What It Looks Like When Someone Is Dying

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Watching a loved one die—whether it’s a spouse, parent, sibling, child, or close friend—is one of the hardest things imaginable. Sometimes it happens quickly, and sometimes it’s spread out over many days, weeks, or even months. While every death is unique, there are certain common end-of-life signs and symptoms. Here’s what to expect as a person approaches the end of their life.

Months or weeks before death

Loss of appetite. This may seem alarming to you, the caregiver, but it’s very natural and normal. The dying person’s body is slowly shutting down, and as it does so, the person requires much less energy. You may be tempted to try to coax them to eat. Don’t. As they become weaker, chewing, swallowing and digesting food can become harder and may place unnecessary strain on them. You can offer them sips of fluid through a straw, or keep their mouth moist with ice chips or a damp sponge.

Increasing tiredness. As their metabolism slows, they will begin to sleep more and more, and sometimes they’ll become difficult to arouse. Sometimes, they’ll be so wiped they won’t be aware of where they are. Let them sleep as much as possible, and try not to wake them unless you have to. Try to plan visits and activities for those times of day when they usually seem most awake.

Problems breathing. They may feel like they’re short of breath all the time, or that it’s harder to breathe than normal. They may also complain of feeling like they have liquid in their lungs. These symptoms may come and go or be constant. You can help by encouraging them to sit up as much as possible, and to sleep at night propped up on pillows. Your hospice team can prescribe oxygen or opioids to help relax their breathing. Deep breathing relaxation techniques and anti-anxiety medications can also help.

Giving away belongings. Sometimes, your loved one may want to talk about things that will happen after they are gone, like their funeral, their finances, or their possessions. It may be hard for you to talk to them about this, but it’s important to realize that they may want to make the final decisions and feel like they have a sense of control.

Disconnectedness. Even months before death, your loved one may seem to want to disengage. They may not be as interested in things that once gave them pleasure—say, their favorite baseball team, or spending time with pets or grandchildren. They may seem withdrawn and not interested in having a conversation. Don’t take this personally—it is their way of processing their impending death. Focus on just being with your loved one, and, if they seem interested, remind them of how much they have always meant to you and others.

The last days or hours before death

Changes in breathing. You may notice that their breathing changes to several quick breaths followed by a very long pause in breathing. Their breathing may also become noisier, as fluids begin to accumulate in their throat. It may sound very distressing to you, but your loved one isn’t aware of these changes in their breathing, nor are they suffering. Sometimes, a vaporizer can help, as can placing the person on their side.

Cold, mottled skin. As their blood pressure drops and blood flow throughout their body slows down, their skin begins to cool and turn a bluish, dusky color. You can help keep them warm by piling on extra blankets.

Constantly sleeping. They may start to sleep more and more, and have periods of time when they are completely unresponsive. They may even drift into a coma. But even if they can’t respond, they may still be able to hear you. You can keep speaking to them and holding their hand.

Confusion. They may become confused about what time it is, where they are, and who you are. They may also experience sensory changes, where they get confused about different sounds and objects (for example, they think a lamp is a person). You can help clear up confusion by identifying yourself and anyone else in the room as they move in and out. You should also explain everything you do, like “It’s time to take your medicine to help with the pain” or “I’m going to give you ice chips to help with your dry mouth.” Loss of control over bladder and bowel function. Your loved one may lose control over their urine and bowel movements. The amount of urine they produce will be minimal and darker in color. Using disposable waterproof pads in the bed can help keep them clean. 

Hallucinations. They may hear things you can’t, or claim to be talking to people long dead for years. Don’t try to correct them by reminding them that Grandma’s been gone for half a century, or wonder out loud why they’re having a ten-minute conversation with their deceased sister whom they couldn’t stand. Talk to them in a calm, gentle tone, and affirm their experiences. If they become frightened, soothe them and tell them everything is okay.

Restlessness. Up to 85 percent of all patients experience restlessness before dying. They may make repetitive motions like pulling at their sheets repeatedly, or seem anxious or agitated. Stay calm, speak soothingly, and do something to relax them, like play their favorite song or hold their hand. If it persists, let the hospice nurse know.

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