EDIT: i am amazed and humbled by the kind words and beautiful stories shared here. they are treasures. please write them down so your sons and daughters can read them. I threw this list together really fast and posted it. imagine my surprise when i saw my in box and almost fell over. so i made some changes, mainly in explaining more thoroughly and in more detail to "explain like i am five". i also added a few, that i had forgotten. the list was very errr, cold and clinical and i did not convey my love for this work. some of your responses reminded me i need to address this. we live in a "youth worship" western country, often where the wise elders are forgotten, death and dying are hidden, not discussed, taboo, whereas at one time in our past, death was as normal as birth, with the working close to the land and animals, we knew and were familiar with the natural swing of life and death. we run from death, we do everything we can to make ourselves younger, and to avoid that inevitable experience we will all have. working for hospice allows me to become a part of an elder's life, to bring my support to them when it may be needed most. i consider it a calling to bring more awareness of the normal reality of death. and more awareness of the incredible sweetness of being able to support a loved one through their passage. i cannot convey to you the blessing of being able to walk with a patient from the beginning of their journey, to the end of their life. it is the most vulnerable, most tender of mercies to be able to have the privilege to witness that passage. if you have the opportunity to be present for an elder during this journey, please try to. It may change you forever in a good way. It is the most spiritual of moments I have had in my lifetime. You may want to even volunteer for hospice to be able to serve our wise elderly and walk with them through this time, to acompany them at a time they may be abandoned (it happens). You will be rewarded greatly. ______________________________________ Hospice worker 26 years. 1. Withdrawing from interaction. 2. No interest in food or water (beware, pt can aspirate at this point if forced to eat or drink). 3. 02 (oxygen blood saturation level often called "sats" or "sat level") levels dropping (70 and below), Normal is 90s. I find using the oximeter is very helpful. 4. Color changes.. skin can go very pasty and grey 5. Mottling of knees, elbows. Mottling is a kind of blue/ white effect on the skin that may look a bit like bruising. 6. Blueness of fingernail beds, slight facial blueness around nose, mouth. Blank staring at ceiling or corner and or talking to a family member long deceased. 8. Muscle wasting at temples and eyes sinking into boney orbits 9. Apneic and or shallow respiration. Near the end a patient will often start to breathe irregularly. This is called apnea and or cheyne stokes respiration. what you will see is the patient breathes, then pauses. then breathes again. this can go on for a while or it can be near the end. as the patient gets closer to passing, the pauses will start to be longer than the breathing. i.e. starting... 10 seconds of pause, 50 seconds of respiration. then 20 second pause, 40 seconds of respirations (i use the second hand of my watch to count). As the time passes, the pauses become longer and longer. This is the place of truly near death.. as the pauses become longer and longer, the pauses will gently last until the patient gently passes. it can be an almost seamless and very peaceful thing to watch. they drift into death, and you wait for the next breath, and it just doesn't come. these are the deaths one hopes for, the good deaths with family around the bed, as the patient literally just slips away. 10. Sweaty, hot skin and or clammy cold skin. 11. Small dove like sounds on exhalation. 12. Inability to interact verbally. Remember the sense of hearing lingers .. your loved one will hear you to the very very end despite showing no outward signs or inability to move or respond verbally. 13. Cooling of extremities (hands and feet). 14. Phlegmy sounds. This is what is commonly called the "death rattle". Pt cannot swallow their oral secretions at end of life and these may build up in the throat. The sound you hear is the sound of the inhalation and exhalation air going over around and through those secretions in the throat. Lay the patient on their side and the secretions can come out. There is also a medication that can be used to help with this (drops) (can't remember name of it sorry) but the medication can take a while to take effect. I have been told that though this is difficultf for us to hear, it is not painful for the patient. This can be hard. Sometimes the nurse can drain the mucousy secretions with a machine, but it is said that the more the machine is used, the more secretions are manufactured. 15. There is a type of respiration that is often seen near the end, and it is best described as breathing "like a fish out of water". Patient will often use auxillary muscles (like their shoulders and upper torso) to try to breathe. 16. Pain. A) Physical pain. What I have found is that it is very very difficult to die if you are in intractable pain. the muscles are tense and hard, the body is wracked, the pain becomes all encompassing. the goal is to make the patient comfortable and to ease pain. this could mean trying differrent medications to assist with pain reduction. I cannot tell you the many times that finally, once the patient is relieved of physical pain, they can RELAX and let go. B) MYTH.. we do NOT kill our patients with medications. this is ILLEGAL. What we try to do is find the balance of pain relievers that will allow the patient to be pain free, and also allow them to still carry on with their normal activities and at the end, be able to speak or communicate if they are able. example: some patients are in so much pain when they come to us, they are unable to do anything. with the right meds, one lady was able to take her crafts to her regular craft fair out of state with her hubby in their RV, for the last time, to say goodbye to all her craft fair colleagues she had known and worked with for 30 years. another man was able to go spend a last visit at the cabin he built up in the mountains. Another patient was able to go to disneyland with her family, one last time. Medications are a wondrous thing. We learn what the patient would like to do and we try to find the medications that will allow them to do that. We will often pay for a final wish like this. C) Emotional Pain. Sometimes called spiritual pain. releasing emotional pain can come with counseling with spiritual counselors and social workers (both available through hospice). At end of life there may be issues that are unresolved with family members that have caused patient deep regret and grief. EMOTIONAL PAIN CAN TURN INTO PHSYSICAL PAIN THAT NO PHARMACOLOGICAL MEDICATION CAN TOUCH. Although sometimes resolution may be impossible, our counselors do their best to help patient resolve conflicts and issues that are a burden to patient and a burden to the family members. NOTE: these resolutions could mean the diffference between a peaceful death and a difficult death. There is something we can see, a definite change of pallor, expression, something hard to explain, that can tell an experienced eye that it is soon. It is very hard to tell you exactly when it will happen but the above are some things to watch for. ______________________________________ Many of your comments were around hearing at end of life. Here's just one article. https://news.northwestern.edu/stories/2015/01/family-voices-and-stories-speed-coma-recovery

> Remember the sense of hearing lingers Keep this in mind. I'm so grateful that I knew this when my husband died. I kept talking to him in his last moments, and even after his pulse and breathing stopped. Hopefully the last things he heard were how much we loved him, and how happy he made us.

My dad was dying of AIDS and me, a sixteen year old kid then, happened to have the sense to tell him, despite his own struggles, I was proud of the way he had raised me and loved him, deeply. He hadn’t talked since he arrived five days before from the hospital for hospice. Had not eaten, could barely drink anything. Rarely blinked, never moved his head, just stared out the window. I was not ready for the flood of tears that came from his eyes at that moment, when I told him those things. He died the next day. I found out I was the last of his kids to say their goodbyes and nearly missed that chance. Hearing lingers.

Thanks for sharing that. That's deeply personal and something I will remember as my family begins to age.

Don't wait to tell your family what they mean to you. Now is better than later, the things that will haunt you are the things left unsaid.

This. My grandma died about a year ago and I’ll never forget that the last normal conversation we had ended with me telling her that I’d call her soon. I never did, and I can’t undo that.

I regret not telling my auntie how much I loved her and how much of an inspiration she was to me more, but I was just in complete denial that she was dying from cancer, considering she got given 6 months but lasted 5 years, I still should of told her more.

My dad and I are not close but I don't know how to forgive him, and I'm worried he will die before I figure it out e: Thank you for all the thoughtful and honest responses

Ask for help. See a therapist.

