If a person says to you, I want to go home now, you may think to reassure them by saying, You are already home. But that may not be the home they mean. Perhaps they are thinking of their childhood home. They may mean the afterlife.
Your loved one may become restless and pull on bed linens or clothing, hallucinate, or even try to get out of bed, due to less oxygen reaching their brain.
Your loved one may sleep more and might be more difficult to awaken. Hearing and vision may decrease. There may be a gradual decrease in the need for food and drink. Your loved one will say he or she doesn't have an appetite or isn't hungry.
Hearing is widely thought to be the last sense to go in the dying process. Now UBC researchers have evidence that some people may still be able to hear while in an unresponsive state at the end of their life.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
How Long Does the Active Stage of Dying Last? The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage.
Hospice has a program that says that no one should have to die alone, and yet this hospice nurse is telling me to take a break? Some patients want to die when no one else is there. Hospice professionals know that companionship while dying is a personal preference.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours.
Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming. In some cases, the person comes from a culture or a family in which death is simply not discussed.
Pulse and heartbeat are irregular or hard to feel or hear. Body temperature drops. Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours) Breathing is interrupted by gasping and slows until it stops entirely.
Sleep Changes at End of Life
This can be distressing for family members because they can't communicate as well with their loved one. At this point, it is not wise to encourage your loved one to be more active, or to wake them during the day so they can sleep at night. It's best to let them sleep as they need to.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”
End-of-life transition refers to a person's journey to death, especially in those with a terminal diagnosis. This process occurs differently for everyone. For some, it takes days or weeks; for others, it occurs rapidly. Partnering with a trusted medical team during this time can limit pain.
About six minutes after the heart stops, the brain essentially dies.
Go Ahead and Cry
When a loved one cries in front of a dying person, that person then gains the permission and confidence to also be candid about emotions. It opens a pathway to a conversation that could be once in a lifetime. Additionally, the loved one who's dying knows others are sad.
When your loved one is nearing death, it is important to end each conversation in a way that will be okay if it is the last time you speak. Casual goodbyes like “See you around,” or “I've got to run, so bye for now,” may leave you wishing you had said something different. Your goodbyes don't need to be mushy.
Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.
You might be unable to stop crying and worrying. Or you might feel that there is no point in doing anything. You might also find it difficult to see life going on as normal for most people. It can feel very strange to watch people go about their daily lives, do shopping, drive, and work.
The emotional discomfort and interpersonal conflicts go hand in hand in causing suffering at the end of life. Financial instability, marital discord, conflicts with family members, and an inability to get one's affairs in order before death are common causes of total pain.
You'll start to feel more tired and drowsy, and have less energy. You'll probably spend more time sleeping, and as time goes on you'll slip in and out of consciousness.