I worked in ICU for five years and witnessed many deaths. Often, patients would suddenly go into cardiac arrest, and despite all our efforts, we could not resuscitate them. But no one ever explained the process of dying that many of our loved ones go through. Not until a friend, who was also a registered nurse, told me about her experiences when her father passed away did I understand more about it.

Nowadays, hospice personnel call it “transition” or “actively dying,” which usually lasts about three days. But there is also a pre-active stage, which can last up to three weeks. Dying may seem like a morbid topic to some, but understanding what happens in each stage can provide comfort to caregivers and loved ones alike.

As a friend at church said, “I wish I had known what to expect. It would have made watching my dad pass away so much easier.”

The Pre-Active Stage

In the days and weeks before death, the body starts shutting down. As a result, your loved one may sleep more and eat less. As my mother-in-law neared death, she wanted only a few spoonfuls of broth or a little pudding. She wasn’t deliberately refusing food. Her body simply didn’t need it, and trying to push her to eat would have accomplished nothing but stress.

In the pre-active phase, our loved ones may also become anxious or fearful. I saw this in my mother. One time, she grabbed a caregiver’s hand and wouldn’t let go, so the caregiver stood patiently and reassured Mom by simply holding her hand. My nurse friend explained that when the body begins shutting down, it rebels against dying, sometimes causing apprehension.

The Active Stage

As the final hours approach, peace often returns. Your loved one can appear almost comatose at times but may still be able to hear you. They frequently have a sudden wakeful period in which they talk to those around them and seem to have renewed energy. Then they become unresponsive again.

Blood pressure drops, causing the skin to become mottled and extremities to cool. Fluid may build up in the throat or lungs, causing a gurgling sound (sometimes called the “death rattle”). Family members may fear that their loved one is choking, but that’s not the case. Air is still moving in and out without the sensation of needing to clear the throat or cough.

Breathing rhythms also change. Your loved one develops a pattern of deep breaths (which may cause the chest to retract or “sink”) that become increasingly shallow until they seem to stop and then resume with faint breathing that becomes deeper again. At this point, family members usually hang on every breath, but this may go on for hours or even days. In the medical community, it’s called Cheyne-Stokes breathing, and I saw it many times.

Eventually, breathing stops, sometimes with a few jarring gasps for air but usually without any fanfare. For several minutes, you may not even realize your loved one has passed away.

Holy Ground

When we’re in the presence of someone who is dying, we stand on holy ground. It’s an honor to witness the transition, and knowing what to expect helps us face those final moments with courage.

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?”
John 11:25-26 NIV

Tracy Crump dispenses hope in her award-winning book, Health, Healing, and Wholeness: Devotions of Hope in the Midst of Illness. A former intensive care nurse, she cared for her parents and her mother-in-law and understands both the burdens and joys of caregiving. Her devotions have been featured in Guideposts books, The Upper Room, and many other publications, and she has contributed 28 stories to Chicken Soup for the Soul® books. She also conducts writing workshops, freelance edits, and produces The Write Life newsletter for writers. But her most important job is Grandma to five completely unspoiled grandchildren.