05/04/2026
End-of-life care is not easy. It can help to know what others experience.
I have been asked once again to share my “Seven Days of End-of-Life Tips.”
Over the next seven days, I will be sharing reflections on some of the moments and changes at the end of life that people often struggle to understand. Each day will bring a gentle insight, something meant to offer comfort, bring clarity, and perhaps ease a bit of the fear or uncertainty that can come with this time. My hope is that these words meet you where you are and support you in whatever way you may need.
I share these insights from what I have witnessed at the bedside, but every end-of-life journey is its own. If something here resonates, I gently encourage you to bring it to your healthcare team, they can help guide what best supports the comfort and care your person deserves.
End-of-Life Tip #1 The Death Rattle
(Note that this doesn’t always happen)
I want to (in my terms) explain the "death rattle,” which is also referred to as “terminal secretions.”
I have come to believe that the sound bothers us more than them. In those last few hours to days when they have become non-responsive, I believe they are less aware of the sound. It usually happens at the end of life because our ability to swallow is reduced and we are unable to cough or bring secretions (saliva/phlegm) up or down so it hovers there and will sometimes make a loud vibrating sound, that sounds like rattling, or gurgling.
Please do not rush to get a suction machine or medications like Atropine. First try to gently reposition them on their side. Sometimes, that alone can move the secretions just enough to quiet the noise, which again bothers us more than them. Repositioning is oftentimes the remedy.
If the secretions are filling their mouth, even spilling out, a suction machine is useful, but I want you to imagine what it must be like for the person lying in the bed. The noise is awful in itself, but the suctioning tool is so uncomfortable, and when you are dying, that is the last thing you want happening to you. Try and use mouth swabs to remove the secretions manually first... please... it is so much gentler and far kinder. If a suction machine is absolutely necessary, please just be gentle as you are using it. 
Medications like Atropine are often effective, but usually more effective when the secretions are pooling in the mouth. A suction machine is also helpful in that same way. Neither are very helpful when the secretions are down the throat and just hovering there. This is why I believe repositioning is the best first thing to try.
Note: Atropine has a side effect of hallucinations, and while I have only seen it happen twice, that is two times too many when someone is dying. Personally I do not want to put anyone through that if it can be avoided.
My hope in sharing some of these tips/tools is to relieve your fear, and to help you be better prepared. To be present for someone when they are dying, means to witness the ways our bodies shut down. It can be messy, and it can even be a little scary, but our bodies know what to do and the things we experience are a natural part of the dying process.
Sometimes, I just lean in and I place my hand on their back and rub it gently, whispering, “it's okay, I am right here, I’ve got you,” making sure they know they are safe, and not alone. And that comforts them. Trust your words, your heart and your touch, it is amazing what comfort these can bring.
❤
xo
Gabby
www.thehospiceheart.net
For all of my tips, you can find my book “End of Life Tips” here:
https://a.co/d/9fKuA4z
