May 26, 2024 • 14 mins
Guest Host Richard Syrett and Julie McFadden aka HospiceNurseJulie on Tik Tok discuss hospice care and the different things that our bodies do to prepare us for death.
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Speaker 1 (00:00):
Now here's a highlight. From Coast to Coast AM on iHeartRadio,
we are back.
Speaker 2 (00:05):
With Julie McFadden, the author of Nothing to Fear, Demystifying Death,
Demystifying Death, to Live more Fully. You can follow her
on social media at Hospice Nurse Julie. I want to
get back to some of the more of the biological
details of dying before we get into the otherworldly deathbed phenomena.
(00:31):
The death rattle. We hear that often when the breathing changes,
and it's described as a death rattle. What is that
death rattle?
Speaker 3 (00:41):
Yes, the real name for that, the medical term would
be terminal secretions. But that sound that people hear, it
sounds like a rattle or a gurgle, and people really
hate it, and I get it, but the I think
it helps to educate about what it actually is. So
a lot of people think it's their loved one quote
(01:03):
unquote drowning, or its fluid coming from their lungs, but
it's not. It's so we create saliva in our mouths
twenty four to seven naturally, and then our body, without
us knowing, automatically will swallow it. Just like right now,
I just did it. And that all happens automatically. Towards
the end of life. Your body is still creating that
(01:25):
saliva to keep your mouth noise, but your brain is
not always telling you to swallow it, or the muscles
to swallow are really relaxed, so they're not swallowing. So
that little bit of saliva builds up in the person's
mouth and then their mouth breathing. Usually so because their
mouth breathing, that breath will go over the secretions and
(01:49):
cause a gurgle noise, and even a little bit of
secretions can make a really big noise. So I think
it's important to let people know what it truly is
so they don't have to be so afraid because it's
generally not disturbing the person who is dying, but the
sound is disturbing the people hearing it.
Speaker 2 (02:12):
Does it Is it advisable to swab the inside of
the mouth or not?
Speaker 3 (02:16):
Yeah, So there's certain things we could do, and if
we do do this, it's usually for the family, not
the patient, just because people don't like it so much.
So you can reposition the person. So I usually lift
the head of bed up a little bit, maybe to
thirty sixty degrees, just shifting your loved one can help.
Even turning them to the side so the secretions come
(02:38):
out can help. There's medications we give to dry up
the secretions. That's usually the first thing we try to do.
I don't think it's totally necessary because sometimes one it
doesn't work, and two then the person has a drying out,
But that's definitely something we still can do now in
the hospital and at home. Sometimes they'll get you a
(03:00):
suction machine, kind of like at the dentist where you
can kind of like suction things out of the knock.
That can be done, and they do it a lot
in the hospital just because we're taught to, but generally speaking,
we don't on hospice because doing that will actually create
more saliva, so it'll actually make it get worse. So
(03:20):
we don't always do that, but it's an option if
we have to.
Speaker 2 (03:24):
What is the way, okay, what is the silence scream
in a dying patient?
Speaker 3 (03:31):
The silent scream? So to be honest, I actually don't
see this very much, but many of my followers would
write into me and say, I loved one and I
have seen it a few times, but it's not I
haven't seen it very frequently, but my followers would say,
you know, right before my loved one died and looked
like they let out, like their face went into like
(03:52):
a look like a scream, but nothing came out, but
they that was kind of like their last thing that
looked like they happen. That happened. And how I describe that,
of course we don't truly know, But how I describe
any kind of weird quote unquote weird thing you might see,
like a silent scream or sometimes people can even like
(04:13):
growl and stuff. At the end of life is the
person you know, the essence of that person is kind
of not there anymore. This is if you can truly
just look at it as like a biology standpoint, This
is a body and a wonderful hostess nurse who's like
the og of teaching hospice and death and dying. Her
(04:35):
name is Barbara Karnes. She likens death and the dying
body to like for as like a laboring process. I
love that analogy, but I also don't The only thing
I don't like about it is that you associate labor
with pain, and I don't think it's a painful process.