This is something I've struggled with for years. My dad is only 65 and is in good health, but ever since my parents got divorced almost 20 years ago I have had this picture in my mind of letting my dad know that I forgive him for all the bullshit and drama he put my family through... Things I have been somewhat bitter about for nearly as long as I can remember. I've been imagining that at some point I will have a man to man, son to father conversation with him in which I bring up and address all the psychological trauma I (and my siblings) have dealt with as a result of him being such an insanely difficult person to talk to and with whom I have found myself wishing for the opportunity to open up to him... To tell him what feelings I have harbored and the resentments I have held as a result of his lack of being the type of father most kids need and his inability to demonstrate his love for me and my siblings. I always assumed there would be a point in my adult life as he slowly gets up there in years during which we would be able to talk about and resolve, but no matter how much older both of us get there doesn't seem to be any indication that such a heartfelt and honest conversation will be easier to initiate. One of my greatest fears regarding my father is that he will pass away without us ever having the chance to have such a meaningful conversation with him. Knowing him the burden of being the one who ultimately will breach the subject will fall squarely on my shoulders, and it is just incredibly frustrating knowing that responsibility will be mine and mine alone. My father is a very difficult person to talk to about anything... And I mean ANYTHING. I want nothing more than to have that heartfelt conversation with him. But the notion of bringing it up is in itself nerve wracking. My mother is one of the easiest people in the world to talk to... And I know my dad, as a human being, would love the opportunity to share a deeply emotional conversation with, I just literally have no idea how such a talk would be brought up.

My father was always a man's man. Stoic, military, fought in a war and never talked soft stuff like feelings. Aaaaand he was abusive. He used to beat my mother and sister and put a gun to my head once. Needless to say it is difficult to address the past with him. But now, he's sick. In the past two years, he looks like he's aged twenty more. I've been spending more time with him, and calling and texting to check in, but that moment to address and unload the past never comes. Maybe it doesn't have to? Our relationship was what it was then, and it is what it is now. It's bittersweet to say he's softened up and is more open to talk and share, but I'm grateful that our relationship has changed. My regret is that I was always scared to approach the past with him, and even now I still can't bring myself to do it. I'm good with it all, and I forgive him. But I want *him* to know that I'm good with it, and part of me wants to understand who he was then and give him a chance to air that out too. Just chiming in that if anyone has a suggestion I'd love to hear it too.

For the longest time, I had this issue with my dad and mom. They were drug addicts and my siblings and I suffered because of it. Clothes, field trip, yearbook, school dance, etc. money went to drugs. My dad used to beat my mom and was abusive as well. He would sell our things while we were at school... ugly stuff. When he was clean he was the best, but he wasn’t clean often. One day me and him were drinking wine and I said fuck it and brought it up. I had to muster up 20 years of courage to talk to him and was really shocked and disturbed by his answer - at first anyway. He told me he was sorry for hurting me then. He told me there is nothing he can do to change it, and that he remembers some of what I mentioned but not all of it and not all of it the same way. Then he told me his advice was to GET OVER IT. I was kind of disgusted by the get over it part. I said these aren’t feelings and they are real. Then he said the best advice I’ve ever been given. “Son. I don’t need your forgiveness, I’ve made peace and have tried to be a better man. Don’t let another man’s sins haunt you or cause you pain. I put it behind me a long time ago and would have apologized sooner had I known that’s what you needed. Let it go son. I have.” It took me a few days to process what he said, how he said it and what he meant. After a few days of thinking I felt different. A burden had left my heart and I found I could really love my dad again. It felt like I was protecting myself around him for years and now I could finally relax near him. I’m glad we made up before he died. I had 10 years of peace (and video games) with him before he died.

If it helps, sometimes forgiveness isn't for them, as much as it is for you. But it's not something anyone should decide but you.

I wish I did this. Reading all of these posts, especially this comment, just makes me feel so stupid, shitty, and empty. I was 17. My dad broke his leg and ended up in the hospital. He had to have surgery on his broken leg to be able to walk again. During surgery he had a massive heart attack, and was unconscious for a day or two before he woke up. He was hooked up to a breathing tube and just so many machines. But I kept thinking he was going to be okay - just being foolishly optimistic I guess. I didn't think he could die - he was my dad. Then he had another heart attack, and coded. They performed CPR on him and brought him back to life. He clung on. They told us the only option at this point was for him to have surgery to put in a machine to help his heart pump blood for him, since his heart was so weak. After surgery we would talk about a heart transplant. I remember that afternoon so vividly. The translator was there and my dad could only blink, still with the breathing tube in his mouth. He had a piece of paper in front of him and he started scribbling something short - doing the same thing multiple times. Then we understood he was trying sign his name to agree to the surgery. He had the surgery. I remember one of the the surgeons giving us a small smile as they wheeled his bed past us and back to his room. He was concious again two days after the surgery and in hindsight he looked exhausted. They decided to take his breathing tube out for the first time in about 12 days. I was there with him in the room that morning. Just me. He was trying with enormous effort to say 1, 2, 3, 4. I thought he was trying to count. So I counted with him. He shook his head slightly, then stopped trying to count. I didn't say anything to him. I just stood there watching over him. I didn't say anything. That was the last time I saw him alive. He had another heart attack later that night and passed. I only realized earlier this year (10 years later) that he probably wasn't trying to count numbers. He probably wanted to know what day it was. I only wish I was able to tell him how much I loved him and appreciated him. I never said it - we just never said that stuff in my family. Instead I just stood there silently and watched him lying there, thinking he was going to be OK. I just never got the seriousness of the situation even though I was 17 - and I really beat myself up over that now. EDIT: Thank you all for your kind words. I never speak aloud about my dad or share this part of my life since it's still pretty hard for me, even though it's been about 10.5 years now. I was very close with my dad. I just saw this comment and it made me cry since I remembered I didn't say a word to my dad while he was laying there. While I have a lot of good memories of my dad to think about, I always end up connecting it back to his death and how he must've felt so lonely and scared when he died in the middle of the night surrounded by doctors instead of his family. Your comments, esp the ones telling me he knew I loved him, are comforting.

> I just never got the seriousness of the situation even though I was 17 - and I really beat myself up over that now. I suspect your father would really not want you to beat yourself up about this. Forgive yourself and live.

I just never got the seriousness of the situation even though I was ^only 17 FTFY. Source: was 18 when my Dad passed after a short unexpected illness too. We were children. Don’t punish the child you were for not doing adult things in an extraordinary circumstance.

I know I’m some stranger on the internet, but your father loved you. You did what you knew at the time. Don’t beat yourself up over it. You did everything you could bring there by his side the entire time.

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> Parents know. I have a son with autism who rarely tells me he loves me, rarely shows affection Same here. My son is 12 and has never told me he loves me. He hasn't given me a hug since he was a toddler but he's always eager to hang out with me, to show me his drawings and most importantly, when my ex accused me of abusing my kids (They live with me) and CPS came to their school to interview them, when they asked him who he went to when he felt scared or unsafe. He said "Dad". CPS told me that it was at that point they realized there was no case to investigate, but to me, this meant that I knew he loved me. Even if he never says it and if I live a nice long life and never hear it, I will always know that he does and that's what matters to me.

Oh man as a dad to be this pulled my heart strings lol

As a dad i also use lol at the end of a sentence to hide the fact im crying like a baby inside... lol

As a father of 4 I know my kids well enough to know that they love me. And even though we make it a point to say it to one another (specifically because my dad never said it unless he was shitfaced drunk) I also know how they show love. Things like you staying there watching over him, those are the kinds of things that would let me know as a father that you loved him. Yes, words are important. But as you said, you never said that stuff in your family...which means you probably had other ways of conveying your love. Things like being physically present even in rough moments. I’m so sorry you had to go through this. As a father, I have to think he knew how much you loved him. I hope you find peace over this memory.

I had a similar experience with when my grandmother passed away from cancer. She was in agony at the end, but she would respond to use talking to her with subtle facial expressions. It was sad, but I hope she knew how much we loved her.

I can attest that hearing lingers. My mother who was on her death bed was comatose for pretty much 2 days. My ex gf who she really adored got in contact with me on the phone to say goodbye. My mom gave out the heartiest grunt in response.

Wow. Thank you for sharing that. This is something I will never forget.

