If you are taking care of a loved one who is at the end of life, there are some classic signs and symptoms that can let you know that death is near. Not everyone will exhibit all four symptoms. A few people may not exhibit any of the symptoms.
But this article provides a general road map through the dying process. If you feel you cannot go through this process alone, it may be time to call in hopsice to help guide you and smooth your way over the rough spots.
The Dying Process Begins: Changes in Appetite
As the time of death draws close--say days to a week or two--most dying people lose interest in eating and drinking altogether. They may become too weak to swallow food or fluids. This is a difficult process for loved ones to watch. In our society, food and nurturing go hand in hand. But as the body shuts down, it no longer requires the energy of food or fluids. Efforts to force feed can lead to vomiting and food and fluids being inhaled into the lungs (aspiration).
Instead, keep your loved one comfortable by putting moisturizer on her lips and gently swabbing her mouth with a washcloth or toothette moistened by water or juice. Your loved one may not eat or drink at all in the days immediately prior to her death. She isn't "starving." It's all just part of the way the body ceases its functioning.
Changes in Mental Status at the End of Life
A few days to a few hours before death occurs, the dying person may be restless, picking at the bed clothes or reaching up towards something we can't see. If he is still able to talk, he may speak of being in the presence of dead loved ones or angels. Never argue with your loved one when he sees these visions.
A day or so before death, the person often gets a burst of energy. He may eat for the first time in days, or sit up and watch a movie with family. It almost seems as if he is on the mend. But the energy fades as fast as it appears, and the terminal decline begins.
Within one to two hours before their deaths, your loved one will likely enter a brief coma-like state. His eyes are often half open and glassy. He may breathe with his mouth open. He will not respond--or will only respond very minimally--to your voice and touch.
Most experts, however, agree your loved on can still hear and understand during this comatose state, so continue to speak to him gently and reassuringly. Don't say anything in the sick room that you don't want your loved one to hear.
Changes in Circulation Occur Days to Hours Before Death
Your loved one's dying body begins to shut down circulation to the extremities to conserve circulation for the head and the heart. Therefore, you loved one's hands and feet may appear to have blue or red splotches on them. The clinical term for this is mottling.
Your loved one's arms and legs may feel cool to the touch. While distressing to some family members, these changes in circulation are not painful to the dying loved one.
The Dying Process Nearly Complete: Changes in Breathing
One of the most recognizable symptoms of dying is a change in the breathing pattern. When death is a couple of days to a few hours away, many dying people adopt a Cheyne-Stokes style of breathing. Breathing begins to grow shallow, then stops altogether for a few seconds (apnea), then returns heavily with an almost panting sound. This cycle can occur multiple times.
You may also become aware of a ratting sound in the back of your loved one's throat. This so-called "death rattle" occurs because your loved one is too weak to swallow the saliva that collects in the throat. The air coming through the saliva makes the strange, unsettling sound. Medications can be used to dry up excess secretions.
Typically the periods of apnea become longer and longer until finally your loved one just slips away. You will know when death has occurred because there will be no more breathing and no heartbeat .
Symptoms of Dying
Death is often seen as something scary in this culture, but if you've ever watched a loved one go through the dying process, you'll know it isn't terrifying at all. Each symptom of death and dying either brings no distress to the dying person or can be controlled with appropriate medications, interventions, support and comfort.
So never be afraid to walk with a loved one to that last, most difficult door. In the end, you'll be glad you made the journey.
Sources
Karnes, Barbara. Gone From My Sight.
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