But it's kind of like the body just doing things
that it has to do to shut down, and it's
(04:55):
going to do weird things sometimes like make a face
before before the person dies or even while they're dying,
but doesn't necessarily mean anything, but because it's your loved one,
not to try to sense of every little thing that happens,
because it's your loved one and it's not something you
(05:17):
see every day, so it's hard to understand. So the
silent scream is something that you might see and we
don't really know what's going on, I mean likely. I
think it's because our muscles all relax and fully let
go at the end of life. So at the very
very end, if it's like right at the end, everything
(05:37):
will relax, including those mouth muscles. For the mouths going
to suddenly hanging open, the eyes could pop open. Every
muscle can kind of release us. Why people have like
defecation and urination sometimes at death because the sphincter is
relax That's why you can see fluid sometimes at the
end of life. So all of these things are happening
because it's like a full let go wow. But it
(06:01):
can look scary at times at times if you don't
know what's going on.
Speaker 2 (06:08):
When I was a kid, I used to love making
faces in front of a mirror. So when I go,
I'm going to make a face guaranteed, that's right.
Speaker 3 (06:14):
Yeah, yeah, yeah, Bryan.
Speaker 2 (06:16):
Ryot The I remember seeing my my uncle in the
last days of his life and he was unconscious, but
his arms and his legs were moving. He was on
his side and they were just kind of moving and twitching.
(06:37):
And is that what is referred to as is called
terminal restlessness.
Speaker 3 (06:44):
Yeah, so terminal restlessness, terminal agitation. It can vary as
far as like how bad it is, right, So if
someone's just kind of people can kind of fidget, they'll
fidget with the blanket, or they'll fidget with things as well.
They don't seem super disturbed by it. I usually kind
of let it go. But if they seem really restless
(07:07):
or kicking, sometimes it'll be like a constant trying to
get up out of bed even though they can't. And
there's usually no talking any sense into them, so you
can't be like no, no, no, sit down, like they don't.
There's no like talking to them because they're not fully
with it, if that makes sense. And again for terminal
agitation or terminal restlessness. This is one of to me,
(07:30):
one of the hardest parts that can happen at the
end of life, and it doesn't happen to everyone, but
it can happen. And we usually try to look to
see if there's a reason why, Right, are they retaining
urine and they feel like they have to pee that
they can't. Are they impacted? Do they have to have
a bale of it but they're impacted? Are they in pain?
Speaker 2 (07:51):
Right?
Speaker 3 (07:52):
So we kind of looked into assess the sea, is
there's something going on here that's making them agitated. Once
we can find that there isn't anything, then we would
label it as terminal agitation. And really the only thing
you can do for that is to kind of decrease stimuli, right,
so you can turn on the lights, try to make
(08:12):
it a little softer, nicer in there, and usually medication
and sometimes a lot of it depending on how bad
someone's agitated. And there's certain diseases and certain personalities that
I see terminal agitation a little more so sometimes, And
that's just really hard because basically it's like you have
(08:35):
to medicate until they're comfortable, and sometimes that means they're
either awake and agitated or asleep and comfortable. And that's
hard for families to.
Speaker 2 (08:47):
Take.
Speaker 3 (08:47):
You know, they want their loves to be awake, but
also when they're awake, they're not comfortable, so when we
have to keep them not awake.
Speaker 2 (08:56):
About maybe a week before my mother went into hospital.