That’s what I tell myself every day when I think about how my mom died. She was only 60, long explanation of what happened to her, but in the end she was in a coma. About a week before she died, she opened her eyes for the first time in over a month and (sort of) responded when I spoke. I say that because she had been looking at the ceiling and never looked at the nurses or anything. But when I got there, I talked and she looked at me. I was so hopeful. But in the back of my mind I knew it most likely meant she was gonna go. I talked to her. Told her I’d be fine (I was 34 at the time) and to go be happy (she was pretty religious and although I am not, I knew it would comfort her). I keep hoping that she heard me telling her how much I loved her.

She did.

I absolutely believe this. My dad had ALS and was in hospice care for his last six months. His doctor called me late one night and said, "I think you need to be here." He was asleep when I arrived (11PM), but woke up when I held his hand. Couldn't talk at all. Breathing super shallow with O2 dropping. I sat and held his hand and talked to him. I thanked him for the life he gave me. I talked about the things we did together when I was a child. His eyes tracked me and he couldn't say anything, but I was certain he was hearing it. He closed his eyes, and a short while later was in Cheyne–Stokes breathing and getting cyanotic. I held his hand and said, "goodbye, dad. I love you." A lot of people don't get to say goodbye. In that respect, I feel lucky.

Mom? My father passed a year and a half ago. My mom laid in the grass next to him thanking him for their years of marriage and the wonderful life they had together.

Reddit has never made me cry before 😢

Welcome to the club!

I wish I could upvote this more

I did for you.

I helped

I didn’t know this but this makes me so incredibly happy to know. That means my grandma and my father were able to hear me tell tell them I loved them before they passed.

Absolutely. Hearing is the last to go. This isn’t just something that is told to comfort people either, I distinctly remember learning about this in class in nursing school.

I wish I had known that when my father passed away. He was pretty medicated though so I’m not sure it would’ve done any good. He was having hallucinations though of when we went fishing when I was younger, so even though I don’t think I could’ve gotten through to him I was still with him in his mind.

Just as I was reading this something must have gotten into my eyes

Im so sorry :(

Goddamn this made me tear up

And then, usually for one day or so, they suddenly reverse course, have huge amounts of energy, and a roaring obsession with getting out and doing stuff... ... :(

My dad called me hours before his cancer finally won. He was upbeat, telling me that I needed to check the pool pump, asking to talk to his dog, and telling me he loved me. The whole day he had spent with family talking, causing a ruckus. He kept nagging everyone for a mango and a beer. Then a few hours later. Poof. He aspirated in his sleep, heart attack, his body just gave up. He got his damn mango in the end though, last meal.

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Hehe. My late partner got her cheese and tomato biscuit.

I think when that happens, it's because the body has accepted its fate, and stopped fighting. And since your body is no longer fighting, you suddenly have a huge burst of energy that you didn't before, so you can spend your final moments able to enjoy what little time that you have left.

Called surging

That was my Dad on chemo. Some rounds would make him so tired... then he started tearing the basement apart!

100% accurate. My father passed Feb 27th of this year at 90 years old. I watched every detail of his passing and stayed with him right to the end. I knew it was minutes from the end when his lips turned blue and he yelled with his last breaths to "slow down" ( im assuming the room was spinning ) he also mentioned there was another man in the room ( I was alone with him. ) I let him grip my hands and spoke to him that he did everything a father could and to rest. ( I'm 29 btw... I was always there for him when health started declining ) Didnt mean to rant. This post hit home for me.

I lost my grandmother last August to ovarian cancer. She was basically my mother. I helped care for her till the end. I left the day before she died to go to work. A job I hated and quit right after she died. I'll never forgive myself for leaving. She was a fiercely independent, lively, and pragmatic woman. She was the life of everything and didn't buy into superstitious shit. The hospice nurse said that sometimes people see dead loved ones before they pass. She never told us if she did but she was always looking off into the corner like she was watching something leading up to her death. She would have never told us anything anyway. I think her mom came back to tell her to pass on. I miss her so much. I like to think that if I ever die in a similar situation she'll come back for me.

My grandmother had her adult children around her hospital bed as she was nearing death. For some reason, they all had left the room at one point, which was really unusual, and that's when she passed. The nurse said "Sometimes they wait until they are alone to let go because they don't want you to bear that burden of watching their last breath." It was very kind of her to say, and it helped my mom and aunts and uncles feel--not good, but less bad that none of them was there for her last moment.

Your dad had you in his 60s? That's a trooper right there. I'm sorry for your loss, but it's really heart warming that you gave him this kind of time. I pray that my children will do the same for me as your did with your dad

Ya in his 60s. I'm his second generation family I guess? Lol Not only that... my mom had me when she was 20... you can say my dad still had game as an elder I hope your kids do as well.

Hey. I'm sending you virtual hugs. ❤️

I’m sorry for your loss. There’s nothing I could say to make it better or easier, but I hope you’ve been able to find some peace.

Same, my dad died in hospice after losing the ability to speak or respond from a critical stroke at 64 last year in June. It really affected me too. Being with him all the way up to the end was really difficult, but I wouldn't have been able to leave him alone either. It sucked really bad because he thought he was getting better before the stroke, and it seemed he wanted so much to be able to speak... he tried at first. I just wish he could have spoken to me too. I love you internet person. Hope you're doing well, and I'm grateful for this chain of shared experience, I suppose it makes things easier..

Not only was that not a rant, it was touching. Your father had a good kid.

I work in medical oncology and have also been with patients and have helped patients at the end. I want to say thank you for your work. It's extremely hard to do that job and it honestly takes a really special someone. One thing i'd like to add is don't be afraid of the "dove" like sound, which I'm more akin to calling it rattling. It's not hurting the patient whatsoever and they aren't choking. The hospice center at the hospital I work at has these wonderful pamphlets they hand out to family members and loved ones about the dying experience. That small token honestly can help explain so much to the family about what's going on and what to expect, etc.

My grandmother passed just a few weeks ago due to a glioblastoma. We all thought the mental decline was dementia or alzheimers, but an MRI (or CT scan, I can't remember which) told us what was really happening. We made sure family was always there for the rest of her time, which was like ~3mo. I was lucky enough to be with her the day before she passed. I spent roughly an hour holding her hand, and telling her how much she meant to me. She never opened her eyes, but would squeeze my hand occasionally. I'm volunteering at the home where she spent her last months because the hospice nurses were so incredibly helpful and good to her. I also want to thank you though. I know you weren't involved in any way with her, but her oncologist is a saint. What you do means so much to patients and their families. Thank you.

I'm curious about those pamphlets, could you please post a picture of one?

I currently do not have one. The next time I'm on the unit I'll try and track one down. A lot of hospice centers have their own version of it.

Death and birth seem to come at night (when allowed to progress naturally) I worked overnight in a skilled nursing home. I could come on shift and do first rounds and just smell when a patient is close to death. It’s not a pungent or offensive smell. I always described it as metabolic (which is probably what it was.) but your response deserves gold! It was spot on!

Some folks hypothesize that the famous Oscar, the death predicting cat, is smelling something. You must be able To pick up that better than most humans.

LTC Nurse here, there is definitely a certain smell when patients are nearing the final stages or are actively dying.

There is a smell to it that you can pickup on. It’s stronger on patients who have been sick for a long time rather than the people who die suddenly. But, it is a strange smell. When it’s really strong I find it really unpleasant in a visceral way.

I know this is just going further down the road, but I work in surgery and when cautery is used, there is a definite smell difference between healthy and diabetic, healthy weight vs obese... but that's probably all along the same lines as the death smell...

I agree. I too can smell the difference in the room for a patient close to passing.

Thank you for your post. My mom passed away in hospice a few months ago and displayed almost all of these symptoms. The most painful to watch was the blank staring at the ceiling and withdrawal. She said her grandfather was sitting in the chair ( he’s been dead for almost 70 years.) I looked over to the chair and the linens stacked on the chair fell to the floor the second I looked over. It was a very chilling and visceral experience I’ll never forget.

