Most of us have heard this term. It is the noisy rattling sound that a dying person makes that can be very disturbing to hear.

Death rattle happens when secretions gather in the throat because the person is too weak to swallow. The gurgling sound happens when air passes through the secretions upon exhale.  This doesn't necessarily mean the person is having trouble breathing.

There are things we can do to minimize this. There are standard medications to use that dry these secretions. Repositioning the person is very effective. Sometimes in repositioning, secretions will come out of the nose or pool in the mouth. Suctioning them at this point will provide comfort and relief for the family.
It is distressing often for the family to hear this. People fear the person is drowning or will choke to death. This is not so.

It is one of the final things that happens. Know that when you hear this, death is usually imminent, but this phenomenon can also happen days before death. It does not always mean within hours; just know that death is not far off.

As a person nears the end of life, there are some very basic similarities that may be seen which cross the type of illness or 'reason' for dying. Below is a list of some of these behaviors. Usually, the closer to death the more pronounced the symptom. Simple to complicated, easy to difficult, know there is always something that can be done to relieve any suffering that may accompany any of the following:

• Lack of energy
• physical weakness
• loss of interest in things that are important
• withdrawal from loved ones
• increased sleepiness
• gazing or staring, as if right through you
• confusion
• restlessness
• loss of appetite
• difficulty swallowing
• incontinence
• temperature fluctuations
• loss of color
• breathing changes
• increased pain or beginning of generalized pain

Dying is a process. This final stage of living may come on swiftly or slowly, but however long it takes, be it days, weeks or months, it is usually predictable. Not everyone will have all the manifestations of course, as each person's death is as unique as a fingerprint.

What I do hear most of the time is the question, "why is this taking so long?" It just does ... unless it doesn't. There are definitely no absolutes regarding any of this other than our heart will stop beating and we all will take our last breath someday. Until then, enjoy!