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Saturday, September 7, 2013

Death Rattle Sounds: Myth vs. Fact (Research, Video-Audio .44)



Death rattle sounds refer to the rattle-like breathing noises caused by respiratory tract secretions during the final days of life. Those who are dying may lose their ability to swallow, resulting in an accumulation of these secretions. The following researched death rattle information addresses several myths that exist regarding this experience. 

Death Rattle Myths and Facts

     1) Myth: Death rattle symptoms are rare.

         Fact: Death rattle symptoms are common in dying patients.

     2) Myth: Death rattle symptoms are difficult to watch or control.

Fact: Death rattle symptoms can be distressing for some observers. Symptoms can be treated through a combination of measures. It should be noted, however, that there is no conclusive evidence to suggest that any drug is superior to a placebo containing no medication. Treatment may serve to alleviate the perceived distress of observers rather than benefiting the patient.

    3)  Myth: Patients showing death rattle symptoms undergo a great deal of pain.
       
Fact: The level of consciousness in patients who may appear to be actively choking while experiencing death rattle symptoms is usually so low that it is generally assumed that they are not in pain. Healthcare providers should consider why they treat death rattle symptoms. Some of the drugs involved have negative side effects. Caregivers and loved ones should be educated regarding the death rattle experience and reassured that it is unlikely that patients are distressed.

Rattle-like breathing sounds resulting from an accumulation of secretions in the dying patient’s airway can be heard during the death rattle. It would be both helpful and interesting to read firsthand comments from healthcare staff and other caregivers regarding their personal involvement with patients and observers during death rattle experiences. This video features death rattle sounds from the mouth of a dying patient. 

(See two links below this video for more death rattle information.)





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.

30 comments:

  1. The death "rattle" is more common than uncommon in the dying patient. The measures to decrease the death rattle such as suctioning,atropine drops, scoplamine patches, help but at what cost to the patient in their comfort and inability to speak.I find the the following to be most helpful. 1.Education of the family and caregivers, as to "that it is harder on the caregivers, than on the patient" 2.Re-positioning the patient on His/her side 3. Soft music in the room to distract the caregivers from the noise of the "Death Rattle".
    Each situation is different, depending on the caregivers and the loudness of the Rattle. Thanks for Discussion and it will be interesting to see how other Nurses handle this Symptom.

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  2. Thanks for sharing your firsthand experience on this matter.

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  3. Unless one has been to the point of the "death rattle" and come back to tell about it, then one can only surmise that it is not uncomfortable. In my lengthy experience with the dying, and the reasoning's of our medical authorities with hospice and not, I can honestly tell the readers that just a little oxygen administered helps with what obviously seems very uncomfortable to the onlooker ~ which very well could be very uncomfortable to the patient who is experiencing it and will not come back to tell us otherwise.

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    1. You bring up a good point about deceased patients (we know of) not coming back to tell us about their actual death rattle comfort levels. In the meantime, extensive research and caregiving experiences with many patients can be very helpful in providing probable solutions.

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    2. My mother in law just woke up and asked to go pee. She has been experiencing the death rattle for two days now. She did not complain of any pain, which she has been very demanding of more morphine when she is in pain. She fell back into her deep sleep with rattle within minutes. Seems that there is no pain. At least not for her.

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    3. Trying to reply to Anonymous from 9/10/13 but not tech savvy & it looks like maybe replying to another party despite numerous tries to get under corresponding post...

      Re: "I can honestly tell the readers that just a little oxygen administered helps with what obviously seems very uncomfortable to the onlooker ~ which very well could be very uncomfortable to the patient who is experiencing it"

      I think you said something very wise there. Administering oxygen seems to be something that may prolong the process of dying. While that may comfort the caregivers/onlookers I think it should be considered if it's in the patient's best interest. While it may be a temporary easement, is it worth prolonging the patient if they have been suffering.

