How do we know when the end is near

Hi Rebecca,

I'm so sorry about your friend's loss, and what a great thing that you were able to say goodbye to her mom, too.

Generally we know the end is near because of the general physical decline that leads to death.  Often there is a period of hours, most often days, where people drift out of consciousness.  Once the lungs begin to fill up they are usually gone in 48 hours or less.  That's all a huge generalization and there certainly are exceptions of every description to that generalization.  I personally have attended cases as a nurse where the physical decline was much less pronounced and the patient remained alert and more or less responsive until the hour of death, but that isn't typical.  I've had a handful of alert patients over the years who have told me they were dying even when I couldn't find a measurable decline in their condition ... and then they've died rather suddenly ... leading me to think these were people who were very in tune with their own bodies.  I now listen very carefully when a patient makes such an announcement, but those are extremely rare cases.  Mostly people go out slowly over a period of time.  My father became weaker and weaker over a period of several months (at the end of a six year illness) and was unresponsive for about eight days at the end.  His lungs began to fill up about five or six days into it and he was gone in about 40 hours.  Hospice provided a good supply of drugs in various forms and I'm satisfied that he was as comfortable as we know how to make somebody in that condition all the way up to the end.