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Saturday, May 30, 2009

Impact of Death Rattle Sounds on Hospice Workers


Anyone who works closely with dying patients may have heard death rattle sounds. Hospice workers, including volunteers, who have heard these sounds in the presence of patients’ relatives and friends may feel the need to explain to them what the patient is experiencing and reassure them.

According to Wikipedia, a “death rattle is a gurgling or rattle-like noise produced shortly before or after death by the accumulation of excessive respiratory secretions in the throat. Those who are dying may lose their ability to swallow, resulting in such an accumulation. While it is medically established that the death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex. It is sometimes misinterpreted as the sound of the person choking to death. In terminal care, drugs may be used to reduce secretions and minimize this effect.”

A study reported in Palliative Medicine was done to see how the death rattle sounds impacted hospice staff and volunteers. Most expressed negative feelings about hearing the sounds. Many felt the need to intervene to end the sounds using a therapeutic option. The study concluded that “doctors and nurses need to consider why, when and how they intervene and the consequences of that intervention.” You can read more about this study here.

Visit here for more current (2013) research and other information about the death rattle experience.

Visit here to hear a recording of the death rattle sound.

It would be interesting to read firsthand information from hospice workers, healthcare staff members, and other caregivers regarding their personal experiences with a patient during a death rattle experience.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

19 comments:

  1. Hi--I am a hospice nurse with 15 years experience. Usually I medicate dying patients who have the death rattle with atropine or scopolomine simply because the sound upsets the family so much. Many families ask fearfully "Is that the death rattle?" and I just explain what causes it and how we will treat it. Knowledge can take away fear.

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  2. Thanks for that information, Karen.

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  3. AnonymousJune 20, 2009

    Hello......not sure you will have an answer BUT, my mother in law is having a difficult time dying. In a hospice setting for 6 weeks.
    Some coherence but only briefly. She is on 17.8 fentanyl by microdrip and
    Ativan .25.....which makes her just zonked out......at times on the Ativan we hear what sounds like the death rattle. We are wondering if the Fentanyl is making it more difficult to work through the pain and then to die on her own. She wants to die, has resolved anything and everything, ready for this at 83. She expresses the desire to die.
    Can you suggest any other helpful ways to approach this for her. Thank you.

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  4. I wish I could help you, but, as you suspected, I am not qualified to comment on this medical matter. I can only suggest that you seek further assistance from others who can. You are fortunate that your mother has "resolved anything and everything" before her death. I hope you find the answers you seek.

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  5. i usually suggest turning patients side to side prior to any medicine and explain to the family what is going on internally with regard to the uvula relaxing air going thru etc

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  6. Hilde, thanks so much for sharing that. Through the years, this post continues to get many hits. Apparently, a I lot of people are interested in death rattle sounds.

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  7. AnonymousMay 02, 2012

    We are experiencing these sounds from my mother-in-law right now and are trying to get her into the hospice care center. Although we understand what causes theses sounds, we are more concerned that she may be feeling pain or discomfort totally unrelated to them. We know the staff at the care center can do a much better job at keeping her totally comfortable than we can at home.

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  8. Thank you for sharing your experience. I wish you all the best on your mother-in-law's journey.

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  9. AnonymousJuly 31, 2012

    My mom went into the hospital for back pain June 18th. After an MRI and 2 CT Scans & 2 biopsys, she was diagnosed with stage 4 cancer. My mom went into Hospice Care July 4th and passed away July 15th. Her breathing the last 2 days were short breaths with long pauses in between. The Hospice Nurses told us that was normal. At midnight on July 15th her breathing changed and by 3:00 a.m. she had a slight rattle. By 5:00 a.m. it was bad.
    My mom died at 5:50 a.m. The most painful, heartbreaking experience I have ever gone through in less than a month...

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    1. I know just what you mean. My mom was rushed to ER on Nov. 15th and was found to have cancer all thru her. She died on Dec. 11th. The day before she died, she had a very noisy death rattle, was trying to cough and sit up. It was very distressing to think she was struggling to breathe. We did get a nurse to roll her on her side and give some meds which helped some, and another nurse's aide suctioned a bunch of mucus out of mouth/throat. That helped. Truly, it was a heartbreaking and traumatic experience for us all.

