Chapter 3: Outlining what to expect

Days and hours prior to death

For most patients, signs of imminent death will include some or all of the following:

  • Decreased wakefulness. It may be difficult to rouse them and they may be too tired for conversation.

  • Increased breathing difficulties. While sleeping, they may appear to stop breathing for several seconds and then restart; this is called apnea.

  • Congestion in the chest and throat. While this can be difficult for family members to hear, comfort them by explaining this doesn’t mean the person is in pain or short of breath.

  • Unconsciousness, and remain this way for days until death.

  • Decreased urine output that may become darker in color.

  • Change in skin color; extremities may become blueish and cold to the touch.

  • Relaxing of facial muscles (e.g. the eyes may be slightly open and the jaw drop open).

Patients may communicate their discomfort by grimacing or becoming restless (moving often in bed, pulling at their clothes, etc.)

Again, remember that not all dying patients will experience death in these ways. Some patients remain quite lucid and their death happens very quickly.

What families can do

  • Create a quiet, calm environment.

  • Provide mouth care (e.g. moistening with a small sponge can give relief to a dry mouth).

  • Spend time with the patient, talking to them, holding their hand.