More things you may witness at a loved one's death
Dying can seem to involve great physical effort.
"My mom had a dry mouth and scary raspy breath that worsened over a few days. But she didn't die until the day we gave her morphine. I felt responsible, wondering if we had rushed things." -- Emma, a 45-year-old artist in San Francisco.
"Some go gently -- you look up and their chest is no longer moving," palliative-care physician Byock says. "But for others it's hard to die. It's like an animal shedding its skin, a physical struggle to wriggle out of this life."
Younger people and those who are healthy aside from a single fatal illness often have the most difficult time. But dying can be effortful for anyone. Palliative care -- comfort care including pain relief -- improves quality of life to life's end. Unfortunately, say hospice workers, families are often reluctant to use painkillers out of a misguided fear that they curb awareness or hasten the death process.
Morphine dosages given in hospice are only enough to ease pain, Byock says. Even with good comfort care, certain reflexive symptoms of the dying process, such as labored breathing, can still appear as distress. Mental confusion is another common effect of the organs -- in this case, the brain -- shutting down (see 10 Signs Death Is Near).
The personality of the dying person usually stays consistent to the end.
"My mother never lost her sense of humor. I was complaining about my brother not coming to my daughter's birthday party. 'So shoot him!' she said in her typically droll way. My mother's last words to me were instructions to kill my brother!" -- Dawn Barclay, a New York manager in her 40s, who saw her mom through 18 months of complications of heart surgery and stroke
People tend to die as they lived, says Maggie Callanan, a hospice nurse who's the author of Final Gifts, who has witnessed more than 2,000 deaths. "Nice people get even nicer, manipulators manipulate, funny people die funny," she explains. "We all have ways of navigating through life, and when dying those tendencies are intensified by ten."