How do you know if someone is close to death?

There’s really no way of telling just by looking at someone—physical appearance can be deceiving. However, there are some signs and symptoms that precede death in many cases. For some people, these signs appear a few hours before death; for others, they appear a few days before. Still, even when many of these signs are present, it's difficult to predict the amount of time before death will occur. Some signs and symptoms are:

- Increased sleeping. As death nears, the person will spend more and more time sleeping and may be difficult to arouse. What you can do: Let your loved one sleep and rest. Recognize that, at this point, being with your loved one is more important than doing things for them.

 

- Less interest in eating and drinking. In the weeks or days before death, the person has a decreased need for food and fluids. What you can do: Offer your loved one his or her favorite foods, but do not force them. Keep the mouth moist with a damp cloth or ‘toothettes’ (a small sponge on a stick). Keep the lips moist with lip balm.

 

- Changes in speech and hearing. As the nervous system slows, the person's speech may be difficult to understand and they may become less responsive to conversation. However, this does not mean that the person cannot hear—there is evidence to suggest that hearing is the last sense to be lost. What you can do: Speak clearly but not more loudly than usual. Carry on all conversations as if they can be heard by your loved one. Express your love and caring. Say the things that have not been said and encourage others to do the same. Your loved one may be able to understand what you are saying even if he or she cannot respond.

 

- Confusion, visions, and restlessness. As the oxygen supply to the brain decreases, your loved one may become more confused about time, place, and the identity of familiar people. Speech may be incoherent and hard to understand. Your loved one may experience visual and auditory dreams or visions. He or she may also become restless, pulling at bed linens, trying to remove clothing, or even trying to get out of bed. These symptoms are all normal and to be anticipated. What you can do: Reorient your loved one by gently reminding him or her of the time and day, and by identifying yourself and others in the room. Keep favorite and familiar objects in the room. Provide physical reassurance by touching, holding hands, or gently massaging the back, hands, or feet. If your loved one is experiencing hallucinations, simply be present to what is happening; it may be appropriate to just listen. Provide a safe environment; bedrails may be needed to keep your loved one from injuring herself.

 

- Changes in breathing patterns. A first indication of approaching death may be changes in the person's breathing. It may become irregular, with periods of no breathing lasting around 20 to 30 seconds. This symptom is very common and indicates decreased circulation. It is not distressing to the person. Breathing may also sound labored and noisy. This is the result of secretions collecting in the back of the throat. It does not mean the person is in discomfort, but it may be upsetting to caregivers.

Does the dying person experience pain?
The degree to which a person feels pain depends on their disease and on how the pain is being treated. In palliative care, we make efforts to minimize the person’s pain through medication, touch, and companionship. The right combination of pain medications can keep a patient comfortable and able to enjoy a high quality of life. Because each person’s experience is different, it is always advisable to get professional medical guidance if you believe someone is experiencing pain.

Does the dying person know what is happening?
The process that a dying person goes through is very individual. Some people seem very aware, while others struggle to let go. Some talk openly and honestly and even manage to get their affairs in order, while others are not able to face their condition. On some level, however, many people seem to have some awareness of what is going on. They may speak in metaphors, such as: "I’m waiting for the train to take me home," or, "There’s a cab waiting for me outside."

At Zen Hospice, we try to create an environment that is calm, receptive, and honest—we don’t keep the truth from our residents. We also provide support by helping the resident actively explore their dying. The dying process can be a time of immense growth and transformation.

What can I do for someone who is dying?
End-of-life experiences are filled with many emotions for both the dying person and his or her loved ones. Although nothing can be done to prevent death, it’s also true that nothing needs to be done. Offering companionship, a willing ear, and a loving heart is a tremendous gift. Also, we can honor the person’s experience. Although we may want them to talk—or not talk—about their dying, the best thing to do is be open and present to whatever comes up.

How do I deal with someone’s seeming unwillingness to face and talk about his or her dying process?
It’s important that the dying person be free to approach their death in their own way. We may want them to address their condition, but they may not want to. Rather than trying to change that, simply honor and make room for the person’s relationship to their own dying.

The death of a loved one is an intense experience for everyone involved. It can be helpful to respect not only what is going on for the dying person, but also what is going on for us individually, and to be able to see, as much as possible, the distinction between their needs and our own. It may be helpful to examine our own motivation and needs in wanting to discuss what is happening. Do we want to feel more intimately involved in the process.? Do we feel left out? Do we want to feel more "helpful," more "useful?" Can we allow ourselves to feel uncomfortable without interfering with the experience our loved one is going through?

What should I do when my loved one dies?
Do not call 911. Notify your local hospice—even if death occurs in the middle of the night. A hospice nurse will come and ascertain that death has occurred.

The time immediately following death is very special and should not be rushed. There is no need to hurry with the removal of the body. You and others may wish to have some private time with your loved one. You may also wish to bathe the body and have a small bedside service. Be assured that your thoughts, feelings, and actions after your loved one's death are as unique and universal as the end of life itself.