What Do I Do in the Final Hours Before Death by Hospice Pioneer Barbara Karnes, RN

What Do I Do in the Final Hours Before Death?

Knowing what is happening reduces fear. Knowing what you can do at the bedside helps you be present. Barbara explains how families can move beyond simply watching to  create meaningful memories during the final hours of life.

Hospice professionals prepare families for the signs of approaching death, but they can't always be at the bedside during the final hours. Even after they have explained what is happening, loved ones often wonder how to be present, what to say, what to do, and whether they are doing enough. Knowing what is happening reduces fear. Knowing what you can do is why I wrote The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death.

Gone From My Sight explains the signs of approaching death and helps families understand what they are seeing as death draws near. The Eleventh Hour picks up where that booklet leaves off. It offers guidance, ideas, and suggestions for those who are at the bedside during the final days, hours, minutes, and moments of life, and even immediately after death. Its focus is on how we can be present and actively participate during this sacred time.

Most of us who have the gift of being present at the bedside of someone who is actively dying let our own fear and lack of knowledge keep us from being active in the experience.

Most of us stand on the periphery, watching, afraid of doing something wrong or not knowing what is "acceptable." So we do nothing but watch. Yet our hearts cry out to do something: hold their hand, talk to them, hug, kiss, be close. Instead, we stand by the wall, away from the bed, and watch.

The Eleventh Hour reminds us that we don't have to just be a watcher. We can participate with our presence, our touch, our words.

The best time to read The Eleventh Hour is before you actually need it. Then, when the time comes, you'll already have the guidance to help you create a sacred, interactive experience. You'll make memories you can carry in your heart forever. It won't take away the sadness, nervousness, or even the fear, but it can soften the experience.

I wrote Gone From My Sight and The Eleventh Hour to work together. One helps you understand what is happening. The other helps you know how to be present during the final days, hours, minutes, and moments before death. My hope is that when your hospice nurse has gone, these booklets will help you feel less alone, less afraid, and more able to share one of life's most sacred experiences.

Something more...

Caring for someone at the end of life brings new questions almost every day. That's why I created the End of Life Guideline Series. It brings together my essential resources, including Gone From My Sight and The Eleventh Hour, to support family caregivers throughout the end-of-life journey. Offered together at a discounted price, the series provides guidance, understanding, and reassurance when you need it most.

3 comments

MARIA D'MARCO

When my mother approached her time to leave, I was given the ‘little blue book’ by the hospice worker I was blessed to have with me during this process.

I tried to get my brothers involved with the information but neither would do so, nor their wives. I knew they were missing out on a chance to divest themselves of their fear.

So, when the final time came, after many little and bigger events explained in your book, which showed up like clockwork, my hospice worker and I were singing songs for my mom and telling her in normal, happy voices that she was almost done — that there were those waiting for her — that she could leave and join them. The lights in the house flashed for over 30 minutes, until she released. We were overjoyed and said thanks to all who had helped her leave.
My one brother and his wife, who were in the room, stood off to the side, sobbing and holding one another, as the hospice gal and I danced and sang and cheered my mom on her way.
We cheer when a baby is born — why can’t we also cheer on the release from the body? Birthing a baby is foreign to most people, as is dying - and there are thousands of books on birth and preparing for it. :O)))
I have given your books to over 20 people in my life. Every single on of those recipients expressed what a tremendous help they were… thank you for your work and dedication to those, all of us, who must eventually leave.
——-
BK Books replied:
Maria, thank you for sharing your beautiful experience with us.I agree birth and death are just the opposite ends of each life. Blessings! Barbara

When my mother approached her time to leave, I was given the ‘little blue book’ by the hospice worker I was blessed to have with me during this process.

I tried to get my brothers involved with the information but neither would do so, nor their wives. I knew they were missing out on a chance to divest themselves of their fear.

