Saying Goodbye Is Never Easy

Last Update: May 25, 2016



Recently, I experienced the loss of a patient. As a healthcare professional, saying goodbye is not easy--especially when I am saying goodbye due to the end of his/her journey here on Earth.

Over the years, I have learned several unique aspects of the dying process. I realize this blog is not going to be cheerful, but a large portion of my patients' caregivers were very appreciative of the following information. So bear with me as I share my experience and some of the phenomenons of the dying process.

3 - Signs of Dying I Consistently Encounter

1. Changes in the Ear - The ear lobes usually hang straight down, but I have learned that one of the initial signs of the dying process is the ear lobes bending backwards. That's right, the bottom of the ear that generally hangs straight down will start to bend backwards. The change in the ear lobe becomes more dramatic and pronounced with the progression of the dying process.

2. Changes in the Skin - Mottled skin...This is a patchy, almost web-like and blotchy discoloration of the skin. The discoloration is usually bluish-red or bluish-purple, and the skin is distinctively colder to the touch. Generally, skin mottling starts in the feet (the body part farthest from the heart) and then works upwards and toward the abdomen. Mottling can be seen anywhere on the body. Sometimes, a fever can be detected or present, but the arms and legs will be noticeably colder.

3. Changes in Breathing - The breathing pattern is distinctively different when your loved one is about to pass away. Shallow almost panting breaths...pauses in breathing... and then gasping or slightly larger breath is a typical breathing pattern when someone is close to the end of their life here on Earth. With the progression of the dying process, the pauses in breathing or cessation of breathing becomes longer and longer until breathing comes to a complete and final stop.

There are other signs of dying addressed on several websites, but I have highlighted the 3 signs that I have consistently encountered both with my patients and my loved ones over the years.

4 - Phenomena I Commonly Encounter

1. The Psuedo-Miraculous Recovery

About 24 hours before dying I have witnessed this phenomenon: A spectacular recovery or a dramatic improvement in the individual! For example, my grandfather had severe dementia--could not remember his sons' names for about 2 years. About 8 hours before my G-Dad passed he was talking to my uncle that had passed away more than 20 years previously, and he addressed my dad--who is still living--by name for the first time in 2 years. In fact, G-Dad scolded my dad for ignoring his brother. Of course, my dad could not see his brother, but my G-Dad not only talked to both of his sons, he addressed each of them by name.

In the same manner, the patient that passed away recently as well as countless others had really SPECTACULAR days prior to dying. Most caregivers say, "I was amazed how well he/she was getting around, talking, and I thought he/she was finally going to get better."

2. The Pattern of 3 or 6

Okay, I know this may appear to be outrageous but like births, deaths typically happen in groups of 3. If there is a 4th, then one of the four was a COMPLETE and UTTER SHOCK with 2 more following--making the total of deaths 6. The pattern of 3 can include both close relatives or acquaintances/friends, but I have experienced this phenomenon every time! My patient that passed away was number 3 and I have not had a SHOCKER yet. All 3 did not include any of my loved ones or close friends, but nonetheless I still feel the loss.

3. Uncharacteristic Coincidences? Not in my book!

I have witnessed numerous patients and even my own loved ones talking to angels or relatives who passed away previously. I have even been told by my patients about 24-36 hours before their passing, "Hey, I saw ________ (fill in the blank with previously deceased loved one), and we had a very pleasant visit." I never try to rationalize, explain, or convince them of anything wrong or impossible because I personally believe in angels and I have witnessed these conversations prior to someone dying on almost every occasion where the person was able to talk.

Flickering lights when there is not a storm or other scientific explanation for the lights to be uncharacteristically blinking on and off. I have only experienced this on one occasion, but I have witnessed this happening as well.

4. Broken-Heart Syndrome..."The Notebook"

I have seen sisters pass within hours of each other--one was expected and the other was a complete SHOCK. They were both in a nursing home; however, the older sister was primarily bed fast--could not walk, get out of bed, or even transfer without maximum assistance--and had exhibited the signs of the dying process (ears bent backwards, mottling of the feet/legs, bluish (cyanosis) discoloration of the lips and fingernails, altered breathing pattern) all morning and was expected to pass away. The younger sister was able to walk, feed herself, and was not exhibiting any signs of characteristic of end-of-life. However, the older sister passed away shortly before lunch and when the younger sister was informed of her sister's death, she was gone within 3 hours! These sisters were never married, had lived their entire lives together, and were quite literally each other's better half with no other living relatives. I believe the younger sister died of a broken heart.