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    4. My husband died in 2004. He was fully concious and on no medication when he passed. I knew nothing about a death rattle and asked him why he was breathing like that and would he like some medication. He refused and died by my side 6 hours later. In my husbands case he was not suffering during the time he had the death rattle.

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    5. Thank you for sharing your positive end-of-life experience with us. It helps to read the stories of others.

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  4. I was intrigued by your article. I wondered if I were to repost it to Facebook, how many likes would it garner? How many would read it? These fear based possibilities are why it is so necessary a subject to be written about and discussed. Like the taboo subject of death in general, we perpetuate the societal fear concerning the process of death because of our denial and fears about discussing the reality of it.

    I, too, am a Hospice volunteer and was a caretaker for both of my parents prior to and during their deaths. (M-Alzheimer’s disease 2010 and F-dementia last month) Although prepared by wonderful Hospice nurses before and during both deaths, the fact that we, the family members were observing a loved one experience what appeared (to us) to be a painful process, it was difficult to witness. But I know that many families are unprepared for their loved ones deaths (in Hospice or not) let alone know what to expect in the process. Therefore, I agree education and discussion are so important for the families as well as our society. I am so grateful for the caring hearts of our nurses and chaplain so that I could be present for my parents’ needs during their processes rather than being distracted by my own. I am also grateful you have addressed this subject. Thank you.

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  5. Chris, your response about how many will like or read about the death rattle is interesting. In a strange kind of irony, people are very curious about the death rattle whether they fear death or not. Perhaps it's similar to crowds being drawn to a tragic accident or crime scene while dreading what they will witness at the same time. I have written about this topic several times through the years. Those past posts can be found in the blog search area above the date at the top.

    Your caregiving experiences with your parents give you another layer of positive enhancement as a hospice volunteer helping others who are far less informed. Thank you for sharing. I wish you continued success in your work.

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  6. My dad passed this morning and his death rattle was horrible. I hope I never have to see that again. At one point he opened his eyes and stared at the ceiling and it sounded like he was trying to clear his throat and just couldn't Awful

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    1. I extend my sympathy to you. Although the death rattle can be difficult to witness, know that a great deal of research supports that the patient does not experience pain on the level that observers may assume.

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  7. I was alone at my husband's bedside in Tampa FL when I heard his death rattle about 15 seconds before his last inhalation. Fortunately, I'd read about it and knew what it was, but it was a ghastly sound.

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  8. It is good that you prepared yourself and knew what to expect. Sometimes the shock of witnessing something totally new makes the experience more unsettling.

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  9. When my dad passed in 2013, his rattle was loud and he coughed often. It lasted for a day and a half. The heat produced by his body that night was tremendous.

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  10. Thank you for sharing your experience with others.

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  11. My mom just passed last week of a sudden illness (small cell carcinoma). She was put into hospice for only 12 hours before she died, and the morning of her death, she seemed extremely distressed. She asked at one point, "What is that rattle in my chest?" I asked the hospice nurse to help calm her. She gave her something for the rattle, plus some morphine and ativan to calm her, and then my mom closed her eyes and died. Because everything was so sudden, I am haunted by this rattle, and by my mom's distress. Was she afraid she wasn't going to be able to breath? It seemed like she had a panic attack, which is what she had to be calmed from. She was very alert but her body was shutting down very quickly - right before my eyes. She died in peace, I think, but I would sure love some insight. Thanks.

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  12. I extend my sympathy to you and your family. You may never know what was going through your mother's mind while she was dying. But you do say you think, "She died in peace." Those words and all the researched-based information explained about the painlessness of the death rattle should put your mind at ease. For more insight, please view the two links listed below the above video. They will take you to two posts on dying, the death rattle, and comments of many other readers who have witnessed that experience.

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  13. A Thankful WifeDecember 06, 2016

    Wow, this is difficult to write!It saddens me greatly that I am on this site, reading all of this. I am concerned that my dear husband's time may possibly be near and I'm trying to learn what to watch out for. Thank you for your mixture of education and gracious kindness, Frances. May the good Lord bless you for showing love to all of us the way you do.

