A California hospice nurse has shared the three signs she most often sees when a person is within 24 hours of death — and says they’re far less frightening than they might seem.
Julie McFadden, known online as Nurse Julie, has spent 16 years in palliative care and built an audience of over 1.7 million TikTok followers by explaining what really happens in our final moments. She’s also the author of Nothing to Fear: Demystifying Death to Live More Fully, a book aimed at reducing the stigma and fear around dying.
Speaking on the Dr Karan Explores podcast, McFadden said some people appear to have remarkable control over the timing of their death. “They’ll say, ‘I’m going to die after this date’ or ‘I’ll wait for my daughter’s wedding,’” she recalled. “I’ve literally had a patient say, ‘I’m dying tonight,’ and then die — even though they weren’t actively dying at the time.”
When the end is close, she says three signs are most common:
1. The “death rattle”
This rattling or gurgling sound happens when a person can no longer swallow or cough, causing saliva and mucus to collect in the throat and airways. As air passes through, it produces the distinctive noise. While unsettling for loved ones, McFadden stresses it isn’t painful and is simply part of the body shutting down.
2. Changes in breathing
Breathing may slow, become irregular, or feature long pauses between breaths. In the very final hours, some patients show “agonal breathing” — short, gasping breaths caused by the brain not getting enough oxygen. Though it can look alarming, McFadden says it’s a natural reflex and not distressing for the patient.
3. The “death stare”
The patient may have their eyes and mouth open but remain unresponsive, with a fixed, unfocused gaze. While it can be confronting, McFadden says it’s often peaceful, and hearing is usually the last sense to go — meaning a loved one’s voice can still be comforting.
McFadden emphasizes that not everyone will show these signs, as some people die suddenly or more gradually. But she believes that understanding them can make the process less frightening for families. “Knowing what to expect,” she says, “can make it less scary for everyone.”
