When death comes suddenly, there is little time to prepare. On the other hand, watching an older person become increasingly frail may mean that it's hard to know when the end of life begins because changes can happen so slowly. But if you do know death is approaching and understand what will happen, then you do have a chance to plan. Listen carefully to what doctors and nurses are saying. They may be suggesting that death could be soon.
Should there always be someone in the room with a dying person?
Staying close to someone who is dying is often called "keeping a vigil." It can be comforting for the caregiver to always be there, but it can also be tiring and stressful. Unless your cultural or religious traditions require it, do not feel that you must stay with the person all the time. You need to eat and rest. If there are other family members or friends around, try taking turns sitting in the room. Some people almost seem to "prefer" to die alone. They appear to slip away just when visitors leave. Of course, experts have no way to prove that's what happened.
Just as each life is unique, so is each death. But, there are some common experiences very near the end:
- Shortness of breath, known as dyspnea
- Tiredness and sleepiness
- Mental confusion
- Constipation or incontinence
- Refusal to eat or drink
Each of these symptoms, taken alone, is not a sign that someone is dying. But, for someone with a serious illness or declining health, these might suggest that that person is nearing the end of life.
In addition, closer to death, the hands, arms, feet, or legs may be cool to the touch. Some parts of the body may become darker or blue-colored. Breathing and heart rates may slow. In fact, there may be times when the person doesn't breathe for many seconds, known as Cheyne-Stokes breathing. Some people hear a death rattle. That is noisy breathing that makes a gurgling or rattling sound. Finally, the chest stops moving, no air comes out of the nose, and there is no pulse. Eyes that are open can seem glassy.
After death, there may still be a few shudders or movements of the arms or legs. There could even be an uncontrolled cry because of muscle movement in the voice box. Sometimes there will be a release of urine or stool, but usually only a small amount since so little has probably been eaten in the last days of life.
Calling 911 or not?
When there is a medical emergency, such as a heart attack, stroke, or serious accident, we know to call 911. But if a person is dying at home and does not want CPR, calling 911 is not necessary. In fact, a call to 911 could cause confusion. Many places require EMTs (emergency medical technicians) who respond to 911 calls to perform CPR if someone's heart has stopped. Consider having a "non-hospital DNR" (see Understanding Health Care Decisions ) if the person is dying at home.