be allowed to be expressed in what ever way seems appropriate for the individual having them. The expression should of course be done in a safe manner. Many individuals are uncertain as to how to approach the topic of death with someone who has experienced a recent loss. In uncertainty some people avoid, ignore or even deny the subject of death. At first the pain may be even easier to handle if it is ignored. Grief has a way of not being denied for long though and it will eventually find its way out and be expressed.

Those who ignore grief may have physical signs of suppressing it such as physical pain (stomach pain, intestinal upsets, trouble sleeping, loss of appetite and also loss of energy). Your natural defense system (immune system) may be seriously tested during this time of mourning. Any existing diseases may worsen at this time or the person grieving may notice that they experience new symptoms of disease. It is important to have medical appointments to monitor any health situations that occur during mourning.

A child will experience the same gamut of feelings regarding the grieving process that an adult encounters including being depressed, lonely, saddened, anger, loss of appetite or an exaggerated need to eat, feeling a lack of direction or focus when completing tasks, or losing motivation to perform an activity and also they can become forgetful.

Adults can assist a child to work through the process of grief at times of loss by allowing them and actually giving them permission to express how they feel and to tell them that it is OK to feel that way. Sometimes the best way to help a child to deal with grief is to allow them to see an adult deal with it in a safe manner.

A child needs to be able to follow the normal routine as much as possible including mealtimes, bedtimes, getting exercise and having the opportunity to play and go to school (if school aged).

The world does not stop while we are grieving and a child should not be asked to stop the activities that they normally do when a family is in mourning.

Depending on the age of the child, he/she will express the feelings in many ways some of which may be uncontrollable crying, temper tantrums or public displays of anger/aggression. Although it is important to handle these situations with firmness and with safety in mind you will also need to remember that the child is in pain and needs you to show compassion and understanding too. The child may not make the connection between the recent loss and the feelings that he/she is having. As important as understanding why the behavior is happening it is equally important to not allow the child to make a habit of using his pain as an excuse to misbehave.

A child may experience regression as a result of the death and grieving process. Regression behavior may include thumb sucking, wetting the bed, returning to baby talk, or in cases of severe regression; not talking at all. Regression behavior is usually only temporary and the skills and maturity level will again be at a normal functioning level as the grief process continues and as the child learns to go through the grief process in more positive ways. There are ways to foster this positive grieving process such as using inanimate objects like puppets or action figures and dolls to encourage kids to act out how they are feeling so they can be more in control of doing so and without feeling like others are watching them. Another way to help your child to focus on getting their feelings out is to make a scrap memory book of the person who has died. Making and then browsing through a memory scrapbook will give the child plenty of opportunity to tell stories about what is happening in the pictures or drawings that will allow him/her to freely express thoughts and feelings. Having the child tell stories about the person and then writing them down and reading them back to the child and then giving him/her a chance to change or add to it is an excellent outlet for the child. A similar idea is to create a family video of members talking about the person and recalling pleasant memories.

Then, there are those who choose to sacrifice their life for the sake of others. Firefighters, police and martyrs throughout history have put their own lives on the line in order to save someone else. They regarded life as something so precious they were willing to give up their own life to save that of another.

When death is that of a suicide or a martyr we wonder what must have been going on in their head in the last few seconds of life. Did they have any regrets? Were they ready to go? Did they have time to prepare or come to grips with the ending of their life?

Those who successfully commit suicide do so for many reasons. All of them have to do with preferring death to life. Those who choose to die by suicide because of a terminal disease choose to decide when to die. They usually make the decision based on quality of life and wish to end it before the quality is unacceptable.

Accidental suicide by way of drugs or alcohol ingestion. Young people especially flirt with dangerous and self-destructive behavior such as drinking alcohol to excess or using drugs that they know are risky and may result in their death. Many individuals who flirt with death by taunting police to shoot or those who purposely crash vehicles may do so because they wish to die but are afraid to take their life out-right.

Many depressed individuals especially the elderly take their own lives out of desperation, despair, loneliness and grief. Some take their life because they can't stand the life of pain from a chronic disease.