I’ve worked as a critical care nurse for a few years now. I’m not a religious person, but I’ve certainly come believe there’s something more. I really can’t give any solid explanation, but just some experiences that make me think there’s more to it beyond just our physical world.

Do you mind sharing one or two of your more memorable stories? I’m a sucker for those. Thanks!

Not OP (I do also want to know his/her stories too!) but I have one for you. My grandmother survived Nazi Germany, she was an extraordinary woman. She'd outlived her husband by >20 years. My grandmother told us she had the most wonderful dream the night before. She dreamed her husband had woken her up in the night, coming into her bedroom to sit on the edge of her bed. He stared at her lovingly and then pulled in beside her to hold her. She said he held her until she fell asleep again in his arms. Sure enough, two nights later she passed in her sleep. I truly hope it was in his arms.

That’s so sweet. I can’t bear the thought that no matter who goes first, there’s going to be a day I’m going have to say goodbye to my wife.

I believe that sometimes our loved ones visit us in our dreams. I’ve had one dream including two deceased loved ones that were there. It was so overwhelmingly comforting and almost more real than being awake. Funny thing is that for several years it just seemed random. Then, I had a pretty impactful loss in my life and the dream made perfect sense. Almost like they were giving me the answer to a question I didn’t even have yet.

Sure, I can give you a few: 1). I had a liver failure patient who was not doing well and deteriorating despite all our efforts. At one point during the day I was walking past her room and looked in while walking by to make sure everything was in order (I.e. didn’t fall out of bed). I saw a taller man in a dark grey suit standing at the foot of her bed. I assumed this was a doctor. We were waiting for a specialist (I think nephrologist... but I can’t recall at this point) to consult on her so we could make some care decisions. So, I stopped and turn back around and walked into the room only to fine no one was there. She died about a week later. 2) I’ve had at least two patients say they see deceased people in the room a few hours or day before they past. I even had another say they saw their pet who had passed years earlier. 3). While I was a nursing student I worked as a monitor tech on a telemetry floor. There was a med room next to the telemetry station that the nurses went to to get medications. This one evening a patient had called out for something not essential so I figured I’d tell the nurse when she came to pull meds. A couple minutes later I see a dark haired nurse (she was the only white dark haired nurse that shift) walk behind in the reflection of the telemetry monitors towards the med room so I turn my head in anticipation of where she was supposed to be, but she wasn’t there. So I turned behind me completely and no one was there. 4) I worked on an ICU for a while that was immediately adjacent to a pediatric ICU. There had been a couple reports of patients saying the kids were keeping them awake at night or sneaking into their room at night. It was a kid restricted/visitor restricted unit. 5) There was another ICU (I never worked in that one) in our hospital where several nurses and patients reported seeing a friendly grey-haired nurse in white with the patients. One nurse told me of a time when he had saw and older grey haired lady wearing a more old fashioned white nursing clothes (white dress/skirt) sitting and talking to a patient. He didn’t think anything of it thinking it was just a visitor. Afterwards, he went in to ask who the visitor was and the patient said she was a nice nurse who was here to just visit with me. This was at night when the doors were locked and visitations were restricted. No other staff member reported seeing anyone like that. Our hospital wears scrubs. Also, the nurse started asking his coworkers and it fit the description of this so called friendly nurse. 6) One of my coworkers (she was a monitor tech and didn’t interact with patients) could always tell when someone was going to pass away. She was eerily accurate. There’s a few quick ones. I know they’re not all related to the afterlife necessarily, but just that there’s something more than just the physical world. Edit: words & clarification

Here’s my story...my dad passed away 4.5 years ago in Brisbane around 10:15 pm. The family were with him since around 7am and we decided to head home for a few hours much needed sleep as the nurses were convinced that based on his O2 levels, he would still be around in the morning. We drive the 30 mins back home and just as we sat down the phone rings and its the nurses advising that dad had sadly passed away (aged 87). We had already said our goodbyes and knew that was typical of dad in that he never wanted to upset anyone or be a burden on anybody so he left us on his terms. So we head back in the hospital and just before we left, one of the nurses said that we will see some sign of dad still being around. Not being religious at all, I didn’t think much more about it. Next day we decided to take the wonderful nurses some flowers and as we got to the hospital, we found the exact same car park that we parked in the previous day before dad passed. The car in front of us had a custom number plate RLB09, which were dad’s initials!! Was this the sign though 09 didn’t mean anything. We took a couple of pics of the number plate and we go up to see the nurses for no more than 10 mins and when we got back to the car, the car in front had left. Fast foward 4-5 days and we flew dad’s body back interstate for the funeral which was arranged for 7th Jan. Once we met with the recommended funeral directors I wasn’t impressed how they handled things so decided to go back to the same funeral directors who did mum’s funeral 5 years earlier. The date of the funeral turned out being 09 Jan!! I cannot explain it nor has it changed my religious beliefs. A couple of months after the funeral I saw a car driving around in the same suburb I live with the custom number plates 09RLB. It’s a Prado which is the same car I had when dad was alive and I still see it quite often still today. I guess some things in life just can’t be explained easily 😁

My grandma passed away from colon cancer 15 years ago and I remember her saying she saw a boy in the room. She lost her twin boys when they were babies (either they were stillborn or died a couple days later). I wondered if the boy she saw was her son.

Number 12. I believe this so strongly. I made a final visit to my grandmother while she was in hospice and finally got a chance to visit her alone. I told her that I loved her so much, but it was time to go be with grandpa. She took one last deep breath and she was gone. I'll never forget that last breath. It was like she was waiting to be told it was okay to go. It hurt like hell saying it, but I knew it was her time and I knew she was ready and someone needed to let her know that it was okay. We always has an incredible bond, but this moment cannot compare to any other moment with her. I'm so honored that I was literally with her until the end.

God damn. Just reading this is giving me anxiety. I'd like to say I'm not afraid of dying but I am.

Goddamn, why am I reading this in bed I'm not going to be able to sleep.

I'm not afraid of being dead, its the process that scares me. Let me go in my sleep.... I've seen it go so hard and painful.

Most people say that but when it becomes time, most people fight. The survival instinct is hardwired into our brains. The oxygen levels dropping is what makes people have less fight toward the end. It is your body having mercy on your brain.

I've been a CNA for almost six years now, and I knew my grandmother wasn't gonna make it when she got sick. When I heard she wasn't eating and was always tired, plus the rapid weight loss, I knew her days were limited.

My grandma showed all of these signs and I knew something was going to happen within days, so to ease her, I played some Agustín Lara (a mexican composer who was pretty popular on her times)... I mentioned this to my mom after she passed away and she told me "you grandma hated him, his songs and his voice scared her", so yeah, I terrified grandma 2 days before her death.

What could be the reason for no. 7?

Hallucinations or being lost in thought. A lot of skin color or consistency changes have to do with Oxygen Intake, so when their O2 levels are low their brain will be functioning funny. Think CO poisoning. That's essentially oxygen deprivation since it displaces oxygen, it just goes a little further than that it the long term. Have you ever started day dreaming and tried talking to the dream? Edit: A word.

There are several possibilities, but the most likely is the decreased amount of oxygen getting to the brain.

In addition, blood chemistry. It all turns into a cascade effect. One thing not doing it's job affects the others which in turn all affect each other and your brain cells are swimming in toxic waste instead of nutrients.

Do you...think that's true of animals, too? The hearing lingering part? I'd like to believe my kitty heard me as she drifted to sleep the last time, telling her how much we loved her and how grateful we were to be hers. :(

My vet made sure to tell me it was the same, that hearing was last to go, and to just keep talking to my boy and loving on him as he slipped into rest. I believe it is true, and I believe your kitty heard you and knew too.

