A Dying Persons Tear

Very curious about something. I'm new to inpatient hospice and have only had 4 deaths so far. Two of the patients had a single tear. One of those patients, the niece saw her previously unresponsive aunt open her eyes wide focusing on something in front of her (not looking at her niece) then took her last few breaths. That's when I arrived I saw her tear. The other nonresponsive patient that passed did not have anyone in the room at the time, so I don't know if he opened his eyes or not, but did have the same single tear. Is this common, and do you think they are seeing something so beautiful it causes a tear, or do you think it's caused by fear/pain? Thank you in advance for your responses. ?

[grobins]

I've been a hospice nurse for about 7 years, and I don't think the tear is a coincidence. I think it is a response to seeing the next life. About 4-5 years ago, I had an experience with a patient who had one foot here and one in the next life, as nd we were talking about what she was seeing. I also had an experience with my mother-in-law, where she spoke about having seen her mom and dad, 3-4 days before she passed. However, all this being said, it really comes down to your own beliefs.

[retiredmednurse]

I have seen this tear often on my med floor for those patients I was at their bedside when they died. I also saw it 2 years ago when my own mother passed away gently at home. I would gently wipe the tear away, but I never thought of anything about it except as a physical proponent of death. The tears I saw never left the eye to run down the face. The tear was in the inner or outer canthus, depending on gravity. The ones who had the tear had a quiet death usually on a morphine gtt and an ativan gtt if it was in-hospital. My mother was ready to die for 10 years and vocally would express this wish. I was surprised by your question as I had never thought of it as anything else. To answer your question, I would say it is a relief to them that death is happened and they can now join their parents, siblings and other family members.

[Leftbehind]

I am not a health care provider, but I stumbled on this post when I was searching for "Lacrima mortis". I am sharing my experiencing with witnessing my dying Mom's tears (two -- one from each eye). Maybe it will help someone.

In the final hour before my precious Mother took her last breath two months ago I saw a single tear stream from one of her eyes, and then two seconds later there was a single tear from her other eye. She was my best friend and buddy, and to this day, I struggle to come to terms as to what the tears signified. My Mother was in hospital at the time, and they had given her strong morphine dosage about 6 few hours earlier because the cancer was more rapidly finishing its onslaught and distress was setting in -- she had been uncontrollably bleeding to death internally for quite some time and her organs were shutting down. It broke my heart when I was alone with her and could not help her when she weakly requested, but without anger or panic and without gasping, "Will someone please help me? I cannot breathe."

Shortly after the nurse gave her the morphine in the early afternoon, and although my Mom's eyes remained open until she took her last breath, the nurse told me that although my Mom will not be able to talk or move any longer because of the morphine, she will still be able to hear. I sat with my sweet Mom over the next and last few hours, holding her hand and praying aloud, and thanking her for everything and anything she did for me -- from braiding my hair when I was a small child, to always saying just what I needed to hear and comfort me as an adult when the world and day's events seemed to come crashing in. It was in the evening a few hours later while I and now also other family members were by her bedside, that I saw those two precious tears -- I was dumbstruck by the sight of the tears. To this day, I hope they were not tears from pain, fear, or sadness, and while I do believe she knew we were there at her side and could feel our touch, I hope and pray the tears were not because she wanted so very much to say or communicate something to us but realized she could not do so. It is my hope that those two tears that she shed were because she started to see deceased loved ones smiling faces beckoning her, and an amazingly beautiful, bright light that shone on the path that was leading her to see God who was drawing her close and welcoming her to live forever in Heaven.

Those two tears often come to my mind, and oh how I wish I could know why they were shed and what message they were meant to deliver to those who witnessed them. To allow other family members to be close, in the evening I sat at the foot of the hospital bed with my hands on her feet and calves -- it is from that view that I witnessed those last tears and about an hour later her last breath. I still regret that it was not until I was driving home that I realized and wished that I had had the mindset when I saw the tears earlier, to immediately get up and either kiss the tears or kiss my finger and wipe the tears away. But as I said, I was dumbstruck at the time. So to my forever-regret, I (unintentionally) never let her know (either by touch or verbally) that "I see the tears Mom, I see the tears.", and that thought makes me cry each time it comes to mind. I will never forget the moment her heart stopped and mine kept beating, and I can never forget those last two tears that my hero shed. I've never heard of 'tear cloths' until I read this thread's posts -- what a beautiful thought and treasure.