She was in bed and sleeping a lot by this
point and practically stopped taking water. So and the five
children we would take turns, you know, coming home and
staying with her and so forth. We wanted to keep
her home as long and as long as possible. Ideally
(09:17):
we were hoping to do it to the end, but
we couldn't. But about a week before she went into hospice,
and she was in hospice, I think three weeks. So
she's in bed, sleeping most of the time, stopped taking
water and food. My brother and I came home to
spend the weekend with her. She got out of her bed,
she came to the table. My brother cooked steak and
(09:40):
she didn't need a big piece, but she sat at
the table. This the last time we sat with her,
had a meal with her, and she ate a steak. Now,
apparently there is something called the rally. I don't know
if that's if this counts as the rally. But talk
to me more about the rally.
Speaker 3 (09:58):
Oh, I think that some counselos the rally. Yeah yeah,
yeah yeah. So the rally, the real name is called
terminal lucidity and are the medical terms. And it happens
a lot, and it happens in one third of all of
our patients, that's one in three. But many people miss it.
People don't realize this is the rally. That's why I
(10:21):
like to educate about it. And the rally is kind
of just what you talked about. You know, you saw
your mother sleeping most of the time, not really eating
and drinking, kind of looking like and now I'm putting
words in your mouth. But generally speaking, the person will
seem like they're getting close, you know, the family that
start talking about let her get people here, I think
she's going to go soon, things like that, And then
(10:43):
suddenly they do something like that, wake up, and not
only wake up, they get out of bed. Now that
all of a sudden they're eating steak, even if it's
just a little bit, maybe talking a little more, getting
their old spunk back a little bit. And then and
then the trick is they're not like that for a
long time, so it's usually twelve hours to maybe forty eight,
(11:04):
and then they die suddenly afterwards, or at least go
back into like a you know, being unconscious something like that,
and die soon after. If someone continued to do so
well for weeks as not the rally, the rally is down, down, down,
spike and death. And we don't know why it happens.
We don't know why it happens. They're theories, but we
(11:26):
don't know for sure.
Speaker 2 (11:29):
So we've got about three minutes here before the top
of the hour. I want to start talking about a
section in the book called the other worldly Beauty of
deathbed phenomena, and I want to share another one with you.
My mother in law past here at the house where
I'm speaking from in October of last year, and I mean,
(11:53):
she was in failing health, but when the end came,
it came very quickly. But she was sitting in front
of the TV, eating would take her supper, in front
of the television, watching Young and the Restless or something,
and she suddenly called out to my wife, her daughter,
and she said, did you see that? Did you see that?
And my wife said, see what, mom? And she said
(12:16):
a fairy just flew. The TV is on a big
unit wall unit. A fairy flew from over there and
it just landed on my plate. And she was looking
down at her plate watching this fairy. And then she said, oh,
she just passed away the fairy, meaning the fairy just died.
And maybe two weeks later, my mother in law was gone.
(12:41):
When people start to see things, and part of me
believe she actually saw a fairy from my mother, she
saw my late aunt outside the living room window a
couple of weeks before she passed.
Speaker 3 (12:57):
My aunt through it.
Speaker 2 (12:58):
Yeah, isn't it? I mean, can you time sort of?
Is there kind of a chronology when you start to
see things like that, it's only a matter of time
before they go.
Speaker 3 (13:11):
Yes, I mean this is also something that was so
fascinating to me. So this is the second most scene death.
The phenomena. It's called visioning. So people start seeing the unseen. Now,
it's usually dead, like you said, like dead relatives, people
who they liked. So not everyone likes their dead relatives,
so it's usually a dead relative they liked or loved,
(13:32):
dead relatives, dead pets, dead friends, children, sometimes deities, so
a god, angels, fairy, sometimes things like that like something
kind of mystical. And the crazy part to me that
I think is so crazy is that as a healthcare professional,
when someone starts telling me that they're seeing these things,
(13:54):
or their families reporting to me, hey, my dad just
saw his parents last night, right that to me, the
hospice nurse tells me this person will likely die like
two to four weeks from now, Like they it's a timeline.
It's it's part of a part of the timeline where
people and it happens so much that we had to
tell people about it so they know.