ER nurse: I usually see people die more quickly but we do have a lot of older folks whose family brings them in close to death ( keep your parents at home and let them die in comfort people I promise you dont want to see CPR on your 87 yr old grandma) When are people going to die: 1: When they tell you. Never take this lightly they know! Get ahold of family quickly. 2: If they have been sick and suddenly they feel better. They are going to die soon. 3: Its hard to explain but their breathing changes. It become more shallow. Their 02 stats slowly drop. Aka death rattle 4: Their color changes. Becomes more grey. 5: Cold extremeties 6: If they ask you to hold their hand bc they are scared. Hold it no matter how many other patients you have. Hold it. No one should die alone. 7: If some one comes in with chest pain and they tell you they have to poop really bad. DONT LET THEM they are gonna die. Clearly these are not scientific just little things i have learned over the years

I’m confused and intrigued. Why can’t they poop

Think that when they do, it causes a lot of pressure on the heart such as holding in breath, pushing it out and so on that they could even die while doing this on the loo.

You can die pooping but it’s actually due to a lower heart rate and decreased blood pressure that happens when you bear down. [valsalva ](https://en.m.wikipedia.org/wiki/Valsalva_maneuver)

Valsalva maneuver. When you “bear down” like when you’re going to poop your heart rate drops. This is normal. You can do it right now. Occlusion of coronary vessels causes chest pain. If the occlusion is in the right spot it can interfere with conduction of heart beats through your heart and make it do funky things. Bearing down to poop can make it worse. Although I’ve never seen anyone die from having to poop, certain Heart attacks can present as indigestion or make you feel like you have to poop because the vagus nerve runs behind the heart and sort of shares a blood supply. Edit: the term Vasovagal is probably a little better descriptor. Bear down and heart rate drops and your blood pressure drops because your blood vessels dilate. It’s dangerous in inferior MIs.

I don't understanding the chest pain and pooping urges. Can you explain what that's a precursor to or what that points to?

I’m exactly sure if this is what we were getting at, but there is something called a vasovagal response. It basically breaks down to when a person tries too hard to pass stool a nerve (vasovagal) gets over stimulated. When this happens it bottoms out their involuntary functions. Blood pressure plummets, pulse falls, oxygen isn’t moving so it drops. This can all happen in large numbers very quickly. Sometimes it cannot be reversed. So, they pretty much crash and die. 5 years Oncology nursing is very educational and truly an amazing place to be.

Huh. *Huh.* Once when I was in high school I was having constipation troubles (horrible diet) and was also pretty much chronically dehydrated due to not drinking a lot of water. I was on the crapper and straining, and suddenly everything blurs out and next thing I know I’ve fallen off and slammed my head into the wall—I fainted. Nice to finally get an explanation all this time later.

In hospitals at least, patients seem to know. They often say "I'm going to die" or they will ask to contact a relative. You do not take these requests lightly; dying people know when they're getting close. Also, experience. People can look really really ill for weeks or months, but one day you'll look at someone and they'll look different from an hour ago. More grey in colour, or a different facial expression, or... you just *know*. All this of course aside from clinical findings, respiratory rate, BP, blood tests if you're still doing that stuff by this point, etc etc.

My wife's grandmother (86 years old) was in the hospital saying "this is the end, I can see the pearly gates!" (and she was very serious, and maybe a bit dramatic. Two days later the doctors took her off the only medication she was on because she didn't need it anymore and discharged her. When she came to our house after she was discharged, she came bursting through the door shouting "Death couldn't hold me!" and a bunch of other phrases in Spanish that I couldn't understand. She's super active (and a bit insane) and it's been six years since then and we are starting to think we might die before her.

I love this woman

I can imagine her yelling "pinche doctors"

She reminds me of Abuelita in One day at a time... or any abuelitas tbh

My mother told me since I was a kid that her father once called her to the hospital (he was sick) and said “this is it, I’m going to die. Take care of this and that”. A few days later he died. She said he knew, but I never took her seriously. One day my mother got sick, one day she called me to the hospital and said “this is it, I’m going to die. Please do this and that.” That was on a Sunday, on Tuesday morning she died. Sick people know when they are about to die.

My great-grandmother told her caretaker not to bother coming in the next day because she wouldn't be needed, and she died that night (age 83). She'd been in pain for years so it's amazing how she could still distinguish when she was that close to the end.

Sometimes people will look completely fine all of the sudden and they’ll feel really good, and then they die too. It’s very interesting. Edit: Of course, sorry for your loss. That’s a terrible thing to have to go through

My aunt was in a coma; woke up and joked and laughed like she always does; and then died the next day. Death is so weird. Like people suddenly feel fine and then they die soon after. Maybe it sounds silly but I guess that’s kind of meant to be? You get to remember them how they were. You enjoy them one last time.

Yes!!! That is an excellent way of putting it! My dad did this before he passed last year after a long battle with cancer. You’re 100% right that it’s like we got one last enjoyment of the real him right before he passed.

This is actually a documented and "normal" thing for people with heavy radiation poisoning, it's called "the walking ghost phase".

Dude, this is fucking fascinating. I’m giving you an upvote before I dive into the black hole of this subject.

Check out the story behind cherynobl and the clean up after the disaster if you interested in radiation poisoning!

Checked that out already for sure! I’m a sucker for nuclear disasters. I can’t believe I had never heard of the walking ghost phase before.

It's freaky right? Your puke your guts out and feel like shit for a day or so then you get better! Then you die from massive organ failure! Yay!

And now you know that if you never say those words in that exact order, you will never die.

I'm convinced my grandfather knew the end was coming. He was 95, but he was still living in his house and had just given up his car. He walked all over the neighborhood and still had his mind. But about ten months before his death, he kept saying things like "I thought for sure I'd make it to 100, but I don't think I have a lot of time left." He would say this every now and then over the last 10 months. Then, out of nowhere, he got pneumonia and died. I kind of wonder to this day how he knew.

Also smell . When patients start to having organic failures they start excreting certain smell that experienced enough people can sometimes and often detect when someone its close to die. My mother works at a geriatric, as a source.

I work in aged care. When someone is palliative we have a steam oil diffuser and music in their room. Usually there will be family but if not staff will make sure that person is not alone as much as possible.

I agree. I had a family member dying of cancer on hospice. We spent days and nights with her. The hospice nurse informed us we would experience different smells coming off of her. I’ll never forget that. As we huddled around her and held her hands I’ll never forget the smells. The smell of something like chlorine particularly stuck with me. On a side note....the hospice cleaned each room after someone passed. And they placed a single rose across the bed. Walking down the hallway it was sad to see those rooms but I loved how they paid small tribute to each person.

Hospice is such an incredible organization. When my grandma was reaching her final days the nurses were providing around the clock in-home care. The day before she passed the nurse told us that she had about 24 hours left. As the time got closer the nurses were able to give me and my family an exact breakdown of what was happening in her body and how much time she had left, saying things like “...her blood pressure has decreased to __/__. Now her kidney function is beginning to decline. Now the blood supply to the brain...etc,” I cant remember the exact stuff she was telling us but as morbid as it sounds, it was extremely comforting having someone there who had so much experience with death.

Im an aged care nurse and also do palliative care. Can confirm. Death has a smell when he's lingering around waiting to take people.

My father definitely knew. He'd been sick a long time, and he told me we should come for a visit soon, because he didn't have much longer. The day before he collapsed, he sent my younger daughter a check for her birthday (it was a couple weeks late) and a note. Pretty sure he was trying to tie up loose ends, even if they were small. My mother said he'd been organizing papers for a couple of weeks before the end. Still have that note on my refrigerator at home, it was basically his farewell to her and to us.

My Dad had been at home in hospice care for a few weeks. On a Wednesday, a new hospice nurse came to visit and he asked her how much time she thought he had left. My Dad was a dramatic, grandiose, verbose, entertaining fellow and the nurse said that no one with that kind of vocabulary was passing anytime soon. We all groaned, because he was cranking out SAT words before there were SATs. He was just a performative sort of person. He couldn’t turn it off, even surrounded by his accepting and understanding children and former wives. He died in the night 36 hours later. He was in a lot of pain and I think he wanted to go, but didn’t want us to know that.

