No one can tell us from personal experience what it is like to die. 

When the person for whom we have been providing care – maybe for years, maybe only for months – is nearing the end of life, it is good to know steps we can take to make this difficult time easier. Before I continue, I want to emphasize what I believe is the most important issue to be addressed – spiritual readiness for death. Many of you have the honor of taking care of one who has lived a long Christian life, and what a blessing and comfort that is. On the other hand, if your family member has never accepted Jesus Christ as his Lord and Savior and received forgiveness for his sins, do not neglect providing an opportunity for him to do so; he just may be waiting for someone to ask that question, “Are you ready to face death and eternity?” Nothing else you do or say will be as consequential as this.

When asked, most people say that when their time comes, they prefer to die naturally, without unwarranted medical intervention. This is not to say that the modern interventions of medical science should not be used to cure disease; but when the prognosis is “there is nothing more we can do” then it is time to provide comfort care (as opposed to curative measures) and emotional and spiritual support.

A wise and compassionate hospice nurse once told me, “Taking all sorts of drastic measures to keep someone alive when natural death is near is not prolonging life, it’s prolonging death.” As death approaches, there are some practical things the caregiver can do to provide physical, emotional and spiritual comfort.

At this point, your loved one will probably remain in bed most, if not all of the time. Maintain a room temperature that is neither too warm or too cool, keeping in mind both the preference of your patient and the possibility that the dying process may require adjustments. As always, keep the patient as clean and dry as possible, regularly providing incontinence care with a gentle touch. Using pillows are a convenient way to reposition (this should be done frequently to prevent pressure sores) and provide support and comfort. When your loved one is no longer taking anything by mouth, you can still use specialized swabs to moisten the oral cavity and lip balm to sooth dry lips. Try gentle massage and application of lotion to hands, feet and legs. You can tell by your loved one’s response if this is something you should continue to do.

Create a peaceful, soothing atmosphere. Avoid bright lights – even direct sunlight should be filtered – and try to block out loud or irritating noises. Playing your loved one’s preferred music softly or reading to them from the Bible or another favorite book may help to provide serenity.

If your loved one is still able to speak, listen. As much as possible, grant requests, especially if he/she is asking to speak to a certain person such as a relative, friend or clergy. Follow your heart and speak those words you want your loved one to know. Be generous and loving. If an apology is in order, express it lest you forever after regret not doing so. If forgiveness is called for, offer it unconditionally. 

If your loved one is no longer able to communicate, continue to speak with him/her. Throughout the medical profession, it is widely believed that hearing is the last sense one loses in the dying process. Never assume a person near death cannot hear you. Speak accordingly, and if needed, remind visitors to do the same. “Keeping vigil” by the bed of a dying person is not the place for loud conversation and raucous behavior. Unfortunately, I have witnessed both. 

Sometimes no words are required. Your presence and your gentle touch may be all that is needed. However, be sensitive, and if you discern the person is trying to communicate – pulling at you, murmuring or crying – do respond verbally in a quiet, gentle tone.

Just before Daddy died, I laid down beside him in his hospital bed (at home) and cradled him in my arms. Several times in the last weeks of my sister Rodema’s life, I felt prompted to lay beside her and let her cuddle up to me the way I had cuddled up to her when I was just a little girl and she was my doting big sister. 

I remember whispering to Daddy, just a few hours before he died, “Wait for me while I go take a shower and get ready for bed.” Sometimes, caregivers are afraid to leave the room and miss the “final breath.” I have heard many people say – and my experiences tend to concur – that something in the human spirit allows a person to make his/her own decision about that final breath.  I have seen a patient breathe laboriously and intermittently until the last of the four children rushed through the door of the room announcing, “Daddy, I’m here!” before finally relaxing and gasping no more. Other times, a patient has gone quietly in her sleep with no one to witness her departure. Daddy waited for me. All the other family members had gone home, but not more than five minutes after I came back to his bedside, he lifted his arms in the air to meet those of the One reaching out to him.

Sometimes death comes quickly; other times it’s a long, lingering process; or it can be in between. I experienced the deaths of so many patients in long term care that I began to recognize the common signs that life was ebbing. It is not possible to predict the precise time of death, but noticing these changes are indicators:

• Loss of appetite. A dying person does not need to eat – or drink. Do not force either.
• Increase in restlessness and agitation – OR – increase in long periods of sleep including unconsciousness
• Calling out for deceased family members
• Changes in breathing pattern that may include long pauses
• Cold extremities
• Change in skin color – predominantly feet to knees but also fingers, nail beds, earlobes, and lips. The purplish or blue splotchy coloring is called mottling and usually appears when death is very near. This appears as a darkening of complexion color in people with dark skin. This occurs as circulation ceases due to a drop in blood pressure and a change in heart rate, which though it is weaker, increases before it slows to a stop.
• Gurgling sounds in the throat (death rattle). This can be very loud and disconcerting to family members but does not cause pain or distress to the dying person. Medically, it is referred to as “terminal respiratory secretions” and occurs when mucous and saliva build up in the throat and the body – now “shutting down” – is unable to clear them. Usually, this occurs in the final hours of the dying process but may begin as much as 48 hours before.

There are medications that can be administered in the final hours if the dying person appears to be in distress. This is something you should discuss with the health care provider.

In closing this series, here is one more suggestion. Even after the doctor tells you death is near, attempt to interact with your loved one as you did before. In other words, do not let “life” revolve around “death.” It is good to know about end-of-life care, but do not dwell on this aspect of caregiving. Appreciate each day you have with your loved one. Some days will be long and weary, but if you ask Him, God will give you strength. 

Caring Quote: Jesus said to her, “I am the resurrection and the life. The one who believes in me will live, even though they die; and whoever lives by believing in me will never die. Do you believe this?”