    My husband is 83 years old, I am 55. We've been married 28 years. I knew way back then that the time may come when, according to general natural chronology, I would survive him. Seems like I've spent the better part of our marriage quietly grieving that day in advance. It's both strangely disconcerting and comforting as I've often wondered what will happen and how I will handle it.

    One thing is for sure:
    He and I accepted Jesus as our Personal Savior 20 years ago and have been quite involved with Him ever since. I have absolutely NO DOUBT that He would lead me through it all, as He did when I went through cancer treatment. (I am currently in remission, Praise Him!~~) That comfort and strength that my husband and I draw from God means everything. According to the Bible, I and my husband KNOW, WITHOUT ANY DOUBT, that we shall rejoice again in Heaven, so our parting would be not "goodbye", but "see ya later!". There is much peace regarding that.

    I write because I have a medical question, actually. My dear husband has very bad COPD from cigarettes (he quit 20 years ago. He wouldn't listen to reason prior). He's in fairly poor health in general. Lately, I feel like I am watching his weak and frail body get worse and worse quickly and it concerns and saddens me.

    The COPD has given him off and on (mainly every several days,.back and forth) FOR YEARS what sounds like The Death Rattle. He takes chest congestion medication and it subsides. He stops the meds, it returns!

    He says that is "in his throat" almost every time we discuss it.

    The other night I was getting nervous because he'd been sleeping an awful lot lately and wound up "absolutely freezing,..can't get warm!" While I have been noticing lately that his mental faculties are forgetting things more and more often, that night was different. There was a new confusion about him all night. I practically MADE him use his oxygen (he always says that he doesn't need it. I think he does~~)' His mental status seemed to be a bit better the next morning. His throat and chest still sounds TERRIBLE, can't get him to see the Doctor as he's been in and out of the hospital with pnuemonias in the past and I believe he'd rather be sick,.and possibly die, at home.

    Now I read all of what is said about The Death Rattle. What should I make of all of this in his case, please?? I routinely ask the Lord for peace....that "gurgling", as I've called it, makes me anxious, altho' I've heard it for YEARS! Can someone be dying that slowly and only be making that awful sound?? I find that I watch him and his health like a hawk, staying with him when I have the opportunity to go out if he is not feeling well, as several times I've had to call 911 immediately and it came out of nowhere!

    PLEASE, help me understand what I'm dealing with here.
    Thank you, and know that God is using you in mighty ways!
    Peace be with you~~

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    1. To A Thankful Wife:

      You and your husband are going through a lot now, and it is important for you to stay centered on your faith, professional medical advisement, and what’s really important for your husband’s quality of life. Medically, you are concerned about his declining mental state, lack of cooperation regarding his own care, and his "gurgling” with the death rattle for years. I am not professionally trained to assist you with his medical issues, but I hope you will continue to work with those who can and encourage your husband to do so as well.

      I can say, however, that I have not heard of the actual death rattle lasting for years. Wikipedia, a free online encyclopedia, reports that, while the death rattle is a strong indication that someone is near death, this sound can also be produced by other problems that cause interference with the swallowing reflex. Medical professionals providing care to your husband and who are familiar with his case can probably explain to you further his specific health issues.

      You say you have known for many years that the time would come when you would survive your husband and that you have been “grieving that day in advance.” You also say you have “NO DOUBT that He (Jesus) would lead me through it all” and that you and your husband “shall rejoice again in Heaven.” Keep holding on and reminding yourself of that peace. Knowing and believing all of this should strengthen you through this period.

      Death is a normal part of life that everyone must experience. Imagine the joy you and your husband will know later. If you need more counseling or support from the medical profession, don’t hesitate to request it. I hope these words have been helpful. Know that I wish you and your husband the best on this journey and beyond.

