Someone’s final hours of life aren’t always as dramatic as the movies show. In reality, the majority of families notice a few physical changes in the person, including the way that they breathe or the feel of their hands. Hospice doctors have noticed such things before, including palliative-care researcher Dr. David Hui & his team at MD Anderson Cancer Center. They witnessed hundreds of dying patients and documented what actually happens at the bedside during someone’s last days and hours. Here’s what they found out.
One of the first things that families tend to notice is how much the dying person sleeps. They may have originally been someone who wakes up easily, but now, they tend to stay asleep through conversations & light touch. Some families notice that these individuals open their eyes for a few seconds before drifting off again.
According to Dr. Hui’s hospice studies, reduced consciousness tends to appear a few days before someone dies. It then happens more frequently towards the end. Of course, it’s not the same throughout the day, as some people seem awake in the morning, then barely respond a few hours later that same day. Many families describe it as feeling like the person is far away, despite the fact that they’re right nearby.
Eating and drinking habits tend to change long before someone’s final hours. But the difference becomes clearer towards the end, as a person might stop asking for meals or take very small sips of water.
According to research by Ezekiel Oluwasayo Ijaopo and his team, this is usually due to people’s sense of coordination weakening as they get closer to death. They find it a lot harder to swallow. As a result, they’re likely to stop wanting to eat or drink anything, so they can avoid swallowing entirely.
There’s also breathing. Towards the end of their life, the person may take several quick breaths and then pause for a few seconds. They then start again. It’s something that doctors refer to as Cheyne-Stokes breathing, and in Dr. Hui’s research, changes in breathing appeared most often during the last three days of someone’s life.
A person may start making a rattling or gurgling sound when they’re breathing, which usually happens because they can’t swallow properly anymore.
Some family members feel scared when they see their loved one has stopped taking steady breaths or has started gurgling. It doesn’t feel normal. In some cases, the pauses can be long enough that family members start to worry that the person has stopped breathing. It may happen over & over.
Changes in breathing patterns also have an effect on how people speak, as their voices may sound softer or breathier as a result. Some families notice that their loved ones start trailing off words mid-sentence. It’s because speaking takes more effort.
As breathing patterns shift, the voice often changes too. Speech may sound softer, breathier, or incomplete. Words might trail off mid-sentence because speaking takes more effort. It’s also common for someone to get a drier mouth, with more cracked or pale lips.
These changes often lead to people whispering instead of speaking normally because it’s easier for them. Soon enough, conversations involve more short phrases or gentle nods than actual words.
However, one of the most jarring changes is in terms of the person’s temperature, as many families notice that the individual feels a lot cooler than before. Clinical observations by Hui’s team actually found that it can be difficult to find a pulse during these moments.
It’s also common for a person’s skin to look paler or become slightly bluish. This change tends to come & go, meaning that they may only be different for an hour before it changes.
But what about their behavior? Not all people in their final hours experience restlessness, yet there are quite a few people who do. It can look a little strange when it happens. For example, a person might reach for objects that aren’t actually there or pick at their clothes. They may also speak in fragments that don’t make much sense.
Ijaopo’s research found that such delirium is especially common in those suffering from advanced illnesses close to death. It can be quite a sudden change. One minute, a person can seem calm, but then out of nowhere, they appear unsettled. This behavior may then disappear suddenly, too.
By far the most important thing to know is that, when families look back on those final hours, they usually describe the individual as undergoing a slow shift. They very rarely experience a single turning point in their last few hours.