[hollyl]

A dying person tear is called "lacrima mortis." My brother shed one single tear in his left eye while taking his last breath. It broke my heart because it happened when I told the nurse that he had been getting better and could have survived the cancer if it were not intervened by the infection medication which I believed caused damages to his liver and killed him. I thought it was tear of sadness and regret. I did a search online. There is no conclusive evidence whether it was emotional or physiological because the tear sample was too small for the analysis.

source: LACRIMA MORTIS: THE TEAR OF DEATH

[Daisy_08, BSN, RN]

I have worked palliative for just over a year. I too have never seen this. Did have one gentleman last month, that was unresponsive for a day or two, very confused and lethargic for weeks prior to that. However one night he he woke up, recognized his wife, kissed her, told her he loved her. Then quickly went back to being unresponsive, and died a few hours later. I have never seen a single tear though.

[tewdles, RN]

ws582 said:

Very curious about something. I'm new to inpatient hospice and have only had 4 deaths so far. Two of the patients had a single tear. One of those patients, the niece saw her previously unresponsive aunt open her eyes wide focusing on something in front of her (not looking at her niece) then took her last few breaths. That's when I arrived I saw her tear. The other nonresponsive patient that passed did not have anyone in the room at the time, so I don't know if he opened his eyes or not, but did have the same single tear. Is this common, and do you think they are seeing something so beautiful it causes a tear, or do you think it's caused by fear/pain? Thank you in advance for your responses. ?

I don't have any idea why they might have a tear...

If I have done my job well, then I suspect that they are not in pain (spiritual, emotional, or physical) otherwise I would be expecting other evidence of the discomfort. We cannot know with certainty what our patients are experiencing at the end. We only know what our science, our faith, and our experience tells us.

In my opinion, we should hold tight to the perceptions and beliefs that give us hope and strength. My mom opened her eyes as she took her last breaths, and she too had a tear in her eye.

[ws582]

I'm very sorry to hear about your mom. Thank you for all your input. I'm new to hospice and love to hear everyone's opinions/advice. I want to do the best job I possibly can and am learning so much from all of you. Thank you.

[margin261]

tpeach- My heart goes out to you for your loss. I've worked in hospice for a while but can't recall this happening with any of them.

As previous posters noted, it is more than likely a physiological response. But hearing is the last to go, it could be possible he was just happy you were with him at that time. Since he was sedated, he was unable to acknowledge you verbally or even to squeeze your hand. Maybe that was the only way to let you know that he knew you were there and he appreciated it.

Since you may never find out the exact reason/cause of it....maybe you can carry that one in your heart. You were there and he knew it and was comforted by it.

I'm truly sorry for your loss, try to take care of yourself.

[tyvin, BSN, RN]

I've worked many years in Hospice and the patients are at rest; willing and wanting to pass (except for one and he wasn't crying)... I've never seen this tear. The family members cry and the patient might cry during goodbyes and family group. Have never seen this tear at passing.

It is usually the matriarch or patriarch of the family who is passing so tears on their part is unusual as this is a defining moment for them in front of people who they've raised and influenced their whole lives. They are experienced in life and have told me they want to be remembered as accepting and content to pass. There's that "I don't want to stress any of them, so I'll leave when they do" phenomenon, which is witnessed quite often.

Beautiful tear...

[tyvin, BSN, RN]

Mothermarie...I am so truly sorry for your loss. It made me very mad to read your post and at how unprepared the whole deal seemed to be. I've always worked for hospice agencies that are professional and don't allow the people to suffer if it can be helped. It all comes down to the doctor and the hospice team and their understanding and actions to ensure the patient's passing goes as well as can be.

I've never worked alone and for the most part have free reign as case manager and anything else I deem fit to help the person's journey. The fact that many of us do not witness the tears at death is a testament to the preparation that is done to ensure the patient's passing with dignity. In my experience if the patients is crying due to pain than that needs to be evaluated stat.

I won't work with families who limit medications toward the end for whatever reason and perhaps that is one reason I've never had to sit with someone suffering so intensely whenever I've worked actual hospice.

