The Last Hours

Someone says the word “hours.” Nothing here is medical advice; ask the people caring for them about anything that worries you.

What you may see

Breathing changes. It may become irregular, with long pauses that make you hold your own breath, and then a gasp and it starts again. It may become noisy, a rattling from fluid the person can no longer clear. This is usually far more distressing to hear than to have.

The person withdraws. They sleep more, speak less, may stop responding to their name. Hands and feet grow cool, color changes, eyes may be half open without seeming to see. They are not being rude, and they have not gone. Most of what a person does in the last hours is turn inward, and it takes all their attention. What looks from the outside like fading is, from the inside, a settling, and none of it is something to resist.

Keep the room calm

One thing is within your power: the atmosphere of the room. Make it quiet. Dim the lights. Turn off the television. Ask visitors to speak softly and come one or two at a time.

Do not clutch at the dying, and do not wail beside them. You may weep. But loud sobbing at the bedside, grabbing the person, begging them to stay, all of this reaches the dying person and pulls at them, because at the moment of death the mind is more open and sensitive than at any other time. If you need to break down, step into the hallway, break down, and come back when you can be steady. This is not coldness. It is the last act of care you can offer: to let the room be a place it is possible to leave from.

Touch lightly, if at all. Rest a hand on the chest or the arm, and avoid handling the head. Let the touch say “here” rather than “stay.”

They can often hear

Hearing is thought to be the last sense to go, and people respond, with a flicker or a breath, to a voice long after they seemed unreachable. So speak, not much and not loudly, near the ear. Tell them they can let go, that they do not have to hold on for you, that they are loved. The words to read at a bedside, and how to read them, are at A Few Words to Keep Near. The dying person is not in a position to learn anything, only to be reminded, and to hear a familiar voice being calm.

When it comes

The breath stops. You may not be sure at first, because of the long pauses earlier. Wait. Let it be over before you decide it is.

There will be an impulse to do something: to call someone, to move. If you can, resist it for a while. The old masters describe death not as a switch but as a settling that continues past the last breath, a quieter inner stopping in which awareness opens most fully, and they treat these moments as among the most important of a whole life. Sit. Nothing needs to happen yet.

The first hours after

If circumstances allow, do not disturb the body for a time. Keep voices low. Do not start the phone calls in the room. If the medical setting requires things to happen quickly, ask calmly whether they can wait a little; often they can. If they cannot, do what must be done gently, and do not blame yourself for what you could not control. If grief comes as a storm, go into the next room and let it, then come back.

Sit with the body the way you sat with the person. If you have a practice, do it now, quietly. If you pray, pray. Or speak to them softly, near the ear: “You can go now. Don’t be afraid. Whatever you see is your own. Rest.” These reminders may still reach the person in the hours after death, when they are said to be more able to hear than they were in the confusion of dying. You do not have to be certain of this, only to act as though it might be true, which costs nothing.

You may feel nothing, or a strange peace, or the floor may go out from under you. All of these are ordinary. Shock is a mercy; it lets you do what must be done. Let someone else make the calls. Eat something. The person is not in the paperwork; step back into the quiet room when you can, even for a minute.

For the days and weeks that follow, and what you can still do for them, see What You Can Still Do for Them.