For many, the process of dying is shrouded in fear and mystery, a subject too uncomfortable to discuss. Julie McFFadden, a palliative care nurse with over 16 years of experience, is on a mission to change that. Known online as “Hospice Nurse Julie,” she uses her platform to educate millions about the natural, and often peaceful, transition at the end of life. By sharing her professional insights, she aims to replace anxiety with understanding, helping families recognize the common signs that death may be near and reassuring them that these changes are a normal part of the body’s final journey.
One of the most common signs Julie discusses is what is medically termed terminal respiratory secretions, but often called the “death rattle.” This sound occurs in the final 24 hours as a person loses the ability to swallow or cough. Saliva and mucus pool in the throat and airways, creating a gurgling or rattling noise as air passes through. While this sound can be deeply unsettling for loved ones to hear, Julie emphasizes a crucial point: it is not a sign of pain or suffering. The patient is typically unconscious and not distressed by the sound; it is simply the body’s systems slowing down and shutting down in a natural progression.
Another significant change occurs in breathing patterns. As the body conserves its remaining energy, breathing often becomes irregular. There may be long, noticeable pauses between breaths, or breaths may become very shallow and spaced far apart. In the final stages, some individuals may exhibit “agonal breathing,” which appears as short, gasping breaths. Julie explains that this is an involuntary reflex of the brainstem when it is deprived of oxygen and is not a conscious or painful experience for the dying person. Understanding that this is a common, reflexive process can help families watch this occur without feeling that their loved one is struggling for air.
The third sign Julie highlights is often the most visually poignant for families. She refers to it as the “death stare,” where a patient’s eyes and mouth may be open, but they are completely unresponsive. Their gaze is fixed and vacant, giving the impression that “no one’s really home.” While this can be confronting, Julie reassures families that this is typically a peaceful state. She also offers a vital piece of comfort: hearing is believed to be the last sense to fade. Even when a patient is unresponsive, speaking to them, sharing memories, and expressing love can be a profound source of connection and comfort in their final hours.
Julie’s work underscores that while these three signs are common markers within the last day of life, every person’s journey is unique. Some individuals may not exhibit all these signs, and the timing can vary. Her central message is one of empowerment through knowledge. By demystifying the dying process, she helps remove the layer of fear, allowing families to focus on being present, offering comfort, and honoring the final chapter of their loved one’s life with grace and peace.
