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Handbook for Mortals : Coping With Events Near Death

How will I know when someone is getting close to death?

Just as doctors cannot pinpoint the precise day when a baby will be born, they cannot predict the exact day or hour when you or your loved one will die. You might need reassurance that it is simply not always possible to know when death is near. Some illnesses, for example, make prediction difficult. However, many illnesses have a few hours or a few days when it is evident that death is close. The person dying usually is no longer eating or drinking, except perhaps a few sips of liquid now and again. The person may be sleepy or confused most of the time and is usually in bed. If the person is dying from cancer or a progressive failure of an organ, he or she will usually have lost a substantial amount of weight. If life support is being stopped, the physician should be able to tell you what to watch for to estimate about how long it will be before death.

Many people near death have cool hands and feet and a persistent purplish discoloration in the parts of the body resting on the bed. Many also will have uneven breathing, sometimes stopping for many seconds and other times breathing quickly. This kind of breathing and discoloration can persist for a few days or may be seen within hours of death.

Some people have some jerking motions or even seizures near death. As disturbing as it may be for you to watch this happen, your loved one will probably not be aware of it. Involuntary motions usually do not need treatment and do not cause problems for the patient. Seizures can often be treated with rectal medications to be sure that they are not distressing to the patient or family.

If the person has been taking opioids, these will be continued because stopping such medications abruptly can lead to uncomfortable symptoms. If the person is no longer able to swallow, opioids can be given by suppository, injection, skin patch, subcutaneous infusion, or IV.

Probably half of patients develop very noisy breathing near death, sometimes called a "death rattle." This is the result of physical changes and does not cause the person to feel as though she is struggling to breathe. In fact, most dying patients are not aware of this noisy breathing. However, if family or caregivers find it unnerving, the doctor or nurse can help reduce the noisy sound, either by giving medication or repositioning the dying person in bed.

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