For families · The final days
The last days & hours.
In the very last days and hours, the body's systems begin a quiet, ordered shutdown. The signs below are normal. They are not emergencies. Nearly all of them can be made comfortable. We are with you, every step.
·The last few days
- Sleep deepens. Most of the day is spent unresponsive or barely responsive. Brief moments of clarity may surprise you — and them.
- No more eating; very little drinking. A few drops of water from a sponge swab. A bit of ice on the lips.
- Less urine; sometimes none. The kidneys are slowing.
- Temperature swings. Fever in the morning, cool to the touch by evening. Light covers; a fan if the patient seems warm.
- Breathing changes. Periods of fast breathing alternating with long pauses (10–30 seconds). This is called Cheyne-Stokes breathing. It looks alarming. It is not painful.
- Restlessness or agitation. Picking at the sheets, reaching, sometimes calling out. Almost always treatable with medication. Call us.
·The last hours
- Skin mottling. A purplish or bluish lace pattern, often starting at the knees, spreading. Hands and feet grow cool. Pulse may be weak and rapid.
- Eyes open but not seeing. Glassy, unfocused. Some eyes close, some don't.
- The "death rattle." Saliva pools in the back of the throat, making a wet, rattling sound with each breath. It distresses families much more than the patient. The atropine drops in the comfort pack help dry it.
- Long pauses in breathing. 30 seconds, 45, a minute. Then another breath. Then another pause. Sometimes the next breath does not come.
- The last breath. Often quieter than the rest, after a longer pause. There may be one or two final, shallow breaths after what seemed like the last. This is not suffering. This is the body finishing.