Monday, August 8, 2022

In Grief: Dying With A Smile

There is something about losing your mother that is permanent and inexpressable - a wound that will never quite heal.
~ Susan Wiggs

A reader writes: I just lost my mother. I am an only child and my father is gone too, so I feel so alone. I am finding it hard to function, but I am a single mom of three children, so I need to pull myself together. My mother and I were closer than two people could ever possibly be. She gave birth to me after 13 years of trying, and dedicated herself to me 100%. We were together every single day. She helped me with my children ever since they were born, even when I was still married.

My mom had not been to a doctor in 30 years until she decided to do something about her cataracts on her eyes. The eye doctor would not remove them until she had a physical. The physical turned up two aneurysms, one near the heart, the other near her diaphragm. She decided to have them fixed so she could see her grandchildren graduate. She had the first surgery in November, and was home in 7 days, back to driving in a month. The second surgery was in March. This surgery caused one complication after another. She stayed in the hospital for 11 days, came home for 4 days, had to go back to the hospital, was moved the an Acute Long Term Care Hospital, got septic, went back to the original hospital for 6 weeks, healed to the point that she was moved back to an ALTC, got septic again after a week and a half, was moved back to the original hospital, and passed away.

I am devastated beyond belief. I took care of her every single day after she got septic. When she was moved to the final hospital, she was unconscious. I stayed by her side until the nurses said it was time. And the thing that I can't get off my mind is her smile. She was unconscious, but right before she passed, she smiled. I have searched everywhere to see if this is a normal process of death, but can find nothing. I just want to know if anyone has experienced this. I would really appreciate someone responding, I want to know what that smile meant. Everyone says "she was at peace", but that is not good enough. I need to know if she really was at peace and happy or if it was a muscle spasm that can be explained by Science. Thank you to anyone who will share their experience or knowledge.

My response: My dear, I shared your message with one of my hospice colleagues, and this is her response. I hope it brings you some measure of comfort, peace and healing: 

Dear One: Your experience breaks my heart, and you have my deepest condolences. You and your mother had such a close, unbreakable bond, it's hard to imagine living without her presence, I am sure. I don't think there is a definitive answer about her mysterious smile. There is evidence about seeing a sort of smile after someone has died that is caused by muscular changes. Your situation is not in that category. I was a bedside hospice social worker for several years and was present at many deaths. I never witnessed the kind of smile you described. What I did see, however, quite commonly, was that unconscious people close to death could have an amazing final mobilization of energy to express something physically to those near them. Frequently it was a faint squeeze of a hand, or a tear seeping out of an eye, or eyes opening for the first time in days or hours, from a person is an apparent deep coma. Believe it or not, people have emerged from that comatose state on rare occasions. What I have heard described is that it is like being muffled under a pile of heavy blankets which keep them from moving a muscle. However, they are aware of sounds, voices and often colors around them in the room. I think this explains how a person close to death can wait until a particular person comes, or sometimes, leaves the room before finally letting go. I can only share my experience with you, but I would caution you not to underestimate the profound mystery of the dying process. That includes an unexplainable ability of a dying person – at times - to choose the moment, and the way, they die, almost as if they are able to consent to the inevitable. When patients of mine did this, it was always in the context of deeply important human relationships. Given your extraordinary closeness with your mother, I would imagine that she – if she could – would have made that effort.

And this comes from Barbara Karnes, RN, an award-winning hospice nurse and nationally prominent speaker on the dynamics of dying. She is the author of the three booklets on which many providers of end-of-life care rely: Gone From My Sight, My Friend I Care, and A Time to Live. Her book, The Final Act of Living, is "a hospice training manual with heart." It is used in universities, for hospice orientation of staff and volunteers, and in end-of-life related areas, yet it is also useful for any lay reader. She is a nationally recognized expert on death and the dying process. Read more about Barbara on her website,

Hi Marty, to answer your question about the smile before death and what is that--here goes:

Most people just before they die will have a facial expression change. Most of the time the look is one of a grimace, a frown, a movement of the face, head and even the arm and neck. Once in awhile I have seen a smile. I personally think that the facial movement and body movement is the actual moment that the soul leaves the body. As I said, this is my own personal belief. There is no scientific research or proof that that is what is happening. The belief for me stems from being at the bed side of so many people and seeing them all have the similar movements and then just a few breaths following the frown or smile.

The fact that this daughter's mom smiled instead of frowning has no particular significance for me. Her body was letting go and she was freed. There was a release and it was registered on the face and in the body.

I hope this offers some help: Don't get caught up in the little details of the moment of death. They are unimportant. What is important is to celebrate the life Mom lived, her relationships, her legacy and to wish her well on her new journey.

My blessings to you Marty and to this family.

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