Hospice Care/End of Life


Dear Christine,

My sweet Father passed away in Hospice this past October. I was blessed with the gift of being with him when he left this world. My question is regarding a physical act that occurred at the very end. He had been in a coma for almost two days. At his last breath his lower jaw thrust forward and he clenched down and bit his top lip. His facial expression never changed during this act, but it caught me off guard. I was with my husband years earlier when he passed (he was also in Hospice). I understand that no two ends are the same, but have not been able to get an answer to this question. I know my father was not in pain, I am just curious as to the physiology of what caused this action. Thank you for what you do and your service as a care giver in the Hospice setting as well as helping people like me by answering questions and providing comfort.

Many Blessings to you,

Hello, Karen--blessings to you as well.  Please accept my sympathy for your losses--that's a lot!

You are right--there is a lot of variability between people in many aspects of living, dying, health and illness....  I don't have a specific answer for you, but I can share my thinking on this topic.

I would suspect that if your father was in fact in a coma (as opposed to other levels of consciousness other than being awake--they have to do with the condition and processes of the brain at the time), then what you was likely some kind of nerve transmission that caused his jaw muscles to cause his jaw to move and tighten.  It is not likely, in that case, that he had the sort of conscious thought that would be required for that action to be the result of any kind of thought or memory or delusion.

But, if he was in a deep sleep of sorts, as often occurs in dying patients at the end, he could certainly have had an experience of which he was aware but you were not.  Many have talked about seeing family and friends who have already died, who seem to have come back to reassure the dying person or to help guide the dying person through the process of death.  If your father was experiencing the presence of or communication with someone who had already died, what you saw might well have been because he was responding to something related to that kind of experience.

I don't have a lot more to offer you.  I am heartened to know that you were with your father and your husband, and that it seems they had good deaths.  I am sorry for your loss, though.  That's a lot to lose, and it always takes a toll to walk that last walk with anyone, much less someone you love.  Be good to yourself, take time (even now) to rest and nourish and hydrate well, to laugh at least once a day (more is better), to cry when the mood strikes.  Hugs are also good.  God bless you.


Hospice Care

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Christine Johnson


I can give suggestions, encouragement and direction on what hospice is and is not, when it is appropriate, and how to go about getting it. I am familiar with Medicaid and Medicare hospice benefits. I can answer general questions about disease process, what dying looks like, how hospice handles pain and other symptoms, what to expect from a hospice when end of life nears. I can provide support, direction and encouragement related to spiritual matters and psychological matters related to death and dying.


I am a certified hospice and palliative care nurse, and have been the director of nurses for three hospice centers, under two different companies. I have also worked as a contract hospice nurse for a large American hospice company. On a personal level, my father died without benefit of hospice (it was not popular then). I have taken care of dying patients in hospitals and recognize that for most of us, it is preferable to die at home (or in our residence, wherever that may be), comfortably and without anxiety. Also I had no support when my father died; hospice clients are the whole family (however that is defined by the "patient"), and support is provided at least a year after the patient passes. These are the sorts of things (and probably others) that I can help with.

HPNA (Hospice and Palliative Nurses Association)

none yet

Registered Nurse (TX), Licensed Marriage and Family Therapist (TX) ADN Nursing, Excelsior College, Albany, New York (2004) 4.0 GPA BA, Psychology (minor Social Work), Oklahoma University, Norman, OK (1986) 3.67 GPA MHR (MA) Human Relations, Oklahoma University, Norman, OK (1988) 3.5 GPA

Awards and Honors
Phi Beta Kappa (and others)

Past/Present Clients
Unable to name as this would violate their privacy (and HIPAA....)

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