Caring for a loved one when death seems imminent can be challenging. You’ve been told it could happen at anytime but none can predict the minute or hour or even day. Exhaustion precludes being perpetually vigilant. We all must rest. We all must receive occasional respite or burn out.

Thankfully there are signs that can at least alert us that death draws nearer and our beloved is actively dying. If you can watch for these signs then you can at least know that death is close and we may wish to remain nearby.

Kelly Ruby Hanson in her excellent book Death Doula lists these symptoms as indications of pre-active dying.

• Increased restlessness, confusion, agitation, inability to stay content in one position, and insisting on changing positions frequently (exhausting family and caregivers)
• Withdrawal from active participation in social activities
• Increased periods of sleep, lethargy
• Decreased intake of food and liquids
• Beginning to show periods of pausing in the breathing (apnea) whether awake or sleeping
• Visions of persons who have already died
• Person states that he or she is dying
• Person requests family visit to settle “unfinished business” and tie up “loose ends”
• Inability to heal or recover from wounds or infections
• Increased swelling (edema) of either the extremities or the entire body

  Active dying stage signs include:

• Inability to swallow any fluids at all (not taking any food by mouth voluntarily as well)
• Person states that he or she is going to die
• Breathing through wide-open mouth continuously and no longer can speak even if awake
• Urinary or bowel incontinence in a person who was not incontinent before
• Marked decrease in urine output and darkening color of urine or very abnormal colors (such as red or brown)
• Blood pressure dropping dramatically from person’s normal blood pressure range (more than a twenty- Or thirty-point drop; systolic blood pressure below 70, diastolic blood pressure below 50)
• Extremities (such as hands, arms, feet, and legs) feel very cold to touch
• Complaints that legs/ feet are numb and cannot be felt at all
• Cyanosis, or a bluish or purple coloring to the person’s arms and legs, especially the feet and hands
• Body remains in rigid, unchanging position
• Jaw drop; the patient’s jaw is no longer held straight and may drop to the side, their head lying toward

None of us can stay hyper-vigilant enough to catch every sign but perhaps working together we can be ready for our loved one’s departure.