Physical Changes to Expect; What You May Notice in the Final Days

There are physical changes to expect to see in your loved one during their final days and hours, just as you may have noticed changes in the weeks and months prior to the final phase of your friend or family member's illness. Knowing what to expect may help to prepare you and ease your mind.

It is easy to project onto your loved one how you would feel in a similar situation. For example, it is easy to project your own feelings of hunger pains onto your loved one who has lost their appetite, and feel a need to feed them to avoid these pains. Try to remember that their body is not responding to things in the same way as your body.

As the body begins to shut down, there are chemical changes which occur help to give your loved one a natural anesthetic affect. While it may be hard for you to sit and watch your friend or family member transition through the final stages, please know that the physical changes to expect is their body doing its part to keep them comfortable.

One of the first changes you may notice is the change in color of your friend or family member's extremities (arms, legs, fingers, toes, even ear lobes). They may appear blue and feel cool or cold to touch. This is sometimes called mottling and is caused by the body's diverting (shunting) oxygenated blood to the "important" organs.

While you may want to try to warm them up by rubbing their skin, please resist! You want to avoid doing this for several reasons: 1) you can rub all you want but, because the body is shutting down, your efforts will be ineffective and 2) more importantly, it can be painful.

If you have ever been in the extreme cold without gloves you may have noticed this mottling occurring in your hands. This is one of the physical changes to expect with the change in circulation. You may recall the burning pain you experienced when you started to rub your hands once you were in a warm area. To a degree, this is what your loved one could experience.

Another of the physical changes to expect is that your loved one tires very easily. They may require assistance with the simplest of tasks such as brushing their hair or teeth. You may notice they sleep for longer and longer periods of time. But, even as they sleep, they can hear you and feel your touch. They may surprise you by waking up and having a "normal" conversation then return to that deep sleep. Eventually, they will remain unresponsive, unable to speak to you. This doesn't mean they can't hear; it just means they are not able to respond.

Individuals who have awakened from comas confirm that, while they were in their coma, they could hear conversations and feel people touching them but they were trapped and unable to respond. Loud noises, being touched without warning or being treated "rough" would startle them.

With this in mind, it is important to remember to speak to your friend or family member. Let them know when and where you will touch them. Your voice and touch can be a comfort to them. Speak from your heart.

Being mindful that your loved one can still feel, even if they cannot respond, means they not only feel your gentle touch but, they can feel pain as well. Even though their body is trying to do its part to keep them comfortable, it needs help. They still need to be kept on a pain management routine.

Watch for any facial grimacing or restlessness which may indicate they are uncomfortable. Even if they are no longer able to swallow pain pills, their pain can still be controlled with medications under their tongue or by continuous intravenous/IV medications.

Over the past weeks and days your loved one, as part of the physical changes to expect, has lost their desire for food and fluids. With the decrease of fluid intake, you will see very small amounts of reddish-orange urine. And, while they are not able to swallow, keeping your loved one's lips and tongue moistened can provide them comfort. You can do this by sponge-tipped toothbrushes called toothettes. By moistening the toothette and squeezing out the excess water, you can use this to keep your friend or family member's lips and tongue moist.

The decrease in urine may correspond with the physical changes to expect in breathing. You may notice a rattle or gurgling sound when they breathe. This is called the death rattle. You will also note a change in the rhythm of their breathing. The once regular rhythm will change to a shallow sort of panting which will peak to a deep breath and pause.

While this may be very difficult to watch, you should know that, in much the same way that organ failure causes metabolic changes and an analgesic affect, the change in breathing has a similar affect by increasing the levels of carbon dioxide. This change in the pattern of breathing is called Cheyne-Stoke respirations (pronounced "chain-stoke").

The change in the breathing pattern is usually one of the last physical changes to expect before your loved one passes away.

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