ABSTRACT
For most patients with advanced illness there is a gentle 'winding down' of the body's systems. Even in cardiac and respiratory failure, sudden, dramatic deaths are uncommon. As they approach the end, their circulation slows so that their fingers, nose and toes feel cool and are a little bluish or mottled. Their breathing pattern may change and become slower or irregular. At the end it is more a gentle absence of life, than a sudden presence of death. Peaceful silence is the most obvious feature. Those close to the patient respond differently. Some find it easy to cry, others feel as though they have dried up. Some feel the urge to speak, often to express relief. Many are so numbed with grief that they feel helpless and useless, but often will not admit to this. They cannot remember names, addresses and telephone numbers.