Speaker 1 (14:15):
Listen to more Coast to Coast AM every weeknight at
one a m. Eastern and go to Coast to coastam
dot com for more
Now here's a highlight. From Coast to Coast AM on iHeartRadio,
we are back.
Speaker 2 (00:05):
With Julie McFadden, the author of Nothing to Fear, Demystifying Death,
Demystifying Death, to Live more Fully. You can follow her
on social media at Hospice Nurse Julie. I want to
get back to some of the more of the biological
details of dying before we get into the otherworldly deathbed phenomena.
(00:31):
The death rattle. We hear that often when the breathing changes,
and it's described as a death rattle. What is that
death rattle?
Speaker 3 (00:41):
Yes, the real name for that, the medical term would
be terminal secretions. But that sound that people hear, it
sounds like a rattle or a gurgle, and people really
hate it, and I get it, but the I think
it helps to educate about what it actually is. So
a lot of people think it's their loved one quote
(01:03):
unquote drowning, or its fluid coming from their lungs, but
it's not. It's so we create saliva in our mouths
twenty four to seven naturally, and then our body, without
us knowing, automatically will swallow it. Just like right now,
I just did it. And that all happens automatically. Towards
the end of life. Your body is still creating that
(01:25):
saliva to keep your mouth noise, but your brain is
not always telling you to swallow it, or the muscles
to swallow are really relaxed, so they're not swallowing. So
that little bit of saliva builds up in the person's
mouth and then their mouth breathing. Usually so because their
mouth breathing, that breath will go over the secretions and
(01:49):
cause a gurgle noise, and even a little bit of
secretions can make a really big noise. So I think
it's important to let people know what it truly is
so they don't have to be so afraid because it's
generally not disturbing the person who is dying, but the
sound is disturbing the people hearing it.
Speaker 2 (02:12):
Does it Is it advisable to swab the inside of
the mouth or not?
Speaker 3 (02:16):
Yeah, So there's certain things we could do, and if
we do do this, it's usually for the family, not
the patient, just because people don't like it so much.
So you can reposition the person. So I usually lift
the head of bed up a little bit, maybe to
thirty sixty degrees, just shifting your loved one can help.
Even turning them to the side so the secretions come
(02:38):
out can help. There's medications we give to dry up
the secretions. That's usually the first thing we try to do.
I don't think it's totally necessary because sometimes one it
doesn't work, and two then the person has a drying out,
But that's definitely something we still can do now in
the hospital and at home. Sometimes they'll get you a
(03:00):
suction machine, kind of like at the dentist where you
can kind of like suction things out of the knock.
That can be done, and they do it a lot
in the hospital just because we're taught to, but generally speaking,
we don't on hospice because doing that will actually create
more saliva, so it'll actually make it get worse. So
(03:20):
we don't always do that, but it's an option if
we have to.
Speaker 2 (03:24):
What is the way, okay, what is the silence scream
in a dying patient?
Speaker 3 (03:31):
The silent scream? So to be honest, I actually don't
see this very much, but many of my followers would
write into me and say, I loved one and I
have seen it a few times, but it's not I
haven't seen it very frequently, but my followers would say,
you know, right before my loved one died and looked
like they let out, like their face went into like
(03:52):
a look like a scream, but nothing came out, but
they that was kind of like their last thing that
looked like they happen. That happened. And how I describe that,
of course we don't truly know, But how I describe
any kind of weird quote unquote weird thing you might see,
like a silent scream or sometimes people can even like
(04:13):
growl and stuff. At the end of life is the
person you know, the essence of that person is kind
of not there anymore. This is if you can truly
just look at it as like a biology standpoint, This
is a body and a wonderful hostess nurse who's like
the og of teaching hospice and death and dying. Her
(04:35):
name is Barbara Karnes. She likens death and the dying
body to like for as like a laboring process. I
love that analogy, but I also don't The only thing
I don't like about it is that you associate labor
with pain, and I don't think it's a painful process.