Most adults from one time or another have come to the realization that they have the option of taking their own life; there is a choice – to live or die. Many have only a fleeting thought along the lines of suicide.

The majority of suicides are calls for help that go unanswered. Intervention and treatment can give the individual the ability to overcome his/her problem and prevent future suicide attempts.

Martyrs can be public servants doing their duty, or they can be ordinary citizens called upon to do something heroic in a moment of time where all thought of self-preservation escapes.

Individuals, the suicide and the martyr have lost all sense of self-preservation and choose to end their life. The difference between the two is that one fails to see the value in life and the other recognizes the value in saving another.

Everyone grieves and feels loss in a certain way so there is no rhyme or reason on how to handle a certain situation, particularly the continuance of tradition in families when the deceased played a key role. For instance, if the deceased was always the one to place the star on top of the Christmas tree, allow the person closest to them (usually a spouse) to decide how to carry on the tradition. They may elect the eldest child to do it or choose a grandchild to do the honors. Whatever feels right is what should be done.

Holidays can be a great source of struggle for the families dealing with the loss of a loved one. Some find it comforting to stick with the familiar, continuing traditional family gatherings while others may want to avoid the traditional scene and create new memories like taking a cruise. Some families find it helpful to start new traditions in honor of their loved one.

Be aware that while family and friends may appear to be handling the loss of their special someone, chances are that the holidays will be tough. Therefore, it makes sense to plan for that difficulty by acknowledging that the holidays will be rough and plan ahead for it. It is not necessarily good to totally change the entire holiday celebration as it may be too shocking for some people and kick start the grieving process all over again. However certain elements should stay the same while changing others is a good compromise.

Talk holiday plans over with friends and family who have always been part of festivities to see how everyone feels. Everyone is hurting over the loss of the loved one and may have some ideas on how to make things easier on everyone while still honoring the memory of the person. Compromise is the key to getting through the holidays while keeping emotions in check. What is not healthy is ignoring that anything is wrong or not participating in the holidays at all.

Adding stress to the equation can make the holidays a bit more unbearable so it is important to make things as simple as possible. If the crowds at the mall might prove to be a deterrent, take some pressure off and shop online or through catalogs. If the family meal is to go on as planned, order the turkey or ham already prepared from a restaurant so that the stress of cooking does not compound the feelings of grief.

As mentioned before, there is no right or wrong answers when it comes to finding ways to get through the holiday season. Open communication with family and friends is important so everyone understands the situation and can make accommodations and adjustments as necessary.

The tasks involved in caring for the dying are similar to caring for special needs individuals they involve giving a quality of life that is respectful of the individual with an emphasis on giving comfort without being overbearing. Unless the individual is in a coma or suffers from dementia their wishes should be honored regarding how to handle the process of death.

Being a caregiver not only requires an understanding of the process of dying, but the patience to allow it to happen without unnecessary intervention. There are barrages of feelings to be expected while going through this process that include: anger, anxiety, courage, exhaustion, fear, isolation, love, sadness and wistfulness for the times past. The exhaustion felt from physically caring for the individual may at time magnify the other feelings as lack of sleep can make it difficult to cope. This is why it is important to enlist the help of a respite worker or relief family member who will share in the care so that you can take a much needed break. If it is not possible to have respite or another family member assumes total care for a while, then it may be necessary to place the individual in a temporary hospice or other care facility. It is imperative that for long-term end-of-life cares that the caregiver not enter depression or cause health problems for self.

There are many support groups that can be found locally through the medical staff caring for your loved one, through a community hospital, or mental health facility that offers respite care.

If the person you are caring for is not just dying but has dementia too, than the caregiver is doing double duty. The added responsibilities associated with keeping a person with dementia safe, are twice as likely to lead to caregiver depression.

Dementia symptoms that a caregiver will need to cope with are:

Agitation
Embarrassing conduct
Hoarding

These behaviors in the dying individual with dementia makes it an all-consuming time commitment that usually means not only less sleep on the part of the caregiver, but less time with other family members, lost work time and less time to do personal errands that arise.

