Expert: Janice Reeves - 2/24/2007

Question
My Dad just died.  He had been in a nursing home for 6 plus years suffering from Alzheimer and a stroke that left him paralyzed on the right side.  He also had seizure disorder.  4 Days before he died all of the sudden he had difficulty breathing.  His pulsox went to 81 and his pulse went to 45.  He began Mottling.  When he was given oxygen he seemed to improve.  He ate a little and we poured water into his mouth.  Then everything went downhill.  He didn't have any medications at all during this cycle of death.  No antiseizure medicine.  No morphine.  He just started dying. I don't know what mottling means.  I can't figure out why he didn't have a seizure.  A tear would fall as I talked to him.  His eyes seemed to follow me.  Then he made a horrible noise as he sat straight up.  He laid back down and within minutes he was gone.  What is mottling.  Without the medications they said he would seize.  Why no seizures.  Why did he sit straight up.  Understand, I told him to go.  He was a very active man that just hated where he was.  I just need to understand.

Thanks

Answer
Dear Lori,
Unanswered questions are distressing and sometimes there are no answers.  I will attempt to provide some answers based on my experience.
Mottling is a great decrease of blood supply to an area of the body.  Usually this is seen in the feet, legs and hands but can be seen in the knees and back.  The heart is working very hard to keep itself going and the heartbeats are not strong enough to get blood out to the extremities.  This is seen by a blue/purple appearance to the skin and usually the skin is very cool to touch.

Why no seizure medications were given?  I do not know and this is often case by case situation.  It is a blessing he and you/family did not have seizures to deal with also.

The tear most likely was a way of letting you know he could hear you.  He knew he was going and felt sad in leaving you.

I have heard of some people sitting up just before death and my father did the same thing although I was not present.  It is as if they have summoned all their conceivable strength for that last moment.

You have indicated your father hated the situation his illness had put him in, this was his release from that existence.

Losing your father is not easy and to see them in such a helpless state knowing such a situation has no hope of recovery is difficult.  I would like you to focus on the times you spent growing up with your father, cherish those memories and the wisdom of life he shared with you.  He will always be alive to you in your heart and you may well hear his voice/what he would say in some situations.

Hugs to you as you travel this path of life.
Jan