But it's kind of like the body just doing things
that it has to do to shut down, and it's
(04:55):
going to do weird things sometimes like make a face
before before the person dies or even while they're dying,
but doesn't necessarily mean anything, but because it's your loved one,
not to try to sense of every little thing that happens,
because it's your loved one and it's not something you
(05:17):
see every day, so it's hard to understand. So the
silent scream is something that you might see and we
don't really know what's going on, I mean likely. I
think it's because our muscles all relax and fully let
go at the end of life. So at the very
very end, if it's like right at the end, everything
(05:37):
will relax, including those mouth muscles. For the mouths going
to suddenly hanging open, the eyes could pop open. Every
muscle can kind of release us. Why people have like
defecation and urination sometimes at death because the sphincter is
relax That's why you can see fluid sometimes at the
end of life. So all of these things are happening
because it's like a full let go wow. But it
(06:01):
can look scary at times at times if you don't
know what's going on.
Speaker 2 (06:08):
When I was a kid, I used to love making
faces in front of a mirror. So when I go,
I'm going to make a face guaranteed, that's right.
Speaker 3 (06:14):
Yeah, yeah, yeah, Bryan.
Speaker 2 (06:16):
Ryot The I remember seeing my my uncle in the
last days of his life and he was unconscious, but
his arms and his legs were moving. He was on
his side and they were just kind of moving and twitching.
(06:37):
And is that what is referred to as is called
terminal restlessness.
Speaker 3 (06:44):
Yeah, so terminal restlessness, terminal agitation. It can vary as
far as like how bad it is, right, So if
someone's just kind of people can kind of fidget, they'll
fidget with the blanket, or they'll fidget with things as well.
They don't seem super disturbed by it. I usually kind
of let it go. But if they seem really restless
(07:07):
or kicking, sometimes it'll be like a constant trying to
get up out of bed even though they can't. And
there's usually no talking any sense into them, so you
can't be like no, no, no, sit down, like they don't.
There's no like talking to them because they're not fully
with it, if that makes sense. And again for terminal
agitation or terminal restlessness. This is one of to me,
(07:30):
one of the hardest parts that can happen at the
end of life, and it doesn't happen to everyone, but
it can happen. And we usually try to look to
see if there's a reason why, Right, are they retaining
urine and they feel like they have to pee that
they can't. Are they impacted? Do they have to have
a bale of it but they're impacted? Are they in pain?
Speaker 2 (07:51):
Right?
Speaker 3 (07:52):
So we kind of looked into assess the sea, is
there's something going on here that's making them agitated. Once
we can find that there isn't anything, then we would
label it as terminal agitation. And really the only thing
you can do for that is to kind of decrease stimuli, right,
so you can turn on the lights, try to make
(08:12):
it a little softer, nicer in there, and usually medication
and sometimes a lot of it depending on how bad
someone's agitated. And there's certain diseases and certain personalities that
I see terminal agitation a little more so sometimes, And
that's just really hard because basically it's like you have
(08:35):
to medicate until they're comfortable, and sometimes that means they're
either awake and agitated or asleep and comfortable. And that's
hard for families to.
Speaker 2 (08:47):
Take.
Speaker 3 (08:47):
You know, they want their loves to be awake, but
also when they're awake, they're not comfortable, so when we
have to keep them not awake.
Speaker 2 (08:56):
About maybe a week before my mother went into hospital.
She was in bed and sleeping a lot by this
point and practically stopped taking water. So and the five
children we would take turns, you know, coming home and
staying with her and so forth. We wanted to keep
her home as long and as long as possible. Ideally
(09:17):
we were hoping to do it to the end, but
we couldn't. But about a week before she went into hospice,
and she was in hospice, I think three weeks. So
she's in bed, sleeping most of the time, stopped taking
water and food. My brother and I came home to
spend the weekend with her. She got out of her bed,
she came to the table. My brother cooked steak and
(09:40):
she didn't need a big piece, but she sat at
the table. This the last time we sat with her,
had a meal with her, and she ate a steak. Now,
apparently there is something called the rally. I don't know
if that's if this counts as the rally. But talk
to me more about the rally.
