Hospice Nurse Explains 3 Common Signs in the Final 24 Hours of Life — “It’s Not as Scary as You Think”
The final hours of a loved one’s life can feel overwhelming, full of questions and uncertainty. Families often wonder: What will it be like? Will they experience pain? How can I tell when the end is near?
Julie McFadden, a California hospice nurse with over 16 years of experience, has dedicated her career to guiding families through these moments with honesty and compassion. Known to her 1.7 million social media followers as “Nurse Julie,” she aims to replace fear with understanding and show that death is a natural part of life, not something to dread.
Helping Families Prepare
In her book Nothing to Fear: Demystifying Death to Live More Fully, Julie shares patterns she has observed from countless bedside experiences. While every passing is unique, recognizing common signs can provide comfort to those watching over their loved ones.
On a recent episode of the Dr. Karan Explores podcast, Julie shared a profound observation: some people seem to have an innate sense of when they will pass. “I’ve had patients say, ‘I’m going to die tonight,’ and they did,” she said. Others may hold on for special occasions, like birthdays, holidays, or the arrival of distant family members.
When the end is near, Julie notes three signs that often appear in the final 24 hours:
1. The “Death Rattle”
One of the most noticeable signs is the so-called death rattle, which happens when a person can no longer swallow or clear their throat. Saliva and mucus build up in the airways, creating a gurgling or rattling sound.
While unsettling for families, Julie emphasizes that this does not indicate pain. “It sounds alarming, but it isn’t uncomfortable for the person,” she explains. “It’s simply the body’s natural process as it shuts down.”
2. Changes in Breathing
Breathing patterns often shift near the end. Breaths may become slow, irregular, or spaced far apart. Sometimes it may appear as though the person has stopped breathing, only to take another breath after a pause.
This may include agonal breathing — short, gasping breaths that look distressing. Julie reassures that these are natural reflexes caused by decreased oxygen to the brain, and the individual is not suffering.
3. The “Death Stare”
The final sign Julie mentions is the “death stare.” The person may appear unresponsive, with eyes and mouth open, gazing into the distance.
Though eerie for loved ones, Julie notes this stage can be peaceful. Hearing is often the last sense to remain, so speaking softly, offering familiar voices, and providing gentle comfort can still be meaningful.
Not Everyone Shows These Signs
Julie reminds families that while these signs are common, they are not universal. Some people pass quickly, while others may linger for days or weeks. Understanding what may occur helps families prepare emotionally and reduces fear.
“Death is a natural part of life,” she says. “Talking about it openly makes it less intimidating. My goal is to help families see the love, peace, and beauty that can exist in those final moments.”
Finding Comfort
For caregivers and family members, knowing these signs can be empowering. It allows for presence, gentle touch, and loving words rather than fear.
The final hours, though physically difficult for the body, can offer moments of profound connection. While life draws to a close, the bonds of love remain unbroken.