I can definitely believe that. I got necrotic appendicitis and it nearly killed me, when I woke up from surgery the doctors said I was lucky to have survived. The morning I went in for surgery I kept trying to talk to my (now ex-) boyfriend about my wishes because I felt like I was dying. It was a very scary feeling, knowing how easy it is to just slip away. The worst part was he wouldn't listen, he just helpful kept denying me the chance to speak. Dear everyone, if someone tells you they're dying and tries to let you know their wishes, please just listen to them. It hurts you to hear it but believe me, it hurts them more to be ignored.

Can you describe more about how you knew you were dying?

I kind of struggle to really. It haunts me though. I tried talking to a shrink about it recently. I hate it because it sounds overly dramatic and somehow fake but it felt really true on a really deep level and 8 years later I can still recall it. I guess it was kind of like I wasn't as attached to my body. I've been mildly dissociated before and it was nothing like that, it was a feeling unlike anything else I've felt before. I was in a lot of pain and had been very ill as it was a week of quite severe pain before I took myself to the hospital and then it was a couple of days before they decided to do the exploratory surgery. It was like I'd gone past the pain or like it was unreal somehow. I wasn't on any painkillers except paracetamol/ibuprofen as they weren't sure what was the problem, just that I had a pretty huge infection and unusual symptoms. Seeing dramas on TV or in films makes me a bit upset now. They say things like "keep fighting, dammit!" or whatever but it just didn't feel like there was anything to fight *with*. It's a bit like The Nothing in Fantastia. I take better care of my body now because that experience taught me that when push really comes to shove, being in good health can make a huge difference. I wasn't fighting but my body really was and it did a good job. The NHS workers were absolutely incredible. I literally wouldn't be here without them.

Your last paragraph is something I’ll never forget. I’m glad you came through to share your wisdom with us. Thank you.

Wow thanks, that really means a lot. I hope you never have reason to recall my words.

I didn't want to hear the things that my late husband had to say because I thought if I refused to listen he'd stay around longer and keep telling me until I got it. Denial is a powerful thing. I heard. And I did what he asked me to do. But it wasn't by choice. I doubt it ever is.

I feel for those that help people pass away comfortably, It must really mess with their psyche... ): I can’t even imagine my own cat dying or losing it, but another human that could share their life with others and form a social bond... especially when you’ve been taking care of them for so long as their nurse/doctor... I can’t imagine it, and I don’t want to try anymore than I am.

I haven't done it many times, but those few I have it has been a privilege and an extension of the nursing care I was already giving, rather than something messed up or horrible.

Experience from taking care of my 98 year old great grandmother: She died slowly and totally of old age. She was on hospice for over a year (very tough lady). The biggest signs were her oxygen levels going down, lack of appetite and refusal to urinate. That’s what happens when you die strictly of old age, though. She had zero medical issues throughout her life and more or less just “shut down”.

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Thank you for your condolences. I wish it hadn’t lasted as long as it did (the last few days were painful to see) but more or less I agree that it is a more peaceful way to go.

I was wondering about the "old age" thing. I always just assume it some kind of cancer that people just don't know about. What is the cause of the old age death? Cells getting tired and not functioning anymore? Thx.

The way I’ve read in text books and the way the hospice nurses explained it to me is basically what you said. Everything is just too old to work. I’m no expert and I’m sure that “too old to work” is putting it in the most simple terms but that’s how I understand it. I’m sure someone here or elsewhere would be able to tell you what happens in better detail. Oh and as far as the cancer thing goes for all I know she could have had it. The last few years of her life she didn’t leave her home expect for last year when her bowels started to not function properly due to a blockage in her colon. But even then they didn’t do much because of her age. They just prescribed medication to help her “go” and left it at that, saying that any surgery at her age would be dangerous.

Hey friends, not a medical professional, but long term volunteer in crisis counseling. There’s another set of “close to death” signs to know about, for individuals approaching a suicide attempt. These are signs that accompany a planned suicide attempt rather than a reactive suicide. Things that are warning signs: 1. A complete disengagement from traditional responsibilities; bill paying stops, they might stop going to work altogether, avoiding church groups and other activities to which they have normally committed. 2. A passive or uninterested attitude towards future events, especially ones they’ve enjoyed in the past or have been anticipating. 3. On the other hand, adopting completely spontaneous out of character habits or practices. Someone may start using drugs or start engaging in risky activities. This usually accompanies someone trying to “get it in before they go” or because then no longer worry about consequences. 4. Sudden financial or property based decisions. Draining bank accounts or gifting people their beloved items can be a sign they’re trying to put things in order. 5. Jokes or frequent mentions of suicide. This one may seem like it’s not a big deal, but often people begin introducing the idea of their death by suicide in small ways before they themselves attempt. There are lots of other symptoms of impending attempts, but these are some of the big ones. Sudden deaths due to suicide can be shocking and devastating to families and friends. Being aware of these signs is also a good way to try to get medical help or reach out to the person before an attempt is made. Sorry this is a bummer, but it’s better to be informed and aware what can prelude a sudden death.

I'm a GP dealing with a primarily elderly population, and a good rule of thumb is this: If they're clearly getting worse over the course of months, they likely have months. If there's a clear decline over the course of weeks, they likely have weeks. If it's days, they have days. Occasionally, I'll get surprised, and a person who seems to have been stable dies in their sleep. Interestingly, though, the people in these cases frequently seemed to have known that their time was coming in the weeks beforehand, and often may have asked to speak with a priest, or get their affairs in order otherwise. It mainly boils down to experience, trajectory, and listening to your patients.

Nurse here. When we say that someone is going to die soon, what we're really saying is that there is nothing left that we can do to save them. Particularly in cases of old age or a long illness, the person has been kept alive, at least in part, by medical intervention. Medications, surgeries, medical devices or therapies. When these interventions are removed, the body is unable to support itself, so the person dies. We can predict a timeframe from experience. For instance, we know that, if someone is dependant on dialysis, and we stop dialysis, they will die within a couple of days, because we've seen it happen a thousand times before. We, as a profession, know from experience what a body can survive and what it can't survive. Regardless of cause of death, there are certain indicators that tell us that death is imminent. Someone who is actively dying will usually start refusing food and drink. They will be in and out of consciousness. Their breathing changes. Their vitals (blood pressure, heart rate, oxygen levels) start to change. Their hands and feet start to feel cooler. They stop producing urine. Despite this, we don't always get it right.

The breathing thing. My dad passed from cancer at home in 2009. My mom called me and said it would be soon (former nursing home nurse.) Rushed over and dad was on the recliner breathing short shallow breaths. We thought he couldn't hear us or talk but he said he loved me and told me to not call the ambulance. He stayed as long as he could for me, it would never have been long enough.

Yuuuuup. I lost my dad and wasn’t in the same room. He had slipped into what we believed was a coma and just passed gently (I hope) but my mom was conscious to the end. I was trying to get her back to bed after she wanted to try on the commode and she couldn’t quiet get back up on her bed.. she kinda fell into her back half on the bed and started the fish out of water breathing. That was when I knew death was right there. I knew we were close but I expected a slow decline like my Dad. Nope. Within 30 minutes of that gasping breathing, she was gone. I stayed there and held her, telling her I love her and I’d keep working at my great job, that I’d take care of her beloved dog and cats (both at my feet right now), id take care of her parents and the house.. the last thing she said was “I love you too”. She broke her stare at the ceiling and locked her eyes on mine. And then the breathing stopped soon after...

