Dear Barbara, I can’t get mom’s last minutes out of my head. Just before she died it was like nothing of this earth. It was like she was possessed, a silent scream, totally distorted facially. Have you seen this horror before?

What you described had to be scary for you. Yes, I have seen facial expression changes in the moments before death. Scary faces, grimaces, silent screams. What do I think it is? Here are my thoughts:

There is a labor to dying. It is hard work for us to get out of our body (some harder than others). Think of the little chick that works, struggles to get out of its shell. As we, humans, are dying we are working, struggling also to get out of our bodies. We, the watchers, see the hard work and don't know how to interpret it. As someone who has seen a lot of dying moments I see that struggle as often intense and unexplainable.

I don't think anything bad is happening. Those facial expressions and movements can be ugly and disconcerting but you were witnessing the final release, the final attachment to the physical being let go.

I don't want you to carry that image as something bad. I want you to understand it was optics we can't explain, distortions of the body as it was releasing its hold on this earth.

I can only say from having been at the bedside of hundreds of people that your mother's facial expression was not unusual. I describe it in my booklet Gone From My Sight or my book The Final Act of Living as a grimace or a frown. More detailed descriptions of faces I've seen could be a silent scream, or facial distortions that a Hollywood producer could use in a horror film.

The other side is I have seen smiles, beautiful, peaceful faces. What I learned from seeing all the various moments of death is it doesn't matter what they look like or why. What we are watching is a struggle to end this life connection, to get out of our physical shell. It's like childbirth in reverse. For some the baby just pops out, for other's, mom has to scream and push for hours.

I do not believe your mother would want you to be concentrating on her last moments and forgetting the good moments of her life. Here is an exercise for you: every day write down one good, beautiful, meaningful memory you have from the many years with your mom.

I don’t want that memory of your mom to overshadow all the good.

I assure you nothing bad or evil or even unusual was happening.

Something More... about The Silent Scream, Grimaces, and Scary Faces As We Die... Why?

I wish that more families were educated on what the dying process looks like and what to expect. More patients and families would experience a sacred death. Their grieving would be normal and not complicated. If you are not offered end of life education, ask for it.