So, when the final time came, after many little and bigger events explained in your book, which showed up like clockwork, my hospice worker and I were singing songs for my mom and telling her in normal, happy voices that she was almost done — that there were those waiting for her — that she could leave and join them. The lights in the house flashed for over 30 minutes, until she released. We were overjoyed and said thanks to all who had helped her leave.
My one brother and his wife, who were in the room, stood off to the side, sobbing and holding one another, as the hospice gal and I danced and sang and cheered my mom on her way.
We cheer when a baby is born — why can’t we also cheer on the release from the body? Birthing a baby is foreign to most people, as is dying - and there are thousands of books on birth and preparing for it. :O)))
I have given your books to over 20 people in my life. Every single on of those recipients expressed what a tremendous help they were… thank you for your work and dedication to those, all of us, who must eventually leave.
——-
BK Books replied:
Maria, thank you for sharing your beautiful experience with us.I agree birth and death are just the opposite ends of each life. Blessings! Barbara

Theresa

Our Hospice nurse gave us these booklets when dad was in Hospice. I treasured them and read every word, sometimes again and again.
Thank you for providing this information, especially during one of the saddest times of our lives. I’m a daughter first and then a nurse. I still wasn’t prepared without the assistance of these books and our wonderful Hospice nurse.
———
BK Books replied:
Theresa, having knowledge of what is happening and what to do while all is happening gives us guidance during a very sad and challenging life experience. Blessings! Barbara

Our Hospice nurse gave us these booklets when dad was in Hospice. I treasured them and read every word, sometimes again and again.
Thank you for providing this information, especially during one of the saddest times of our lives. I’m a daughter first and then a nurse. I still wasn’t prepared without the assistance of these books and our wonderful Hospice nurse.
———
BK Books replied:
Theresa, having knowledge of what is happening and what to do while all is happening gives us guidance during a very sad and challenging life experience. Blessings! Barbara

Amy Allison

Dear Barbara,
Thank you from the bottom of my heart for these gifts you gave me in order to be with both my Father and Mother as they were dying. I am forever grateful and I buy your series for so many in my life who need a resource. You are an angel on earth.

I noticed what might be a typo on your blog which is two nearly identical paragraphs- not sure if that was intentional but wanted you to know in case.
See below:

A.) The best time to read it is before you actually need it. Then, when the time comes, you’ll already have the guidance to help you create a sacred, interactive experience. You’ll make memories you can carry in your heart forever. The Eleventh Hour won’t take away the sadness, nervousness, or even the fear, but it can soften the experience.

B.) The best time to read The Eleventh Hour is before you actually need it. Then, when the time comes, you’ll already have the guidance to help you create a sacred, interactive experience. You’ll make memories you can carry in your heart forever. It won’t take away the sadness, nervousness, or even the fear, but it can soften the experience.

Heartfelt thanks,
Amy
———
BK Books replied:
Thank you, Amy. I’ll check it out. Blessings! Barbara

Dear Barbara,
Thank you from the bottom of my heart for these gifts you gave me in order to be with both my Father and Mother as they were dying. I am forever grateful and I buy your series for so many in my life who need a resource. You are an angel on earth.

I noticed what might be a typo on your blog which is two nearly identical paragraphs- not sure if that was intentional but wanted you to know in case.
See below:

A.) The best time to read it is before you actually need it. Then, when the time comes, you’ll already have the guidance to help you create a sacred, interactive experience. You’ll make memories you can carry in your heart forever. The Eleventh Hour won’t take away the sadness, nervousness, or even the fear, but it can soften the experience.

B.) The best time to read The Eleventh Hour is before you actually need it. Then, when the time comes, you’ll already have the guidance to help you create a sacred, interactive experience. You’ll make memories you can carry in your heart forever. It won’t take away the sadness, nervousness, or even the fear, but it can soften the experience.

Heartfelt thanks,
Amy
———
BK Books replied:
Thank you, Amy. I’ll check it out. Blessings! Barbara

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