Clinical News Summer 2017

Noisy Breathing at the End-of-Life

By Ellissa Tiller, MD, FAAHPM, CPE, VPMA

Movie deaths do not prepare us for the death rattle. Its unfamiliar noise scares us and makes us feel helpless. It makes us worry that our loved one is suffering. We want it to stop. We’re not ready to let go.

Mrs. G. was in her early 60’s when she contracted multiple myeloma. Unfortunately, chemotherapy failed and transplantation was ruled out. She was on a rapid downhill course. In her final days, as she lay there unconscious, she developed a pronounced harsh noise with every respiration. Mrs. G. did not grimace or become restless. She was started on various drying agents. Her nurse friend, who was unfamiliar with the dying process, was very worried that Mrs. G. was suffering and ultimately demanded that the patient receive IV atropine in a desperate attempt to stop what she thought was profound suffering. This apprehension transferred to the patient’s husband and caused him to have a prolonged grief reaction.