I've witnessed it, and yea, there are tears, and it's bad. I see how they let them pass with no help from hospice in LTC or SNFs, and that too makes me mad. I've held the trembling hands of COPD patients trying desperately to take a breath and eventually die from no oxygen...no morphine; looking straight into my eyes for some kind of help, some kind of relief...the docs too busy and the patients don't need it; I've heard it all...I've tasted the salt on my face. People drowning in their own mucous without any sign of a suction machine in sight...yea; I've seen those tears; I see them right now. This is probably the reason I will always have a suction machine delivered anywhere I'm working if I can. Also, the reason I am so bold with the docs now. They know when I call I won't back down until I get what I want.

I finally said I won't do this anymore...these people shouldn't have to suffer...this is no way to die. I needed control, and home hospice was the way for me to achieve that.

If the case is that bad, they usually don't opt to go home and pass like all my patients do. An in home hospice should be a manageable death; one that can be celebrated with family and friends, and if not, that's OK too, but still pain management is key. Yea, for the most part, I've had cushy areas where the worst it got was a death rattle, or bed sores. People pass and they are manageable deaths...suits me just fine. I got a lot of friends waiting for me on the other side. It took a long time for me to get here, and I'm going to keep assisting people to the other side. I've paid my dues.

I also think it's an absolute injustice for anyone like your sister to have had to go through with what she did. Do you have the answers you seek from her chart, or talking with her doctor about how something more could have been done to ease her pain? That's where I would start if you want closure about the events. There are some very bad hospices out there as well; people need to be careful and aware of their rights concerning all of this.

I understand you anger; you have a right to it. I think your sister would want you to grieve, but eventually heal and think of her with fond memories. Don't forget the pain, as that was part of her life as well.

[ws582]

Mothermarie,

I am the one who started this thread 4 years ago. It's been a long time since I've logged on, and I just happened to see my thread pop up, so I started reading the comments and came across yours. I am truly sorry for your loss and for what your sister went through. My heart goes out to you and your family.

I had only been a hospice nurse for 2 months when I posted this thread. I've been at the same inpatient hospice unit now for 4 years. The small single tear I spoke of I have seen many times since. It's never a tear that runs down the cheek, and is usually in one eye for some reason. It never appears to be from pain, or shortness of breath, and the person always has a relaxed facial expression. Several nurses I work with have seen this as well. Since we work at an inpatient unit, we witness this much more often than the home nurses would, because it seems to occur minutes or sometimes a couple hours before a person passes. All these years later, and I'm still not sure what causes the tear. I understand it could be physiological, but I personally believe there's an emotional reason behind it. I have 2 theories.

First, people who have had near death experiences always talk about how beautiful and peaceful it is. It would be very interesting to know if these people had this tear during their experience. My second theory is this: Many of my patients (when they were alert and could speak) knew they would be passing soon. People usually become very lethargic or unresponsive when they are close to passing and are no longer able to speak. I believe they are still aware though, and that tear may be caused by them being sad because they know it's time to leave. Yes, I am sorry they feel sadness, but on the other hand, it is the intense love they have for you that makes them sad to leave. This is something I explain to my family members who are afraid to say good-bye to their loved one because they feel they will cry too much and make the patient feel bad. You cry so hard for them because you love them so much. It's an absolute blessing to have someone you love so much that you don't want to leave them. Tears are proof of that intense love.

Like I said earlier, it could possibly be physiological, but most of my patients are dehydrated and their eyes are very dry. Some people even keep their eyes open, so they are excessively dry. I've seen single tears in these people as well. Something I'm sure of though, is that the single tears I've seen were definitely not due to discomfort or physical pain.

You also spoke about hearing being the last sense to go and for how long. I am a firm believer in people being able to hear until the end. The reason why I believe this so strongly is I've had several people who were completely unresponsive and waited until their family left before they passed. Family would be at the bedside 24/7, and they step into the bathroom for 5 minutes, and the person passes. I've also had people hold on when it looked absolutely impossible, and less than 5 minutes after the family arrives the person passes. We have all seen it too many times to be coincidental. If I'm alone with someone when they pass, I always assume they can hear me and wish them a peaceful journey.

[indygirl526, ASN, RN]

Oh my goodness I love this idea! I work on an inpatient palliative unit and I've had a couple with a single tear. It's very moving.