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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.

Thank you for your responses. I forgot he also has a scope patch on too. That was a good point that the cancer may have spread, but it sure did look like dryness to the extreme. I feel so badly for him and now am scared of over drying patients using these meds. I know it's natural for the mouth to dry out, but in your experiences, can you tell when someone is beginning to get too much of these meds so they can be stopped before this happens? I've had patients receive the robinul too late and battled with secretions and difficulty breathing....just unsure how to handle it in the future.

I only have 4 months of hospice experience, but today I saw something disturbing and asked the nurses I worked with, but no one had ever seen this. I had a pt today that is actively dying. He's diagnosed with lung CA with mets to his brain. I was performing oral care when I saw something black hanging down from the top of his mouth. I looked inside with my flashlight and a large portion of the roof of his mouth had turned black (including his uvula) and was all dried up and hard. The uvula was even hanging at an angle completely stiff. Pt had several doses of atropine and robinul over the past 3 days. I've often wondered if these meds would dry the pt so much it would be uncomfortable for them, but of course they can't tell us. Could these meds possibly do this to his mouth? It was shocking to see and looked incredibly uncomfortable. There was also a large section of clear, hard plastic looking stuff that was firmly stuck to the inside of his cheek. Also, I've read these increased secretions are not uncomfortable to the pt, but uncomfortable for families to hear, so we give these meds. Do you think it's true it's not uncomfortable for the pt? Not sure what's worse: increased secretions or dried up/cracking mouth. Thanks in advance for your replys.

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.

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. ?

That gives me chills. It sounds like most of the deaths are peaceful. Is that right? I've been reading a lot of hospice care books and was wondering if it's unusual for people to suffer at the end like the lady you spoke of. I've worried about that going into this field.

Thank you for sharing. Those are wonderful stories.

What a cool story! Thank you for sharing.

I read the following this morning on Good Morning America about baby Angel Babcock: Angel's mother, Moriah Babcock, 20, father Joseph Babcock, 21, and two siblings Jayden and Kendall were found dead in the same field as the toddler Friday afternoon. Angel's grandmother told ABC News that when she let her granddaughter go Sunday afternoon, she knew the baby girl was going in the arms of her father."We were all around the bed, I had my hand on the side of her, and I reached for her hand, and was holding her hand," Babcock said. "I don't know what made me let go but she put her arms straight up, she was daddy's little girl. So daddy picked her up and took her. The whole room seen that. He was just like, standing in front of her. She wanted to go with daddy." I'm very interested in becoming a hospice nurse, so I've been doing a lot of research. I've read several times how some people who are very close to dying reach out or act as if a loved one is there with them. Am very interested to hear if anyone has witnessed something like this. Thank you :)

I was hoping you'd say that MissIt :) Thank you so much for your input!

Thank you so much for your responses. I have a better understanding now except for one part. I really long to be able to spend more time with the patients. I know you said you don't have "tons" of time, but compared to med/surg, would you say it's considerably more, or does all the paperwork/charting still keep you from the time the patients deserve? I usually end my day thinking they needed more from me, but I couldn't give it because of all the "busy" work. Thanks again in advance :)

Hi everyone! I'm very interested in hospice, and wanted to ask a few questions. My only nursing experience is 6 months at a long term/rehab facility and 2 years currently on a med/surg floor. I love nursing, but the floor is soooo hectic with tons of orders, transferring people back and forth for tests, discharges, admissions, etc. I don't get to spend nearly as much time with the patients that I want to and my favorite part of my job is making them comfortable. I'm not considering home hospice at this time, but very interested in inpatient hospice. I know you must have some crazy hectic days, but on a typical day, would you say you have more time to devote to each patient, or are you constantly running like on the med/surg floor? How many patients do you have on day shift? MissIt, what kind of treatments are you refering to (respiratory? or do you have a respiratory tech there?). Also, I'm a nervous about starting IVs on hospice patients. I'm decent, but I'm sure they're so ill, it must be extremely difficult. One last thing: On my med/surg floor, most nurses are so busy they can't help out when you get overwhelmed. Do the nurses you work with typically help each other out if they're drowning? Thanks in advance for your input :)

tdrynelle, thank you for your response. I have a couple questions for you. Are the RNs at your company generally the case managers or do some of them do home visits only? Also, how many hours a week would you say you average? I have 6 months experience in STR/LTC and 1 1/2 years on a med/surg floor. Would you say that is enough to begin home health? It's scarey, because I have so much support on the floor and in home health you're on your own. I'm not sure if I'm ready. Thank you for your time :)

CloudySue and caliotter3, thank you so much for answering so quickly. Sounds great, but I'm confused and I hope this doesn't sound stupid: Intermittent visit work is seeing multiple pts a day and shift work is working at one pt's home for a certain shift, is that right? I know you said the night shift pays more, but for days would you say the pay is similar to the hosital (I average approx $25 hour). Even if it's a bit less, I think a lower stress level mentally and physically would be worth it. Just wondering approximately how much less it is. I appreciate your time and hope I find my niche soon :) I absolutely love helping people, but the hecticness is taking its toll on me. Oh, also, do home health agencies usually offer shift work and intermittent visits or is it two different type of companies? Thanks :)

I love the hospital's 12 hour shift, but getting extremely burned out on the med/surg floor. I'm very interested in home health and wondering if agencies allow you to work (3) 12 h days or even (4) 10 hour days? Seems like there would be patients who prefer early/late visits. Any comments would be greatly appreciated. Thank you.