Dear Barbara, my mom recently passed away while surrounded by her kids and husband. I cannot stop replaying her last moments over and over again in my head. I know this is normal. However, she had a disease that impacted her speech and for a week before she died, she could not speak at all and slept constantly. Then, minutes before she died, she gave a few whimpers and shed one tear. My brother and I are tormented by this, as we want to know why these things both happened. Why the whimpers? Why the tear? She had an incredibly strong Christian faith, so I am trying to reassure myself that it was not sadness, but perhaps, joy and awe. Or maybe she was just simply sad to leave her kids and husband. I know we will never know. But I am wondering if you could speak on any similar experiences you have witnessed of either or both of these things.
It is interesting to me how much importance we all seem to place on the last few minutes before physical life ends. You are not the first person to ask me about what occurred during a loved one's last moments. We witness the tears, the facial expressions, the sounds, the grimaces. Yet we are so often unaware of those very expressions as life progresses on its routine daily basis. It isn’t until life is ending that we become observant.
What happens at the moment of death or in the hours before death, is generally just normal body actions. A tear is natural -- the eyes are partially open and have been for days or even weeks. There is a drying out of the eyes and the body is trying very hard to produce moisture. Without blinking (and the eyes are not blinking) moisture accumulates and rolls down the cheek producing a tear (generally not a lot of “tears” because the body is dehydrated and not functioning as it normally would).
It seems poetic to believe the tear is sadness or emotionally based. I believe the “tear” is physiologically based. The person at the moment of death is so withdrawn from their body that they are not expressing emotions or even feeling emotions. Their work is that of the little chick working to get out of the shell. They have already withdrawn from what goes on around them days or even weeks before this moment.
The “whimpers” are part of the sounds of dying, no more, no less. Sighs, moans, gurgles, and soundless cries are all part of the normal, natural way a person dies. We, with our fear and deep sadness of the moment, react and hold on to every expression as if it has meaning. It doesn’t.
What does have meaning and is important is that the person who is actively dying can, on some unconscious level, hear. Imagine standing outside watching and experiencing a beautiful piece of nature. You are caught up in the splendor of the moment and from a distance you hear someone speaking to you, calling to you. You hear but softly from a distance. I believe that is how the person actively dying hears us. We, the watchers, need to say what is in our hearts (hopeful we have taken the opportunity to do that long before this moment) and then after we have said our goodbyes just be a presence. Touch, hold, be love as we walk to the end of life with our special person.
Something more about Whimpers and Tears...
When a loved one enters the dying process, it would be so helpful to know what to expect, what to look for. After being at the bedside of hundreds of deaths, I decided to write a hand book for families to help them navigate these waters. Gone From My Sight is the first and most widely used handbook on the signs of approaching death. Churches, families, social workers, nurses, chaplains need this book. Do you have yours?
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I just wanted to ask if these books come in Spanish?
Hi Carol, your question do I see a “difference in the dying process and emotions, actions, of Christians and those professing no faith in Christ?” is one others have asked also. My answer is really, no, I don’t see a difference. People die the way they have lived. Their dying is reflected in their personality traits, their fears, their beliefs. We don’t suddenly go from being a challenging personality to being a submissive one. Our personality actually intensifies so from this example we become more challenging, not less as we approach death.
Sometimes as death approaches, or in the case of suicide in the days to moments before the action is taken, people explore their beliefs, previous and current and come to “terms” with what they have chosen to believe. Some pray when they have not prayed in a long time. Some do not. This relationship we have with our God (or not have) is such a personal one that these thoughts are generally not shared but kept deep, deep, within ourselves.
Nicole’s death is heart wrenching. There will never be answers for why she found life so difficult. What I have learned is that sometimes life is just too hard. It is just too hard to be alive. I hope you find a bit of comfort in the knowledge that she is at rest now from this challenging life that she had.
Hi Mary, I read your comment on this Blog Whimpers and Tears post about families being concerned about “gasping for air and short of breath”. Yes, it seems no matter how much teaching and prep work we do with families about the normal dying process and what all happens it never truly prepares them for the actual experience.
Ninety percent of our work in end of life is teaching. Repetition is part of that teaching. Repeat, repeat, repeat. “ Mom is doing a good job. Mom is doing what she is suppose to be doing. This is how a person dies. Nothing bad is happening, nothing pathological. This is how people die. See how she is breathing with her mouth open, those fish like movements. She is suppose to do that. The sounds—those are normal. Those are the sounds people make as they are dying.” All these things we say, over and over again as we guide a family through this final life experience of their special person.
Get the family involved in the moment. Get them individually to say goodbye. Talk about the positive as well as the negative. Encourage touching and holding. Get the family beyond their fears to what they are seeing and interpreting as “bad” into an interactive, giving love and encouragement space.
Mary, thanks for asking. Think I’ll take these comments and do another Blog with them.
Dear Barbara,
As a nurse for the past thirty four years, I have had the opportunity to fulfill many different nursing roles. The majority of my experience has been with Geriatrics. I have been a bedside nurse, as well as a DNS in SNFs and Hospice Director/Primary Nurse. As a very hands on Nurse Manager, I always made certain that my facility staff had direct access to your publications. I have probably used the “Gone From My Sight” booklet several hundreds of times. It was the perfect educational/supportive tool for the families and loved ones of my patients/residents. It was a very beneficial segway into those difficult discussions that needed to take place. Since I retired as of my last position of DNS, I can only hope that the new Director has continued to use it as well as having incorporated your other publications as needed. I just wanted to let you know how helpful and meaningful your work has been to me throughout my years in our profession. I very much enjoy following your email communications. Keep sharing your expertise and knowledge as you currently do. You are contributing a great deal to the Nursing Profession.
Sincerely,
Deb Peters, RN
Barbara
Recently we had two hospice patient families express dissapointment that it appeared to them that their loved ones were “gasping for air and short of breath” while in the end stages of dying. Families were very upset, one of the individuals was even a RN! The patients were receiving medication for symptom control so it was not r/t a lack of medication. We do give all families your “little blue book” and explain the process, indicating that all family members should read the book as it will help them understand what will occur during the dying process. Do you have any further tips or hints we can use to help distressed families as their loved ones die?
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