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  14. My mom just passed away 9 days ago she had the death rattle we bag the nurse to give her more medicine and to ease her she replied that she's not in any pain. I knew something wasn't right the sound was so loud and lasted four hours. I begged the nurse to give her something she said it was a protocol. Bull the more I look into it they should've given her Ativan hours before to relax her but they waited. Finally when they gave it to her the sound subsided there was still a death rattle but not as severe she died 20 minutes later I'm mad because she struggled for 4 hours and no one can say that she wasn't in pain . if I can give any advice I would demand anxiety medicine and ask about "comfort pack" that every hospice place should offer it holds all the meds the ease the patient . We never knew about any of this.

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    1. I extend my sympathy to you and your family, Robin. Thank you for sharing your story. I can only say that a body of research supports that the patient does not experience pain on the level that observers may assume. Perhaps a nurse or doctor reading this blog and familiar with what you explained can respond to your concerns, particularly regarding use of a "comfort pack."

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    2. A Thankful WifeDecember 12, 2016

      Robin.....I am sorry to hear about your mother. Please know that I am praying for your comfort and strength at this difficult time. Thank you SO MUCH for sharing your info regarding "The Comfort Pack", I'm sure reading what you took the time to write will be then be implemented by many who have found it. May the good Lord bless you as you heal, and may Peace be with you~~

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    3. Feeling guilty February 14, 2017

      My mom passed a few days ago. She had a lot of illnesses going on, including myacena gravis (spell?) which is a rare desease. She seemed to be in pain, even though she was on morphine and then added ativan. She had the "death rattle" for 6 days. I had heard the rattle in my grandma's death, but my moms was so much worse. It sound like she was choking to death. She could not swallow, but hospice still had us giving liquid meds through the mouth every hour. She kept gathering very thick secretions and choking. We tried to remove it with very little success. When she finally passed the solid secretions came of of her mouth a lot. Anyone else have this happen. I feel so guilty because the whole purpose was to keep her pain free. I feel I choked her to death. It was horrible! I just wanted her to pass fast, so she wouldn't be in anymore pain.

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    4. I extend my sympathy to you on the passing of your mother. I am not a medical professional, but I can tell you that, although the death rattle can be difficult to witness, a great deal of research supports that the patient's level of consciousness is so low that she does not experience pain on the level that observers may assume. Your response as a witness is common. You may also want to read about the experiences of others in the two links listed right below the video.

      It is important that you address the guilt you still feel. I hope you will get some professional assistance if this continues to upset you, perhaps through your hospice organization. That service is available. Your mother, who appreciated so much of your loving care during her illness, would want you to live your life with more positive memories of what you two shared.

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  15. My mom had an accident in June, she had a total hip replacement. First 2 months she was recovering very well, one day she couldn't get out from the bed, it was a very painful decline for her and she died 4 months later. tests showed she has a severe diabetes neuropathy and it had exacerbated due to the surgery. Before dying she had death rattle for 3 days, before the day of her death she had a very high temperature. she died while she was fed liquid food. did she die of chocking? or was it a slow death for her?

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  16. Vinay, it's impossible for me to know how your mother died. You could ask a professional in the hospice healthcare field and that person may or may not know. I can only repeat to you what I have said to several others about death rattle and a low level of consciousness that greatly decreases pain. I extend my sympathy to you and encourage you to move forward as your mother would want you to do in celebration of her life.

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  17. Hi Vinay (I love your name~~),
    I just wanted to say how sorry I am for your loss. How awful to be having to wonder such questions regarding your Mother... I am sorry for that as well.

    Know that I will pray for you. May you find comfort in the arms of our Savior, Jesus....Peace be with you~

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  18. My mom died just seven days ago.The sounds prior to her death still haunt me. It sounded like she was drowning now I know it was death rattles

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    1. Yes, the sounds were probably the death rattle. I hope the research-based information on this post has helped you in understanding the experience better. My condolences to you, Loriann, as you begin again on your continuing journey.

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