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Witnessing the death of a loved one

Few things in life are as sad or as sacred as witnessing the death of a loved one. In our culture, however, because death and dying have long have been cloaked in silence and mystery, the thought of being present when someone dies is frightening for many. Learning to recognize the signs of imminent death, knowing how to talk to the dying person, and knowing what to do after death occurs will help to alleviate your fears and allow you to stay with your loved one through the closing of the circle of life and death.

Signs that death is near

Terminal patients have good days and bad days. On the worst days, it's common for family members to think that the end must be near. But just as the impending birth of a child is heralded by the typical signs of active labor, imminent death can be identified by specific signs of active dying.

  • Bodily systems slow down. Caregivers may observe a change in color and decrease in amount of urine output. Blood pressure also decreases. The person who is dying may stop speaking or responding to questions.
  • Decrease in food and fluid intake. Swallowing may become difficult or impossible, or appetite and thirst may decrease. If nausea and vomiting occur as a side effect of pain medication, ask the doctor to change the medication or adjust the dose.
  • Changes in breathing. A Cheyne-Stokes breathing pattern – several rapid breaths followed by a period of no breathing – may develop. Difficult breathing, shortness of breath, gurgling, or a buildup of fluid in the lungs may also occur.
  • Incontinence. The dying person may lose control of their bladder or bowel function. 
  • Decrease in blood circulation. Circulation decreases to the arms and legs; legs and feet may become numb, and hands and feet are cooler to the touch. Blood may pool on the underside of the body, and skin may turn blue. 
  • Restlessness, agitation and confusion. Restlessness and agitation may be observed as jerking motions and pulling at bed linens or clothing. If your loved one is disoriented or confused, he may fail to recognize family members or report seeing people who have already died. Agitation in an unconscious person is often seen as a sign of pain, which requires additional comfort measures to be undertaken.
  • Change in sleeping and in level of consciousness. Sleeping increases, while consciousness and responsiveness decrease. The dying person becomes difficult to arouse and eventually slips into a coma.
Keeping a vigil

When a person is actively dying, family members may gather to say goodbye and provide care to their loved one. All care is now focused on the patient's comfort, rather than treating medical conditions.
Even though she may be comatose, your loved one may still be able to hear, and so it's important that you continue to communicate.

  • Talk to her, expressing your love and gratitude for her presence in your life.
  • Play carefully selected music to help soothe the anxieties that are common when death is near.
  • Avoid discussions among family members that may be upsetting to the dying person. 
  • If you sense that your loved one is clinging to life for your sake, assure him that you will be alright, and that it's okay to let go.

Be sure to touch your loved one, too. Touch is soothing – simple gestures such as massaging the legs and feet with lotion or stroking an arm can provide reassurance and comfort.

When death occurs

When your loved one's breathing appears to have stopped, confirm that death has come by checking for other signs of the end of life:

  • No pulse or heartbeat

  • Loss of bladder and bowel control

  • No response to touch or sound

  • Eyes fixed on one spot

  • Jaw relaxed and mouth slightly open 

If your family member dies in a hospital or nursing home, let the nursing staff know. They'll confirm the death and call the funeral home, at your request.

Should your loved one die at home, there is no need to move quickly. Take time to say goodbye and share your grief. This is your family's private time for mourning before the funeral. Reciting prayers or performing familiar religious or cultural rituals may provide comfort for your family as you join together to honor the dead.

What should you do next?

When you're ready to surrender the body of your loved one, call 911. To clarify that this is not an emergency, inform the dispatcher that the deceased had been ill and the death was expected. If deceased was receiving hospice care, call the hospice nurse on duty. Then notify the funeral director who will carry out arrangements for the funeral and burial or cremation.

The coming days will bring a roller coaster of emotions, a stream of visitors, and profound exhaustion. Allow yourself time for mourning, be kind to yourself in your grief, and seek support from others if you need it. Above all, you can take comfort in the fact that you stood by your loved one and helped to make his or her final days more comfortable.

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Further sources of information

You may find our other articles in the Death and dying: a broader context section helpful too.

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