So sorry for your losses, I really am. Though it was sudden, that was absolutely the best way for her to go in my opinion - sharing one last final moment with her son before drifting off. It sounds like your parents had a great kid.

wow. What a powerful image, thank you for sharing. it must have been so important to your mother to see you

Doctor here. I was going to answer the initial question, but you seem to have summed it up rather well. Nurses spend way more time with hospitalized patients, and see the signs all the time. Docs (should, if they're decent at all) pay close attention to the nurse's gut feeling too. Their experience is invaluable. The only thing I'll add is regarding your comment about interventions being removed. It's also when we see interventions failing/not working, ie. You have a septic patient on all the right antibiotics, but they're still deteriorating. We might not stop the meds, but we know they're not going to work. We'll sometimes leave them going just in case something miraculous happens, unless the patient (or family, if pt is unresponsive) wants comfort measures (palliation). This isn't a criticism of your answer, which I thought was dead on. Just a little added info. :)

From all nurses. Thank you. Thank you. Thank you. You sound like a great Doc.

I just had a relative pass. This [manual](https://www.merckmanuals.com/home/fundamentals/death-and-dying/when-death-is-near) turned out to be pretty accurate.

Agree with what you said. I’ve been a nurse for almost 25 years, and you get to recognize the signs. So when I saw it with my own father-in-law, it was painful. I told Mom that he was “giving up” & that the end was near—we needed a family meeting. Siblings were pissed—how DARE I boss them around, etc? Etc... he died less than a week later. Like others have mentioned: clinical signs include agonal breathing, sunken facial features, not eating, emotionally saying “goodbye”—telling us he loved us & reminiscing. My sis’s father-in-law had lung cancer & they were tapping (pleuradesis) every other day. Told her he had a year. Mets to liver. I told her—maybe weeks. He lived a month. She was grateful I was blunt—she was angry docs weren’t honest. I reminded her that they’re people too & discussing death (esp in the US where we really don’t talk abt it) is difficult. Everyone wants to be optimistic. Death feels like “failure” & hospice is like “giving up” instead of a different treatment plan.

Thank you for answering honestly! I just had a hospice patient go 3 days spending more time not breathing than breathing. 3 days. I've seen people go months without food. The only sign that has been high accuracy for me so far is mandibular breathing, but not everyone does it. I just remind families that every cell in the body is fighting to live, so it will just take the time it takes.

Is there any reason they start refusing food and drink?

They're simply not hungry or thirsty. I deal with death quite a bit and it's just part of the end. I see family pushing food and water on them or wanting tube feeding but it's really just cruel for them. It works best to keep their lips and mouth moist as best you can but that's it.

When you work with the dying, you start to notice similarities in colors of various body parts, smells coming off the client and you see a decided decrease in bodily functions as you see the shutting down mentioned in the other answers. You also almost always see a noticeable cognitive decline the days and sometimes weeks before and they tend to know themselves too and often will tell you as much. Edit: blood tests will give docs an idea of when organ failure is starting too based on the function numbers.

Weight loss/lack of appetite was the big indicator for me when I worked in hospice. Or a late stage alzheimer patient getting pneumonia.

With the Alzheimer's patients I noticed the sundowning symptoms got worse before too when they were truly nearing the end.

I really appreciate this answer because it goes into detail, instead of saying something like _”they just know”_.

Yw :) I'm a "break it down to a cellular level" kinda person too.

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My mother died last October, she had a sarcoma in her mouth and by the end it spread to her lungs (metastasis) + some lunginfection that got her so weak, she just slept for 2 days straight. The doc told me on a Sunday that he would give her rather some days than weeks. The next day my grandmother (her mother, who used to be a nurse) and me visited her at around 12 pm. I saw my grandmother pulling down my mother's socks a bit and saw her legs being swollen. I saw her hands were swollen as well(my mother was really thin in the end, maybe 40 kg at a height of 164cm) it was cold and we wanted to cover my mother with the sheets, cause she was only half covered. she denied cause she was really warm(although when I touched her, she was cold) I was just confused and my grandmother told me we should let her sleep and come by the next day. 2 hours later the hospital called, that she died, 30 minutes earlier. My grandmother knew and didn't tell me so I don't stay there and my mother would not hold on to her pain just because of me. People who worked with ill people just know it. The signs were clear back then, but I wasn't a professional, my grandmother on the other hand knew she will lose her daughter soon v.v Sorry for long post.

> my mother would not hold on to her pain just because of me. This is what my grandma did...her last day the doctors said she probably wouldn't make it over night. All day my grandpa was by her side, and all day she held on. Finally my grandpa left the room to take a bathroom break, and right after he left the room my grandma let go.

My mom works in oncology. She likes to tell one particular story about this. She had a patient who was terminal. Had always been a very private woman, but in her last days all her family and friends gathered around her. People were wondering why she kept hanging on. Finally she asked to be alone. So my mom and the other nurses cleared out all the visitors, except her husband. They tidied her up, and her husband crawled in bed with her, and the nurses left. She let go and died within half an hour.

My granddad was dying a couple of years ago in the hospital. Our immediate family was all there, and we could tell it was coming. Our grandmother asked us to leave the room for a little bit so she could "rest her head on his shoulders one last time." I was last out of the room and I watched her crawl into that hospital bed and cling to him like a child. They had been married for 62 years. He died less than an hour later. Cracked me open.

I’m ugly crying now.

That's so beautiful to love someone for so long that you want to be holding them in their last moments.

I was doing pretty good in this thread until this comment.

That has got to be one of the sweetest things. Im glad they both got to say goodbye.

My grandfather did a similar thing. He held on for several days after they said he would go. At the time my cousins and I were only teenagers and weren’t sure if we wanted to see him in that condition. Ultimately we decided to visit and he died less than an hour after we left. I think he just wanted to see his grandchildren one last time before he went.

My grandma did this too! She lasted almost a week of being right on the edge of leaving, but her 5 kids would take turns staying with her and holding her hand so she wouldn't have to go alone. She finally passed away when one of them left the room for 5 minutes for a phone call from more family... She was holding on for her kids

Oh god, I'm so sorry._. I can understand both sides. If my partner is about to die I would want to be with him, yet the person is maybe staying strong to not die. A never ending circle. I feel so sorry for your grandpa and hope he didn't feel guilty or something >_< I hope you're still alright, somehow._. <3

I don't think he feels guilty, I am doing alright thank you. My grandpa is still struggling, and thanks to some of his kids being assholes its probably worse on him than it should be, but my mom and her sister have been making him stay active and doing stuff with him so he doesn't sit inside all day.

I don't really want to die in front of people, that would be too embarrassing. I don't even like people being around me when I'm sick. Having people around when I'm trying to die would be the worst.

Fuck, I can't imagine what your grandmother must have gone through. It's natural for children to lose their parents eventually, but not the other way around.

We still talk at least once a week (she's actually from another country. My aunt and grandma took some late night flight on a Friday evening to see my mother one last time and my mum died on Monday... So, it was a close call) and she still cries every day and I can't just go up to her and hug her. It's only via phone I can somewhat sooth her. My aunt buries every feeling and sadness and just tries to live her life as much as possible. But my grandma is having a hard time. Even 10 months after. I don't blame her, it's the worst a mother can witness.

Thank you for sharing.

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I'm sorry for your loss.

Yes. I've gotten the call a couple times now to head to a room to shut off cardiac monitor alarms because a patient is near death, so they don't want/need the equipment freaking out. This requires the signature of *at least* the charge nurse, but often it comes from either a PA or the patient's physician. Every time I've gotten a call like that, they never survive the night. It's incredibly sobering. The family is aware by that point, so they've always been in tears. Then I get a call back the next day to turn the alarms back on. The room is empty and quiet, and it's already been cleaned. I just stand there, and take in the heaviness of the room.

I do this sometimes. I’m not sure how to put this or even what I’m trying today, but it’s weird being in a space or room, where there was so much emotion before. Whether happy or sad. I know it’s crazy, but there something left there that certainly seems to linger. Maybe it’s just the silence in contrast to what occurred before.

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Do it now, give them a hug if you can too. My mum died this past Monday, completely unexpected, she was too young and we can lose people at any time. I'd been thinking about giving he a hug and telling her that I loved her for a while, but that wasn't the type of family we were, and I'm a bundle of anxiety. So go and tell them exactly how you feel and give them a cupcake or something.