Speaker 3 (09:58):
Oh, I think that some counselos the rally. Yeah yeah,
yeah yeah. So the rally, the real name is called
terminal lucidity and are the medical terms. And it happens
a lot, and it happens in one third of all of
our patients, that's one in three. But many people miss it.
People don't realize this is the rally. That's why I
(10:21):
like to educate about it. And the rally is kind
of just what you talked about. You know, you saw
your mother sleeping most of the time, not really eating
and drinking, kind of looking like and now I'm putting
words in your mouth. But generally speaking, the person will
seem like they're getting close, you know, the family that
start talking about let her get people here, I think
she's going to go soon, things like that, And then
(10:43):
suddenly they do something like that, wake up, and not
only wake up, they get out of bed. Now that
all of a sudden they're eating steak, even if it's
just a little bit, maybe talking a little more, getting
their old spunk back a little bit. And then and
then the trick is they're not like that for a
long time, so it's usually twelve hours to maybe forty eight,
(11:04):
and then they die suddenly afterwards, or at least go
back into like a you know, being unconscious something like that,
and die soon after. If someone continued to do so
well for weeks as not the rally, the rally is down, down, down,
spike and death. And we don't know why it happens.
We don't know why it happens. They're theories, but we
(11:26):
don't know for sure.
Speaker 2 (11:29):
So we've got about three minutes here before the top
of the hour. I want to start talking about a
section in the book called the other worldly Beauty of
deathbed phenomena, and I want to share another one with you.
My mother in law past here at the house where
I'm speaking from in October of last year, and I mean,
(11:53):
she was in failing health, but when the end came,
it came very quickly. But she was sitting in front
of the TV, eating would take her supper, in front
of the television, watching Young and the Restless or something,
and she suddenly called out to my wife, her daughter,
and she said, did you see that? Did you see that?
And my wife said, see what, mom? And she said
(12:16):
a fairy just flew. The TV is on a big
unit wall unit. A fairy flew from over there and
it just landed on my plate. And she was looking
down at her plate watching this fairy. And then she said, oh,
she just passed away the fairy, meaning the fairy just died.
And maybe two weeks later, my mother in law was gone.
(12:41):
When people start to see things, and part of me
believe she actually saw a fairy from my mother, she
saw my late aunt outside the living room window a
couple of weeks before she passed.
Speaker 3 (12:57):
My aunt through it.
Speaker 2 (12:58):
Yeah, isn't it? I mean, can you time sort of?
Is there kind of a chronology when you start to
see things like that, it's only a matter of time
before they go.
Speaker 3 (13:11):
Yes, I mean this is also something that was so
fascinating to me. So this is the second most scene death.
The phenomena. It's called visioning. So people start seeing the unseen. Now,
it's usually dead, like you said, like dead relatives, people
who they liked. So not everyone likes their dead relatives,
so it's usually a dead relative they liked or loved,
(13:32):
dead relatives, dead pets, dead friends, children, sometimes deities, so
a god, angels, fairy, sometimes things like that like something
kind of mystical. And the crazy part to me that
I think is so crazy is that as a healthcare professional,
when someone starts telling me that they're seeing these things,
(13:54):
or their families reporting to me, hey, my dad just
saw his parents last night, right that to me, the
hospice nurse tells me this person will likely die like
two to four weeks from now, Like they it's a timeline.
It's it's part of a part of the timeline where
people and it happens so much that we had to
tell people about it so they know.
Speaker 1 (14:15):
Listen to more Coast to Coast AM every weeknight at
one a m. Eastern and go to Coast to coastam
dot com for more
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