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
Hi Kathy, thank you for sharing your mother’s last moments with me. You are right about how hard it is to hear and watch someone we love have the congestion that fills the lungs as death approaches. Because of her failing heart and liver dysfunction her body just couldn’t keep the fluid from building up in her lungs. Sometimes there are medications that help but most of the time that congestion, as difficult as it is for us watchers to experience, is a natural part of how we die. Know that your mom was so removed from her body awareness as she approached the moment of death she was not in as much distress as it appeared. Think of the little chick working, struggling to get out of its shell—that is what your mom was doing. She was working very hard to get out of her physical body so she could be with her Jesus. My blessings are with you. Barbara
On September 2/2018 my mother 76 yrs old passed away from cirrhosis and heart failure. Her last few hits of life was very stressful for me watching her breathing struggling to get air. The death rattle was the worst I’ve ever had to hear and see. It lasted for 3 days. Hospice nurses started her morphine and adivan to help her. I wasn’t ready to loose my mother I was tired of seeing her suffering. I don’t believe she was in pain I believe she suffered breathing. The gurgling sound is a nightmare even still. Her eyes opened the last minute of her life, I believe it was Jesus waiting and for me to tell her it was ok to go and I would see her in heaven. Jesus is real, pray with them and for them hold there hand and say I love you one last time. I sang amazing grace as she took her last breath so I know she was ready.
Hi, Barbara my name is Charlene. On July 30,2013 I lost my MOM to bone cancer.It was a hard and hurtful time . But I thank God she’s out of her pain. But at the same time my heart missing her being with us. Her nurse gave us a booklet on gone from my sight. I wanna thank you for guiding me through her moving on. It let me know what to expect what she was going through and the signs of her passing on to her next journey.Id always love to read the eleventh hour. But I can’t get it. After the experience with my MOM people would ask me about what there love ones with cancer are feeling and why this or that is happening. I’d always tell them about your book and how it really helps and makes you feel a little bit better. It gives us not in knowing there not hurting anymore. So thanks again and I’m gonna keep telling people if it helps them to understand. I’d love the book eleventh hour,and another one of gone from my sight. I gave mine to another to help them out. Thanks again Charlene.
Dear Melissa, the vigil you and your family are living with is a challenging one. Know your mom will die when she is ready. Just remember the little chick working it’s way out of it’s shell. That is your mom’s work right now and for some of us it takes longer than others. As for her “being scared”. We will all be scared to some degree as we approach our death. At this point in your mom’s progress her personality is beyond conscious fear. She is just working to get out of her physical body. It is in the months and even weeks before death that fear is evident, now not so much. It sounds like you as a family are doing a great job loving her, talking with her, being by her side. Remember to tell her "when she is ready you all understand it is her time to leave. It is not what you want but you understand”. She can hear you during all this time even if she can’t respond or doesn’t appear to be listening. I hope you have my booklets Gone From My Sight and The Eleventh Hour to help guide you. My blessings are with you, your mother, and your loving family. Barbara
Day 8 of no food and water for Mom. Family all here just loving and comforting her. We just want her to be at peace as she’s always been so afraid to die. Wish I could ease those fears. As the good Lord will most definitely welcome his servant into his kingdom. So sad to be losing such a bright light in this dark world.
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