As the caregiver or family member of a seriously ill patient, it is important for you to know how the human body prepares for death. When you understand the process, you’re better able to comfort your loved one and find peace of mind for yourself.

This booklet describes signs and symptoms that are common when a person nears death. It is only a guideline — each death is as unique as the person who faces it. Your loved one may experience all, some, or perhaps none of the symptoms we describe here. Likewise, there is no set timeline. For some patients, signs of impending death begin months before the actual event. For others, it may just be days.

Throughout this process, you are not alone. The Hernando-Pasco Hospice team can be with you for support prior to and during your loved one’s death. Please do not hesitate to call us when you have a question, a concern, or a need to talk with someone who understands and respects your experience.

Understanding How We DieHelpful Information for

Caregivers and Family Members

These changes are normal, natural ways in which the body prepares to die. They are not medical emergencies. The best responses are comfort-enhancing measures.

Common Mental and Emotional Signs

Long Periods of Deep SleepYour loved one may spend more and more time sleeping when his body’s functions start slowing down. He may be difficult to rouse from sleep and he may spend most of the day and night in bed. His eyes could stay open even though he is asleep.

ConfusionAs your loved one sleeps more, he may become confused about the time, place and persons surrounding him. While his attention is drawing inward, he may speak of seeing a place or people not visible to anyone else.

Withdrawal or a Surge of EnergyYour loved one may speak less than usual or may not speak at all. He may turn to face the wall or sleep in a fetal position. This is not a slight against family; his body and mind are preparing him to detach from his surroundings and relationships.

On the other hand, it is not uncommon for someone near the end of life to “wake up” and talk clearly, ask for a favorite meal and actually show improvement in symptoms for a few hours or even a few days.

Holding OnA dying patient may try to hold on to life if he senses you are having difficulty letting go. Some patients wait until certain people arrive to let go; others wait until they are alone. Assure your loved one that you will be all right and give him permission to let go when he is ready.

Common Physical Signs

Changes in Body TemperatureYour loved one’s body may become increasingly cold, especially the arms, hands and legs. He may run a fever. You may notice that his skin looks bluish or blotchy. His body is decreasing blood circulation to the limbs to conserve it for his vital organs.

Decreasing Bladder and Bowel Function and ControlAs the body’s organs slow, so does the need to eliminate waste. You may notice a decrease in the amount of the patient’s urine, and its color could be unusually dark. Your loved one could eventually lose control of his bowel and bladder functions.

Unusual BreathingNoisy breathing could occur if mucous collects in the throat. Your loved one’s breathing patterns may change; there may be periods when he breathes very rapidly, or periods of up to a minute when he does not breathe at all.

RestlessnessAs your loved one begins to draw inward, he may make repetitive motions such as pulling at bed linens or clothing.

Loss of AppetiteFood is necessary for health and well-being because it provides energy to fuel the body. As the body prepares to die, it no longer needs this fuel. Although it may be difficult for families to accept, it is normal for a dying patient’s appetite to gradually decrease until it is lost altogether.

Gone From My Sightby Henry Van Dyke (1852-1933)

American clergyman, educator and author

I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean.

She is an object of beauty and strength. I stand and watch her until, at length, she hangs like a speck of white cloud just where the sea and sky come to mingle with each other.

Then someone at my side says, “There. She is gone!”

“Gone where?”

Gone from my sight. That is all. She is just as large in mast and hull and spar as she was when she left my side and she is just as able to bear her load of living freight to her destined port.

Her diminished size is in me; not in her.

And just at the moment when someone at my side says, “There. She is gone!” there are other eyes watching her coming, and other voices ready to take up the glad shout: “Here she comes!”

And that is dying.

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