Many caregivers who work with the dying recognize that there are four distinct phases in the dying process which are linked to the four elements held in our bodies: Earth, Water, Fire, and Air. These stages may take place gradually, over a period of weeks or months, or merge into each other seamlessly, over days or hours or even minutes. Understanding and recognizing these stages can give us helpful insights in knowing how to help the dying person and their family at each phase.
In many spiritual traditions all things are made from four elements: Earth, Water, Fire and Air. All people, animals, and plants are combinations of these elements. Everything has its own unique blend of the four elements. Here in Canada our First Nations Peoples can teach us volumes in this regard.
The Element of Earth
Earth is the first element to leave the body. This is the element most connected to the physical body: our vitality and strength. It is linked to flesh and bones, the densest elements and it takes the longest time to withdraw from the body. In some cases as long as eight to ten years, the process of ageing.
Connected to the direction north, Earth is considered the ultimate feminine element (Mother Earth). Earth is fertile and stable, solid and firm and traditionally associated with endurance and feminine energy. It corresponds with both colors green and brown.
The sense most affected by the withdrawal of Earth is the sense of smell. The person may suddenly be repulsed by certain familiar smells but may yearn for others. Their own personal smell may also change: there may be a mustiness or tang to the skin. It is almost an autumn odor. You may also notice a change of smell in the person’s breath or excretions.
The individual you are serving will begin to lose vitality. They may tire easily, feel drained, have less stamina and possibly lose weight. They begin to lose enthusiasm for life’s activities. They may walk less and you may find them sitting for long periods of time.
Their complexion will begin to fade and take on a grayish hue. Their cheeks will likely sink. Their strength to grasp objects diminishes and they may find it hard to keep a firm grip on objects such as cutlery, pens, or a toothbrush.
As the Earth elemental withdrawal continues, they may begin to find it difficult to get out of bed or to sit up. They will feel drowsy and find it harder and harder to open their eyes. Emotionally they may become needy and tearful and not want to be left alone for too long. They may also express a fear of the dark or of silence. They will likely start to feel very ungrounded, perhaps a little lost.
The Element of Water
Water is also feminine energy and is the second element to leave the body. Used for healing, cleansing, and purification, Water is related to the direction west, and connected with love and emotion. In many spiritual paths, holy water is used in blessings, ceremonies, and rituals. Water relates to blood and body liquids and can take up to four months to complete its withdrawal from the body.
Water affects the sense of taste and cognitive hearing or understanding. Meals and drinks may taste differently than normal. The individual you are working with my have trouble understanding what you are talking about.
Physically, the tongue will begin to feel dry and perhaps a little rough. Your client may feel thirsty and experience difficulty chewing. They may begin to lose control of bodily liquids: noses run, eyes water, there is dribbling from the corner of the mouth, and perhaps incontinence.
Emotionally they may mention that they feel lonely and demand more attention and company and may begin to reminisce, particularly about their parents and family members. This is when deep emotional (soul) wounds may surface and they may talk about past trauma, loss, or abuse.
The Element of Fire
Fire is the third element to leave the body is. The Fire element relates to the major organs of the body. Fire is a purifying, masculine energy, associated with the direction South, and connected to strong will and energy. Fire both creates and destroys, and symbolizes masculine fertility. Fire can heal or harm, and can bring about new life or destroy the old and worn.
Fire is linked to the sense of sight and also affects ‘vision’ in the sense that the dying friend may be able to see things in other realms that we cannot perceive. Also peripheral vision is lost while eyesight gets weaker.
There may be sudden and dramatic temperature fluctuations: either shivering or burning as if there is a fever. During the cold phase, the skin can look dry and pale but may then be followed by vivid flushing as the body temperature fluctuates. The lips will become cracked and parched and the mouth and nose will become dry. The nose may bleed easily and profusely. They may lose their sense of smell. One of the most common symptoms of the Fire element stage is terminal agitation.
During this time the dying person will distance himself or herself from the physical world. They will shift between clarity and confusion and may eventually transform into calm acceptance. They may see visions, talk of visitations from deceased loved ones, and have glimpses of the future. As their physical vision withdraws their inner vision may expand. They often recognize that they are dying and may even tell you when they are going to die.
The Element of Air
Air is the element of the East and the last to leave the body. It is connected to the soul and the breath of life and related to communication, wisdom, and the mind. It is associated with the lungs and the ears and affects the senses of touch and hearing.
As air begins to leave the body you may notice some of these occurrences:
- Breathing becomes labored and erratic
- There may be rasping and panting or irregularity between breaths
- The ‘in’ breath may be short and the ‘out’ breath weaker and longer
- There may be a rattling sound in the lungs
- Their eyes may roll upwards or be tightly shut
Emotionally they may be frightened and cry out especially during sleep. They can also be restless and fidgety.