What to expect when your loved one is dying- from breathing to a ‘Lazarus’ moment

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Katrina Taee is an end-of-life doula, a nonmedical professional trained to care for a person as they approach death. She has revealed what you can expect when a loved one is dying and why it can be a peaceful experience with nothing to fear.

Eating and swallowing

The need for food diminishes and they will naturally eat less, sometimes refusing food altogether towards the very end. This can be distressing for families, but the body knows exactly what it’s doing and realises that it simply doesn’t need the fuel like it used to.

The body is reserving its energy for vital functions such as maintaining a heartbeat and taking the next breath as opposed to burning energy consuming food. Eating can actually make someone feel unwell as their digestive system has effectively shut down already.

The swallowing reflex will also slowly diminish, so another reason for not eating is the body protecting the person from not being able to swallow food.

Appearance

Appearance wise, the face may be pale in complexion, white, bluish or yellow if jaundiced. Their eyes may be glassy or even ‘milky’ and may be open or shut. Sometimes pupils may be unresponsive so are fixed and staring.

Extremities may feel cold or hot to touch and sometimes nails have a bluish tinge due to poor circulation as the heart slows down.

There may also be swelling, which is usually due to fluid accumulating, and can make the skin appear to be ‘tight’. Sometimes there is a mottling of the skin and they may feel clammy or sticky, hot or cold. These symptoms can sound frightening, but they are normal responses to the major organs slowing down as the end gently approaches.

Breathing

Changes in breathing are common as death approaches. Changes such as heavier breathing, noisy breathing or gasping breaths. To watch this can be upsetting for loved ones but usually, it does not cause distress to the one who is dying.

The ‘death rattle’ is when some phlegm or secretions rolls backwards and forwards in their airway making a noise. This is not distressing the patient as they are often non-responsive or deeply asleep at his point.

Sometimes there can be an episode of very noisy breathing as the end gets draws closer. This is called Cheyne-Stokes breathing and it is characterised by loud breaths followed by a period of no breaths. It is difficult to listen to because families often wonder if the person has died before witnessing another breath.

Right at the end of life, the breaths generally become quieter, stiller and increasingly spaced out until eventually one breath is not followed by another.

Agitated mood and restlessness

This can present itself as a need to get out of bed, agitated behaviour or ‘knitting’ of the hands. They might reach out as if towards something or somebody.

It is natural and wholly part of the dying process, even if it’s not always present. It is a temporary phase and a strong indicator that death is approaching.

Visioning

Another sign that death is near is what is referred to as visioning, when a loved one may comment on subjects such as taking a trip, packing, going with someone and going home.

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‘The Lazarus Moment’

A phenomenon that Katrina calls ‘the Lazarus Moment’ describes someone who has been unresponsive or deeply asleep, suddenly waking up, sometimes sitting up, looking at those around and sometimes even talking to relatives.

This is often unexpected and sometimes shocking, but usually very welcomed by families as it might be seen as a golden last moment of normality.

Sometimes there is a burst of energy a day or two before death. The patient is more awake, talking and even eating and drinking a little. Relatives can occasionally misinterpret this as someone getting better, which it isn’t.

It can however be a happy time, one that is remembered fondly by families and is often recounted in the story of the death.

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