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  10. Thank you for sharing your experience. I extend my sympathy to you and your family. You did indeed go through a lot in less than a month. I hope you are seeking and getting any support you need as you make this transition in your own life.

    These suggestions may help:

    1) Flow with the grieving process. Each person’s bereavement is unique. Maintain good health, accept assistance from others, and get counseling support if needed.

    2) Remember that you are responsible for your own happiness. Hobbies, travel, social functions, volunteer service, and other enjoyable and fulfilling activities add quality to your life.

    3) Establish new holiday traditions and family rituals if you think you should. You can include ways to commemorate your mother. Keep her stories alive for generations to come.

    4) Remember that life is for living. Your mother would want you to move forward productively on your journey. Doing so is another tribute to her.

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  11. My mother died in her care home about 8 weeks ago. We were very aware on her last day that she was close to death because she had lapsed into a sort of coma, her breathing was very shallow and there were long pauses in between breaths. In her last few minutes she had a death rattle twice. I have never been with anyone as they died before and it made me jump. It was quite disturbing. It sounded to me as though she was about to be sick. My brother is a priest and is more used to seeing death, so was not as alarmed. It helped me to know afterwards she wasn't suffering when she made this noise.

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  12. I extend my sympathy to you and your family. You were fortunate to have your brother with you to provide that support. Thanks for sharing your experience.

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  13. Thank you Frances. You probably realise I am not a hospice worker. I live in the UK and I should explain that I found your site when I was looking on the internet because the sound of Mum's death rattle has stayed with me. There are you-tube recordings of a death rattle sound, but I am not sure I want to hear it again deliberately. We knew Mum was dying about a week before she passed away, and my brother, husband and I were able to spend some time with her every day. For much of that time she was able to interact with us, and we were also able to bring some of her elderly friends to her care home to spend some time with her too. It was only on her last day that she lapsed into a sort of coma and we had no reaction from her at all. I had 'googled' signs of dying so I would know what to expect, so I was aware she might have a death rattle but it still startled me at the time. Something that also sort of upset me, that no one has been able to explain is that in her last couple of minutes of life two tears squeezed out of one of her eyes. I know I am probably reading more into that than I should, but it was still sad to see them at the time.

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  14. It sounds like your mother had a beautiful death journey with positive interactions and supportive closure. Sometimes without realizing it, we interpret patients' responses based on our own feelings. While you may have been disturbed hearing the death rattle sound, you say your mother "wasn't suffering when she made this noise."

    Keep in mind that even when your mother stopped communicating, she still may have heard and appreciated what was going on and being said around her. Your mother experienced what most people dream of when they think of their own deaths. After reading your description of your mother's death journey experience, I think her two tears represented her joy and gratitude in being blessed with such comforting closure provided by loving family and friends.

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    Replies
    1. How can we be certain that the patient isn't suffering during that death rattle sound? My mom went through that just last week (and died a day later). She was coughing and trying to sit up and her oxygen levels were going way down. The nurses rolled her on her side and suctioned out of bunch of thick mucus. It helped her, but I still fear that she was suffering and couldn't breathe.

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  15. Thank you so much, Frances. Your words are very comforting. it is never easy to lose your mum but you have made me feel better. With best wishes, Catherine ('anonymous')

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  16. My mother is upstairs at my house and has been here for a year. The past month has been insane, the hospice nurses that come expected her to die within the last month. I have just started hearing noises when she breathes, 2 short breaths for what would be a normal breath..the noise is like a gurgling sound. Is this the death rattle. I'm really trying to find information on when the final hours are going to be. She cannot use her arms for the past two weeks. She has the mottling on her forearms and hands, not really on her feet. Also she is hot to the touch not cold. She has always run cold before in her life. Anyone give any hint of what the hours are.

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  17. Continue to work with the hospice nurses. No one can predict with certainty the exact hour your mother will die. You can listen to a recording of a person's death rattle at this post I did recently:

    http://hospiceandnursinghomes.blogspot.com/2013/09/death-rattle-sounds-myths-and-facts.html

    In the meantime, try to relax and allow death to come in its own time. I wish you strength and peace.

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