Similarly--high school sweethearts, love-at-first-sighters, and intimately connected spouses--follow the script depicted in the movie, "The Notebook." One spouse passes away and the other spouse will fail to thrive (lose his/her appetite, withdraw, stop taking medications, etc...), get lost in their grief, cannot function in the absence of "the love-of-their-life, and pass away shortly following their spouse's death.


I could literally spend hours and tell countless stories with each of the above phenomena. I admit that the process of dying is unique, personal, and there are more signs/symptoms of the dying process. The 3 signs I listed above are the most common signs that I have encountered. The only patients that passed away without demonstrating any signs of the dying process were the 2 patients I gave tribute to earlier this week and the sister I mentioned above. All 3 were a complete surprise -- 2 were victims of pulmonary embolisms, 1 was from a broken heart--and their passing was very SUDDEN. The signs of someone about to pass away can literally start weeks or days before the final breath is taken and the heart stops beating. Loss of a loved one or even someone you know (friend, close acquaintance) is something we all encounter at one or more times throughout our lives. By writing this, I hope to provide some helpful information.

If you start to see any of the 3 signs I mentioned above, please seek out support and guidance from a knowledgeable professional (Hospice, Doctor, Clergy, Home Health Nurse, etc...), to help you physically, emotionally, spiritually, and in any other area you need while dealing with the passing of a loved one. I pray you do not go it alone...there is ALWAYS someone to help--even if it's just a shoulder to cry on!

Saying goodbye is not easy, but inevitable. If you want or need to share your story, I would be honored to listen. Maybe you have experienced one of the 4 Phenomena I highlighted above, or you have experienced a different/unique occurrence associated with the passing of your loved one from this existence to another--I would love to hear your story.

I pray the following every day before my family gets in the car and starts the day:

"Dear Lord, please guide, direct, protect us, and bring us all home into the loving arms of each other."

Until next time, I extend the same prayer for you and your loved ones.


~Shawna, PT, MPT

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Recent Comments


Thanks for this highly informative blog, Shawna!

This is absolutely my pleasure and another way I can give back as well as pay tribute for those who have passed on but taught me so much. Thank you for your support and comment.

Gladly given, my friend!

I love hearing about these types of stories and have heard and seen similar situations as well.
I worked in a retirement home for years, and I had experienced many many deaths.
Back in 1995, my mom contracted the flesh eating disease and was in a medically induced coma for a week while they were operating on her to remove the damaged flesh. When she was in the ICU and cameto (sort of), she kept talking about this solider that was in her room watching her. We thought she was just going crazy from the drugs! Years later, she went and seen a medium and she told my mom she has a guardian angel watching over her who was her great uncle and described him. He was in the army years ago and everything she described about this guardian angel, fit the description of the man she saw in ICU.

I also went to see this same medium about a year afterwards. She told me that my grandma was always around me and she that she has to walk downstairs to come and visit me (I was living in a basement apt). She told me how proud my grandma was of me and that I had picked the right career. She also told me not to get a tattoo that I was only "thinking about" because I would regret it. But I went against her wishes and now I regret this tattoo!! lol

She also told me that my biological grandfather came through and she told me stuff no one could have known - I didn't even know. She told me how to find my father which ended up being spot on!!

Hello Shawna:
I am sorry for the loss of your patient. I understand how that is because I come from a family of Caregivers and my husband is a RN. It is not easy losing anyone that you have been close to or in contact with for any reason.

The pointers you gave are stupendous and I thank you for sharing this with us here at WA

Hats off to you and all the caregivers out there! I love Home Health because I get to develop a great relationship with my patients, but when they pass away, it still has an impact. I am just thankful and blessed to help others as a tribute to those who have passed away.

Thank you for your inspiring and supportive comments. I am truly blessed by you and this community.

WOW, very informative. Thanks for sharing.

This information is very helpful to ALL of us who will go (or have gone) thru this event. It makes the process MUCH easier when you know what to expect and are not surprised, worried or confused about the changes you describe. I experienced every one of these signs with both of my parents. Thanks for taking the time Shawna! Steve

Hi Steve, you are so right about this impacting everyone but maybe knowledge is comforting. It has been a privilege to read and share all these testimonies. Thank you friend.

