A natural death doesn’t happen like it does in the movies. It is a slow, gradual process, and it is fairly predictable. It is all normal – but it isn’t normal to you if you haven’t seen it. Reading about it will make it easier to deal with.

The main goal is to keep the person comfortable and for you to remain calm.

These are some things that are likely to happen. Every person is different, so these may happen in a different order, or not at all. I have compiled these from various sources online and my own personal experience with dying people.

Be advised – the dying process can take around a week.

—- Loss of appetite
The person’s energy needs lessen. She may not want to eat, or want to eat only simple foods. Follow her lead, and offer liquids at least. You can use a lip balm on her lips to keep them from cracking.

—–Excessive fatigue and sleep, and increased weakness.
Because of her lessening energy needs, she will sleep more and more. Do not rouse her unnecessarily. Assume that she can hear everything that you say.

Do not talk about her in the same room.

— Mental confusion or disorientation
The person may not be aware of where she is or what is happening. Remain calm. Let her know who you are. Speak gently to her.

She may see people who aren’t there, especially people who have passed on before her. Do not argue with the person about this. This will make her agitated. She has one foot in this world and one in the other. What she is experiencing isn’t unusual – it is just something you aren’t experiencing. This doesn’t mean it isn’t real.

She may pick at her bedclothes. This “work” represents unfinished business. As long as the person is safe, let her do this.

— Breathing changes
It will get harder and harder for her to breathe. Oxygen may help with this, and sometimes a gentle fan blowing on her face will help too. The goal is to make the person more comfortable and relaxed. The person doesn’t need as much oxygen as before.

Later on, her breath may change to something known as Cheyne-Stokes. She will not breathe for a bit, and then sge will breathe in suddenly, gasping. It is distressing to hear, but not for the dying person.

Around this time the person will have difficulty swallowing, and there will be increased secretions in her throat. It will sound like gurgling or like marbles are rattling around. This is what is called the “death rattle”.

One option that I’ve seen is to use a Scopolamine patch. It will dry up the secretions, as a dry mouth is a side effect. These have to be prescribed.

It may help to have the person propped up or have her head tilted slightly to the side.

It is believed that the person is unaware and unaffected by the secretions and the different breathing.

—–Social withdrawal
The person may not be interested in doing anything with anyone. This is a very intimate and personal time and requires a lot of inward focus. Don’t take it personally if she doesn’t want to see you. Dying is hard work. However, she might be interested in some company, but not be able to reply.

Some people may get to the point that they can only answer yes/no questions. Be mindful of this, and change your interactions accordingly.

Sometimes there might be a burst of energy a few days before the person dies. She has saved up her energy and then it will appear that she is going to get better. Cherish this experience if it happens – it is fleeting.

—-Changes in urination
There will be less and less urine, and it will be more concentrated. Hospice may choose to use a catheter to keep the bed unsoiled. Loss of bladder and bowel control is normal.

—-Swelling in the feet and ankles
This is a natural result of the kidneys slowing down. This is normal.

—-Changes in the extremities.
Just like when the body gets colder, the extremities start to lose circulation minutes or hours before death. Hands and feet will become cooler and paler (or bluish) The veins may become mottled.

Talk with the person gently and calmly. Assure her that she is loved, and that you will remember her. Let her know that her life mattered. She needs to know that you will be able to go on without her.