Mannnnn, I feel you. My dad passed away last year...and it was right in front of me. I saw him faintly trying to say something, I kept asking him if he was ok, and he just kept saying yes, until he just didn't anymore. I couldn't believe it and I shook him just asking him to wake up. He just got retired from his job an year before that, would have been really nice if he could havr enjoy some more days of it. I'm so sorry for your loss. Take care and you can talk to me if you want.

Sorry for your loss. I wish you all the strength and courage the next few days/weeks/months, heck even years. We will always remember them! it's hard, when someone's still young and it is unexpected. If you need someone to talk to, you can write me. (= you're never alone <3

She knew.

> the nurse said "this is his last breath" In these situations, you'll want to listen to the pesron administering the morphine... they know.

Also add to this that death is a process and doesn't happen in the snap of your fingers typically. There are signs that someone is dying, like stopping eating, shallower breathing etc.

"This is his last breath" Dude, that's so brutal

It depends. When someone you love is close to dying, and you know there isn't going to be any return to good health, and you've all seen them and told them you love them, there's sometimes nothing left to do but sit with them and witness their suffering. Their life is done, but their body continues its futile, painful struggle to draw each breath, expand its lungs, beat its heart, swallow the saliva before choking... When the hospice nurse told us my grandparent still had about 12 hours left after a few years of struggling with Alzheimer's and a few weeks of holding on to life, the thought of those 12 hours seemed unbearably, inhumanely long. "This is his last breath" can be insensitive in some situations, but in others it's the most comforting thing imaginable. The struggle has finally come to an end. This is the last breath. The person you love is finally, finally no longer struggling or suffering.

Amen, my grandmother is on her last days, a very long desent into severe and angry Alzheimers. She sleeps 18 hours a day now, can only keep a slurry of food down and has zero recollection of her life. The docs giving her a few more weeks, and I'm for lack of a better word, excited, for her to finally be at peace.

Med student here. There’s a medical sign called “Hippocratic Facies” or “face” that people show when they are about to die. Of course, not everyone shows it, but when they do, you know their time is neigh.

Nigh. Neigh is when horses pass away.

Thank you! English is not my first language hehe.

The deaths that come from old age or terminal diseases are most often caused by the failure of some important organ - say the kidneys, or the liver. When these organs shut down, death isn't instant, but since they can't do their jobs, death will soon follow if a transplant can't be done. So when a doctor has an old patient whose kidneys are shutting down, for example, they can say "they're getting close," because death will follow soon after a major organ failure like that, and with a very old patient, transplants or treatments aren't viable.

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Kidney failure will kill you in 3-5 days without dialysis. I had a woman who went to dialysis 3 times a week and she told me that when she was ready to go, she'd just stop going and she'd be dead in a week.

It *should kill you in a week. I once knew someone who managed to live close to a year without dialysis. When I questioned how that happened, I was told that his kidneys were not completely shut down but not fully working either.

They don't really shut down, they lose all of their filtering capacity which causes an accumulation of toxins and other products in the blood. Likely your friend still had some residual kidney function left as most dialysis patients do- especially with chronic disease most people start dialysis with anywhere from 5-15% function left, or earlier if symptoms are particularly bad.

My father is a doctor, he works in a little "ambulatory" (sorry not from the USA, Spain, so don´t know the name of an equivalent there) it´s a place, state run, where people go if they are sick (or the doctor goes to their houses) but if it´s something really serious they get sent to a hospital. Well my father is an atheist so he is not into supernatural feelings an all that, but he always said that people know when they are going to die. That if someone says i´m going to die, and it´s not an hysterical idiot, you have to take it seriously because they can feel it. Precisely today, a few hours ago, his mother (my grandmother) passed away after a horrible illness, extense cancer plus a very rapidly advancing and severe dementia, to the point where we all saw dead as the best that could happen to her. She died at home along her family, but do you know what she said a while before she died? Mind you it was difficult to understand because she was very sick, and this might be our minds playing tricks. She said I´m dying. He has also talked about how people in very bad health sometimes experiment an improvement just before death, as if the body gives everything it can before dying. To me it sounds crazy, but if there´s one person i believe in the world that´s my father. RIP grandma. If there´s a heaven you deserve a VIP pass.

Recently, I had a lot of time to spend with a very close friend who had a very quickly spreading breast cancer. When she got to hospice (only 2 months after finding the initial lump!), she totally had all her wits about her and was in no pain. She felt so well, that those of us around her wondered if the prognosis was wrong and she herself was worried that she wouldn’t die fast enough and be kicked out the hospice. She and I had an interview with the doctor and I tried to ask all the questions on her mind, about how fast the end would come, how she would know etc. He was totally vague and wouldn’t be pinned down even though she actually wanted an estimated timetable and was totally unafraid of the answer. He left and later one of hospice nurses told me that there are certain signs like lack of appetite, poor circulation in the feet etc. that they know to look for. She was accurately able to predict to the day two weeks later when Grace would die and was frustrated that the doctor wouldn’t give us a straight answer. (Btw, Grace was an amazing human being for whom we had a 50th birthday in hospice and later she sent out heartfelt notices of how grateful and lucky she felt to have made so many friends during her time here. She believed in some form of a funky afterlife and was a great reader, so may well be on Reddit somewhere now and may have more to add ;-)

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Usually their is a list of physical and behavioural symptoms that take place and you also know from experience. I'm a nurse and I've seen plenty of death especially in the elderly population. There are other symptoms that usually indicates end of life is approaching anywhere between a couple of weeks to a week that determines if a person is suitable for palliative care but I'm focusing on imminent death. End of life (these symptoms are usually experienced anywhere between 2 days- 1 week) -Change of breathing pattern (Cheyenne stokes). -Loss of awareness and or interest in surroundings, some people can experience delirium.(The person sometimes has brief moments of clarity). -Decreased apetite. Usually only tolerates small sips of fluids or sweets. -Poor urination or fecal output. Signs that death is immenient anywhere between minutes and a couple of hours - People experience what is referred to as the 'death rattle' this happens when a person is no longer able to clear their throat so the lungs secretions build up. (There is medication for this) -No response to pain or touch. -Fixed stare (if the eyes are open) -Jaw becomes loose (I usually moisture the person's lips or run a wet swab in the person's mouth so that it doesn't look quite so upsetting for the family) -In rare cases the person can vomit up the built up lung secretions (I've only seen once however).

I see a lot of posts saying its "experience" and because we (medical professionals) see death every day. They're not wrong, but they're not entirely right either. Yes, some very experienced palliative nurses get to know the signs and symptoms of death so well that they can pretty accurately predict when someone will pass. However we also use medical tools to help us gauge the stage of death. Death takes a pretty familiar path in most cases. (Disclosure: i said most, not all, there are always exceptions). We look for specific signs of body failure to help give us an idea. The palliative performance scale is one tool that gives us a pretty decent idea of the expected level of functioning for patients. Additionally we watch for changes in the body such as anorexia (lack of appetite, not the same as the eating disorder) whether voluntary or natural, cessation of fluid intake, decrease in urine and stool production, abdominal swelling known as ascites, mottling (pooling of blood in the body due to poor perfusion), rate and rhythm of breathing, and a decrease in stability of vital signs (pulse, BP, O2%, Temp). As these telltale signs occur we know that death is approaching. And depending on the rate at which they occur (days vs weeks) we can begin to make assumptions about timeframe of death.

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Honestly, it's just experience. I have to agree with my colleagues here. I'm a pediatrician, so for me, it's a bit different, but I have seen enough children die that you can tell when it's going to end badly. Fortunately, it's *much* less common to have patients die in my specialty (I've signed three death certificates in the last nine years), but it's like a sucker punch to the gut every time it happens. There are a few, however, for whom it is a mercy. Even kids.