Death is a subject many people do not like to discuss, but it’s a part of life that we all have to face. 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 (BP), and a change in skin colour, 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 cardiopulmonary resuscitation (CPR) saves most people’s lives. In a study in the Emergency Medicine Journal, 95 percent of 500 emergency department patients had got most of their information about CPR from TV shows, and more than half believed the success rate of CPR to be 75 percent.

The reality is different however, and especially so for people with chronic illnesses. According to previous research, overall survival rates after CPR average about 12 percent for out-of-hospital cardiac arrests, and 24 to 40 percent for in-hospital arrests. Although CPR does 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. A study in Scientific Reports 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, 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 the person can breathe 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 odour, 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 in front of them. It turns out there may be some scientific truth to this phenomenon. In a study published in 2022, 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 were taking brain scans of the 87-year-old patient, who was in the hospital after a fall resulted in bleeding on his brain, and who died of cardiac arrest. The scans kept running after his heart stopped and revealed a burst of brain-wave activity associated with memory and dreaming that lasted approximately 30 seconds. The researchers hypothesised that this flash of activity could be memories replaying from his life. An older study in rodents found similarly high levels of brain waves shortly after the hearts of the rats stopped beating.

10. Consciousness May Continue After Death

Researchers have long been trying to understand what happens to the mind after death. A study of cardiac arrest patients published in September 2023 in the journal Resuscitation may provide some answers. The research included more than 550 patients from U.S. and British hospitals who received CPR after their heart 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 the sensation of separation from their body, 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, an associate professor in the department of medicine at NYU Langone Health, in a statement.