Many communities offer support groups for caregivers of terminally ill individuals, or those caring for special needs family members. Support can come in the form of meetings, brochures, respite or workshops that teach coping skills for caregivers.

There are two basic types of help available to those in need of assistance during the dying process. Palliative care is the type of care involving medical treatment that is focused on making the individual comfortable by reducing the severity of the symptoms he/she experiences with the disease they are dying from or if possible to slow the progress of the disease. This type of care recognizes that there is not going to be a cure. Palliative care is delivered during any point of illness and extended for as long a time as needed. The second type of care is perhaps the most recognized and that is hospice care. In the United States hospice care is a very specific form of palliative care that is limited to the last six months of life (estimated by a doctor's diagnosis).

Palliative care is usually delivered in medical facility such as a nursing home, or hospital and hospice care is a 24 hours a day service offered in the individual's home, a hospital, nursing home or a hospice care facility.

The focus of hospice care is to inform the patient and the family members about the medical care needed, pain management methods, emotional support and spiritual counseling is given to the dying individual as well as to the family members supporting the dying individual. Counseling is made available that can help all involved deal with the grief stages, and dying process so that family caregivers, and those in bereavement can understand all of the support options that are available through the hospice as well as through the community. Hospice teams are available no matter where the patient is receiving the hospice care. These teams typically consist of medical doctors and nurses, other medical staff, social workers, psychologists, trained volunteers, and also spiritual advisors.

The cost of hospice care is usually covered by private medical insurance and Medicare will generally pay for these services after a doctor has made the diagnosis and death is placed at 6 months or less. If the services of a hospice are not covered by insurance, the typical costs out of pocket are usually several hundred dollars.

Choosing palliative care or hospice care should never be about giving up, it should be about choosing help for an individual in the last stage of life and seeing to it that they are being given every chance to experience this stage in as much comfort as possible with the kind of emotional and spiritual support that he/she and the family members deserve.

There are a number of things to consider when estate planning. There are living wills, the consideration of donating organs upon death, creating a living trust, establishing a power of attorney and allocating assets to friends and family. In terms of a living will, this document directs family and medical professionals to your wishes should you become incapacitated. It should address resuscitation efforts as well as a feeding tube and use of a ventilator. These conditions should be known when establishing a living trust:

* Loved ones and medical professionals treating you cannot serve as witnesses to the document.

* A living trust can be revoked at any time and even be re-amended.

* If you establish that you do not want any life-sustaining efforts, your death because of this will be considered natural in terms of your family receiving death benefits.

Planning the dissolution of your estate in the event of your death does not have to be confusing. In advance, you should choose who you want to receive any real estate, jewelry, antiques, mementoes and other things of value. Bank accounts, investments and other financial issues should be designated in advance as well. An executor for your estate should be appointed to look after your best interests and ensure your wishes are carried out.

The same person serving as executor could potentially also hold durable power of attorney which states your wishes in regards to medical treatment. You should clearly outline what life saving measures you want or don't want in addition to other medical choices. In addition, the power of attorney gives the person who is holding it power to act on your behalf, such as paying bills in the event of your incapacitation.

Another thing to address is organ donation. If you wish to donate your organs, you should talk with your doctor and loved ones in advance, while you are still of sound body and mind. Sign the back of your driver's license and fill out an organ donor card to carry in your wallet at all times. You may want to mention your wishes in regards to organ donation in your living will or any other advanced directives you have created to look after your best interests. Organ donation can be a touchy subject, particularly if first brought up when a loved one just died. Therefore, knowing your wishes in this regard in advance removes the awkwardness and debate.

All in all, planning for your death can be a complicated business. Just think of the heartache your family would have to go through if you did not plan in advance. Having everything set in place means that the only thing you family has to do is get through the grief of losing you.

The body begins to shut down physically one system at a time, usually in an orderly and progressive fashion. While the body is going through this process there is no need for invasive interventions but only for comforting ones. The changes in the dying person's body may be subtle, may happen quickly or not at all, depending on how rapidly they progress through the process.

