1. The Actively Dying Phase John Mulder, MD VP of Medical Services Faith Hospice

2. End of Life Signs and Symptoms

3. One to Three Months Withdrawal from the world and people Decreased food intake Increase in sleep Going inside of self Less Communication

4. One to Two Weeks Agitation Talking with the unseen Confusion Picking at clothes Disorientation

5. One to Two Weeks Decreased blood pressure Pulse increase or decrease Color changed, pale, bluish Increased perspiration Respiration irregularities Physical

6. Congestion Sleeping but responding Complaints of body tired and heavy Not eating, takings little fluid Body temperature, hot/cold Physical One to Two Weeks

7. Days or Hours Intensification of one to two week sings Surge of energy Decrease in blood pressure Eyes glassy, tearing, half open Irregular breathing, stop/start

8. Restlessness or no activity Purplish knees, feet, hands, blotchy Pulse weak and hard to find Decrease urine output May wet or stool in bed Days or Hours

9. Minutes “Fish out of water” breathing Cannot be awakened

10. “What we once enjoyed and deeply loved we can never lose, for all that we love deeply becomes part of us.” -Helen Keller

11. John Mulder, MD jmulder2@earthlink.net