Dear Barbara, I would like to know why the breathing pattern is different at
end of life. My Mother had fast and labored respirations. She did have
COPD, but my Dad had the same breathing pattern and he did not die from
COPD. This was very disturbing to me. Are they suffering when breathing
like that?
The irregular, difficult breathing that occurs at end of life frightens most
people. As we watch we feel something bad is happening. Our loved one is
hurting, struggling, suffering, and of course this is disturbing to us.
In the hours to minutes, sometimes even days, before death, a person’s
breathing changes. First it becomes fast, often with congestion, and then
gradually the breaths becomes slower and slower. As breathing slows (ten
times, or even six times, a minute) the person actually breaths like a fish,
with their mouth opening and closing. This can be frightening if you don’t
know that it’s normal.
The congestion that occurs before death will depend upon how hydrated or
dehydrated a person is. The more fluids in their body, the more congestion.
Sometimes changing their position (laying them on their side) will help to
redistribute the fluid, and the breathing will sound quieter. Suctioning the
fluid generally does not eliminate it. The bottom line is that congestion and
difficult breathing are a part of the normal dying process.
Is the person suffering? I think not, although it appears that they are. By the
time they are hours from death their awareness of what is going on around
them and of their body has diminished. What I envision is the little chick
working hard to get out of its shell. In the hours before death from disease
our body is shutting down. It is laboring to release itself from this planet. It
is a struggle, just as the chick is struggling, but I don’t think either the
person or the chick are suffering.
Something more about Laboring to Leave:
Difficult breathing during the natural dying process is only one of the many changes that we will witness when a person is dying. It's comforting to know what to expect during that process. Gone From My Sight (The Little Blue Book) is a "road map" of what will occur during the dying process. The Eleventh Hour is the companion book and is more specific about the changes in the last days, hours, minutes, seconds and just after death. These two books, along with your nursing staff, will provide knowledge so that you can better support the one who is laboring to leave.
27 comments
My mum passed away last week had terminal lung cancer, her last hour I think will haunt me forever. I had all the support from district nurses and mum had a syringe driver in place and She seemed to be pain free and comfortable . However before she passed mum spent and hour struggling to cough as she seemed to have lots of fluid build up on her chest but couldn’t cough it up then was gasping and struggling for breath and just before she passed she tried to breath in twice but it was as if she was underwater and drowned! Her face went all distorted and she was gone. I just can’t get this out of my head my head and wonder if I could have done anything else apart from keep talking to her and trying to keep her calm. The nurse was present and didn’t appear to be alarmed by what was happening but I just can’t get my head around it all? I keep wondering did she suffer was she. In pain? Why could she have gone peacefully is there anything I could have done differently? I have worked in care for over 18 years and never dealt with anything like this before?
Oh, Emily, you did nothing wrong. From what you described your mother was minutes to hours from death when you gave her the last dose of morphine. Her clenched teeth was just her body reaction, not that she didn’t want it or had any feelings about anything at that time. Her body was so shut down that the morphine didn’t even get into her blood stream that last dose. No need for guilt about her last minutes. You might think about writing your mother a letter. Put all your thoughts, concerns, and love on paper then burn the paper and release the ashes to the wind.
My blessings are with you! Barbara
My mom died recently. She had been struggling to breathe her last week and my sister had given her morphine in low doses of 0.25 mg once or twice a day.
I got to my mom for her last 36 hours. She was 99. The morning before she died she was moaning and occasionally coughing and the hospice nurse said I should give her morphine every 3 hours. So I did. 24 hours later she died. She went from fast, shallow, labored breathing to death in an instant. I had just turned my back to her.
I feel guilty, like I killed her. She never took any of the hospice meds until her last week. She told my sister she wanted medicine to help her breathe but she wasn’t able to tell me this because she was not arousable. So I had to hold her head with each dose of morphine and I felt she didn’t want it. She clenched her teeth when I tried to put the dose under her tongue.
Before the morphine doses she had mottled feet and cold hands and had stopped eating and drinking.
But I feel like I hastened her death and this is haunting me. She died so quickly and without effort, just one minute fast, labored breathing, the next she was gone.
She was old, 99, but I am haunted by the feeling I forced her to have morphine and so I hastened her death.
Hi Anna, Sometimes rapid breathing occurs before death, sometimes not. I am not sure why but both, slow and/or fast breathing, is part of the natural way the body dies. It is interesting that you noticed your dog died in a similar manner. Animals die the same way people do. It is just that most people don’t notice it. You might want to read my booklet on animals, A Pace In My Heart. You also asked if they feel pain? Dying is not painful. Disease causes pain. If the disease that the person or animal is dying from causes pain then we want to treat that pain until the last breath. There are a lot of diseases that people and animals die from that do not cause pain so just because death is approaching does not mean that pain will be present. As death approaches the person or animal is like in a dream state, everything seems like a dream. They hear but from afar. Their work is to get out of their body. Like a little chick works to get out of its shell so we work to get out of our body. For some it is harder work than for others. Would a fan or cool compress have helped? It probably would have made you feel like you were doing something helpful but I’m not sure it would have made a difference in either your father or you dog’s comfort. Blessings! Barbara
My father sat with his mother as she died. Her breathing was very rapid (without pause) and then she stopped breathing, her body shook and she died. Same thing happened as I was sitting with my elderly dog. Towards the last few minutes of her precious life, her breathing was VERY rapid (without pause), then it slowed right down, before she took her final “agonal breath” and soon after her body shook a little, she passed some fecal matter and then as she died. What is troubling me and my father is the Very rapid breathing without pause. I keep wondering if I should have had the fan going, or used a cold compress or something. What does the Very rapid breathing (without pause) shortly before death mean? Why do some have very slow breathing right before death and others have very rapid breathing right before death? Do they feel pain? What is going on for them please? I hope they found comfort having loved ones near by. Would a fan or cold compress made any difference?
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