The second part of the dying process is the emotional and spiritual one and is a dynamic part of the process. The spirit will begin the process of detaching from all that is of the physical world. The individual should be encouraged to make the transition.

The beliefs, values and lifestyle of the dying individual will help to dictate how the process of death will be orchestrated so that death when it comes can be peaceful. Death is the time to give the individual your acceptance for who they are and to give them comfort and support.

Sleeping patterns will change as death approaches. The body will spend more time sleeping during the day and the individual may be difficult to wake.

The breathing pattern will become irregular and the individual may experience some apnea (pause of 10 to 30 seconds between breaths).

There may be oral secretions that collect at the back of the throat that may cause a noisy breathing. There are several things that can be done to make the individual more comfortable including positioning of the bed and pillows, using oxygen or a cool mist humidifier or medications.

The limbs may become cool to the touch and the underside of the body may become darker in color and the skin may turn bluish or splotchy. The discoloration is due to the slowing of the blood circulation. Blankets can be used for warmth but the person may not feel cool.

The dying individual may become easily confused about time, or the identity of those around him. This mental confusion is due to the slowing of the body's metabolism.

At this stage the individual may become restless or may start seeing things that are not there. These things happen because of decreased oxygen circulating to the brain and the changes in body metabolism. Try not to startle or frighten the individual, by speaking to them in a calm voice.

During this last stage of life, the body needs little in the way of nourishment or fluids. There is an increased risk for choking due to confusion or inability to swallow. It is important not to force anything by mouth at this point.

There may be a loss of bladder or bowel control. It is important to keep the skin clean, warm and dry.

There may be a slight decrease in the ability to hear or see and the individual may experience "visions" of people or events from the past. It is important to have a peaceful, quiet atmosphere and to talk in quiet tones.

The dying individual may not experience all of the signs or symptoms of the dying process.

Each one of us will handle grief when it comes to us differently. There are however, common behaviors, emotions, and physical symptoms that are typically encountered along the journey from pain to healing. No other event in life causes the depth of grief so much as when we experience the death of a loved one or our own imminent death. It is at these times that the symptoms of grief surround us and are undeniable.

The typical physical symptoms of grief such as those experienced when dealing with the death of someone loved are:

* Periods of fatigue mixed periods of high energy or extreme alertness

* Hearing or vision loss that is associated with "dissociation". Dissociation is defined by dictionary.com as being, " the act or instance of dissociating or the state of being dissociated; disjunction; separation: the separation of" fantasy and reality in the mind of someone in deep grief.

* Experiencing difficulty getting or staying asleep or one might experience the opposite and sleep too much

* An increased or decreased appetite from what is normal for that person

* Muscle tremors

* Chills

* Sweating

* Rapid respirations or having difficulty breathing

* Increased blood pressure or increased heart rate (pulse)

* Problems with stomach pains or intestinal upset

* Dizziness, fainting or feeling nauseous

The typical mental symptoms of grief such as those experienced when dealing with the death of someone loved are:

* Confusion expressed by lapses in judgment, comprehension difficulties, difficulty concentrating or memory loss

* Experiencing "intrusion" which is unwanted thoughts, nightmares or unwanted arousal

* Intense feelings of detachment, denial of circumstances being not in reality

The typical emotional symptoms of grief such as those experienced when dealing with the death of someone loved are:

* Anger

* Anxiety, apprehension or fear

* Guilt

* Numbness or an inability to feel or to express feelings

* Feeling remote or removed from the situation emotionally

* Depressed emotionally

* Shock

All three areas of symptoms: physical, mental and emotional are felt by all those who grieve. Not all of the symptoms may be experienced at the same intensity. Certain symptoms may only be experienced briefly and others with deep intensity that lasts hours, days, or weeks. Symptoms of grief when expressed allow us to move through the process of accepting our loss and being able to cope with it.

When we are presented with our own death or contemplate what it might be like we are certainly faced with grief or loss. Especially as death nears and we experience the physical stages of impending death our minds and emotions travel the stages of grief in our quest to cope with our own death.