I have noticed concern by medical workers as to what to do during the hours to minutes before death. Here are some ideas to consider. When the patient is hours to minutes before death they may be experiencing some or all of the following things. Not responding to the environment, mottled, breathing irregular, maybe breathing like a fish, slight agitation, murmuring words but not making sense. Family and significant others are gathered in anticipation of death occurring soon. What do we as professionals do to assist the family in having a positive experience?
* Consider yourself a Conductor. Your job is to be as invisible as possible
yet get everyone working together and feeling supported.
* Fear is what most in the room are experiencing. Fear of the unknown,
fear of pain, fear of what they are seeing, fear of what they think will
happen. Reassure family that what is happening is normal and natural. It
is your job to assure them nothing bad is happening, to neutralize the fear
everyone has brought to this experience.
* Knowledge reduces fear. Begin gently explaining what is happening.
“Mom is doing a good job. She is doing what she is supposed to be
doing”. Go over each thing Mom is doing and explain simply what is
happening (don’t use medical terminology, speak at a 5th grade level) and
that it is all normal. “Her breathing is 10 times a minute and her blood
Pressure is 60/40. This tells me her body is slowing down.” “This is how
you die, and she is doing just what she is supposed to be doing’”
* Explain what is going to happen next. “Mom will start breathing like a fish
breaths. Her breaths will get slower and slower until she stops, then she
may take a couple of long spaced out breaths.”
* Encourage the family and significant others to individually talk to the
person who is dying. To spend some quiet time and share their thoughts
and their goodbyes. Reassure the family that the person can hear.
* Tell the family they can lay on the bed, hold their loved one, talk to them,
cry with them.
* Music played softly is often comforting to everyone present. I would pick
music that the patient enjoyed during their life. It doesn't have to be
classical, hymns, or harps.
* This is not a medical event. You are not doing medical interventions
unless:
1. The patient’s restlessness is a danger to themselves.
2. Their congestion is excessive and positioning is not effective. Don’t
use suction but you can use a Scopolamine Patch.
(It probably won’t help, but if its causing the family distress you can try.)
3. If pain has been a part of the disease process, then continue giving
pain medication until death. If pain has not been a part of the disease
process then there is no need to give a narcotic just because the person is
approaching death. Dying itself is not painful, disease causes pain.
4. If respirations are severely labored due to the disease process,
then you can use small amounts of morphine. Remember as death
approaches congestion and labored breathing are normal.
* This is a challenging time for medical professionals. We are used to
fixing, to doing something. Now we are not fixing or doing. When I have
taken a person’s blood pressure for the third time and it is 60/40 that tells
me I am nervous and wanting to do something. You don’t need to know
what the blood pressure is once you have taken it the first time. You know
death is approaching and all the tools we were taught to rely on in health
care no longer apply. Education, support, and guidance are the tools we
now bring to the room.
* If labor (those hours before death) becomes long I would encourage the
family to share stories, look at scrapbooks, and reminisce while in the
room. Have a normal, natural family gathering.
* Explain that we have some control over the time that we die. If you are
with someone when they die you are there because they want you there.
If you are not, even while you tried to be, then know you were given a gift
of love and protection.
* Because we can hear and have limited control over the time that we die
we need to gently tell the person who is dying what is going on in the
room. Who is entering, who is leaving. “It is 12:00 and I am going to bed
now. I will be back in the morning. I love you. If you need to leave before I
return I understand.”
When someone is dying a gradual death from disease and is hours to
minutes from death they don't need a doctor, nurse, social worker, or even
a chaplain. They need someone who understands the normal, natural dying
process and can gently guide and support the family to help create a
sacred memory from this very sacred experience.
Something more about The Final Hours Before Death...
My book, The Eleventh Hour, details more specifically how to conduct a vigil before someone's death. It is quite helpful not only for the caregivers but the family of the dying as well.
48 comments
Barbara thank you so much for your response. My father passed away February 1st at 9:35 am. Everything that you said was so helpful. When I first commented I was so confused it hurt so so bad seeing him dying. I almost convinced my self that he was getting better the five days he was home on hospice before passing. After reading what you said I told my dad that I loved him very much that I was going to be ok that he raised me so good. I told him that I was going home for the night to be with my kids that I would be back in the morning and gave him the biggest kisses I could. When i woke up at 6:30 i had a gut feeling that he waited for me to leave to protect me while he passed but I had no messages or phone calls saying that he did so I was really excited to go spend the day with him. I got the kids off to school and got over as quick as I could to his house. When I got there I noticed the rattle was gone I knew he was close. I told him that I was back, that I missed and loved him so so much and so does the kids. I cried and started kissing him all over his face as he took his last breath. He went so peaceful no struggling for air. I told him that I was so proud of him, that he did such a good job. Hes so amazing I’m so lucky that I got to be there with him as he passed on, it has made me so happy! I miss him so much though..
Oh Mikka, I am so sorry your dad is dying. It is hard to watch our loved one releasing from their body. From what you have told me it sounds like your dad is doing what is natural when someone is dying. I do not believe anything pathological is happening. Just a little chick working to get out of his shell. The congestion, the talking is all normal. What can you do? Continue to talk to him. He can hear you. Tell him how much you love him, tell him anything you need to say to him, the good parts of your life with him and the difficult parts. Can you tell him that when he is ready he can go? As hard as it is to be without him tell him you understand he is leaving. Also tell him when you are leaving the room and/or the house. We have limited control over the time that we actually die and he may die when you are not there as a way of protecting you. He may wait for you to be there. Either way take the gift he gives you. My blessings are with you, your dad and your family during this heartfelt time. Barbara
My dad is about to pass. He came home on hospice 3 days ago due to kidney failure. He started rattling this morning and seems to be getting louder by every hour. When I touch him he jerks away and sometimes open his eyes and move his arms then hes right back to eyes closed and gurgling. When I talk to him he seems to jerk to. I dont know what to do. I feel like I’m bothering him. I’m so confused. I just want to be a little kids again. I love my daddy so much
Hi Timothy, About your mother’s final hours: from your description of her dying it sounds like she did exactly what she was suppose to do to release from her body. She did a good job. I see no pathology here. Her mouth movements in response to your wetting her tongue was also very normal. You did good by wetting her tongue which gets dried out when a person is breathing with their mouth open. It wasn’t that she was thirsty but that her tongue was dry. I do not believe your mom was “ asking for help” in her final moments. Just think of a little chicken working to get out of it’s shell. That is what your mom was doing. She was working to release from her body, that is what you were watching.You might find my booklet My Friend, I Care helpful in this time of grief. My blessings are with you. Barbara
I lost my mom to cancer 1/6/2019, she had gone about 4 or 5 days not eating, the death raddle about 12 hours before death, last few hours she was none responsive but I talked to her and read the Bible and held her hand, She would only close her mouth when I would put the wet sponge in, it made me feel as if she was thirsting to death, and nothing I could do to help her. I remember the last words she said was my name before she became unresponsive, I still wonder what or if she was trying to ask for help or what. I saw her every day my whole life and I took so many things for granted that I wish I hadn’t. Reading everyone’s thoughts here seems to help. I have used a lot of my time trying to get back close to God, In the end he is only one that can help and save us
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