The Final Hours Before Death

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

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.


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Charles, I hope by the time you read this your father is at rest. The labor of dying is indeed hard work and also very hard on us the watchers. I’m holding you both in my thoughts. Blessings! Barbara

Charles Owen

My Dad is dying right now. He has not moved or opened his eyes all day. All of a sudden he seems to be physically agitated, Moving his arms, breathing is shallow and the rattle is loud. He is 86. No one should have to die like this.

Demi Mills

My mom is in hospice now as I type this post. Thank you for this information. It has helped me understand more of what to expect and to be able to help my sister who is here with me. The COVID-19 kept all 7 of us siblings from getting to be with her at the same time. I was so happy and proud that we could take the shifts and spend them with mom and accept this was just how it has to be although we wish we could all be with her.

Lisa Barbetti

I am sitting here with my father-in-law who had stomach cancer and has spread to his brain he is exhibiting many of the end of life symptoms thank you so much for all of the comments and all of the post it has definitely helped me and prepared me to help our family members who are emotionally upset and not ready to lose their father and grandfather. I am a school psychologist and I thought I knew the right things to say and to help ease our family members during this most difficult process. However after reading many of the post I am really not as prepared as I thought I was. Many of the post has help me to understand that his final hours are here. I feel now that I have the strength to help my family transition through this most difficult time. My love to all who are going through this. This certainly helps us to appreciate life and those around us and not take anything for granted. my love to everyone who has a loved one who is in their final stages of life on earth and who Are ready to join their deceased loved ones with God in heaven. Sorry for any typos or misspelled words as we all know this is very emotional💕


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..

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