Shawna - EVERYONE who reads your article WILL benefit. Because part of life (here on earth) IS death. There is no Plan B! But as you say, if you are even somewhat prepared, it makes this experience MUCH easier! I wish I had the privilege of reading your article before both of my parents passed away. It would have made a HUGE difference in the way their passing impacted my emotional state. Again, MANY thanks for providing this information to our community! This is what WA is all about and makes me very proud to be a member. Helping each other is our mission! Happy Hump Day!

Thanks for sharing these and the wonderful stories. I'm sorry also for the lost of your patient.

My pleasure. I hope this helps and comforts someone to prepare for a life-change. Thank you for commenting

Thank you for your condolences. I have been told sharing is caring and sometimes sharing is the hardest form of caring. It has been inspirational and liberating. Thank you for commenting

Hi Shawna, I had a pacemaker fitted last year due to my heart deciding it quite liked completely stopping now and again! Prior to that (and before they found the actual problem,) I was having something called a 'reveal' fitted to see if they could find out why I kept on fainting. While on the operating table, my heart stopped (again,) and I could feel myself falling backwards through a tunnel, before landing with a bump onto my bottom. I looked to the side and I could see my mom and my sister, (both passed) and from the age of both of them, that would have made me around the age of 3. My mom started saying my name and I was scared to open my eyes in case I was with her and my sister, (I wasn't ready for that.) When I opened my eyes I was back on the operating table with a nurse saying, 'Phew, you gave us a fright there!' I strongly believe in there being more to this world than we know and the fact that our loved ones are waiting for us when we pass.

Wow, Jude, amazing! Crossing between this life and the other has happened to so many people. I am not psychic nor did I have a "near death" experience but one night, while in bed and still awake, I was in this bar/restaurant when I saw my Mom and Dad walk in. They appeared to be in their 30s and they were walking hand in hand. I was telling Ian what was going on as it was happening. I didn't want to open my eyes because I needed to see them. They did not talk to me but smiled when they saw me in there. It was a truly beautiful few minutes for me to see these two young lovers again. This was about a month or two after Mom passed on. My Dad was gone three years before her. My Dad was also at my wedding to Ian in 2011. He kissed me on the cheek after the ceremony :)

I find that really comforting to be honest Lisa and it means that it makes me far less afraid of passing :)

I totally agree with you, Jude. And to be perpetually in our 30s again? Hallelujah is all I can say LOL

I have titled your comment as the "Blessed Kiss" and I have shared these stories with my family during our morning devotional. The results were goose bumps and my girls saying, "Wow. God is really nice to us!" Thank you so much friend.

Oh my friend, you and many others are sweet testaments of angels and peace. You are so amazing.

What an Amazing Experience and so comforting. Even the smallest of things (a gentle kiss, a heartfelt hug, a genuine smile, and a whisper of encouragement) are still the most powerful and treasured moments. I love you and Jude's comments. I told her it was titled, "The Blessed Kiss" during my family's devotional. Thank you for sharing.

It certainly was a "blessed kiss" and made me feel so good knowing my Dad was there. See, we were married on 31st of October. It is said that is the night where the veil is thinnest between this world and the "heavenly" world. It is a time when the deceased can make it through to this side. Long ago Halloween (Samhain as it is called in paganism--also the most spiritual) was a time for getting into costumes of frightening creatures to scare off the spirits. I want my spirits with me as much as possible. They never hurt me in life so they wouldn't hurt me now either. :)

Wow, Shawna, I didn't know about the ear thing. I just never noticed even though I have watched a few people in their last hours of life. My first husband was one of those as well as my Dad. The death gurgle was a very frightening sound. I listen to my first husband do that for only a few minutes before getting up, stroking his hair and telling him it was okay to go. I did the same thing with my Dad because my sister nor my Mom could do it. They were both gone within a minute after being told it was ok to go.

I also saw the pseudo recovery with my grandfather and I know it happened with my mother as well though I was not with her. I believe my Mom was waiting for me to get there to say goodbye but she couldn't hang on any longer.

This is a very sad post but also very informative. Thank you for sharing.

I have read and re-read your story and still get goose bumps. You have made me smile and look to the Heavens with great appreciation. Thank you friend

sad and morbid but good to know - thank you for sharing

Wow...things I never really knew before. Really interesting and still very sad. Xx

It has been my personal experience and I just felt inspired to share. Sharing has helped and reading these BEAUTIFUL stories is calming. Truly humbled and able to smile with perpetual goose bumps.

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