My old preceptor always said "if a patient tells you they are going to die, believe them"

One time we had a patient who was going for a CABG and she kept saying things like “I’m not going to survive this” and we tried to calm her anxiety, the surgeon talked with her to reassure her. She died on the table.

I have experienced a similar case, and our coworkers agreed that the patient was just aware of their own terminal lucidity, realized they were feeling better/mind was clearer, and knew it was about to end.

Just think about all the family members that think their terminal family member is getting better before they go? It makes sense.

I had a patient who was 23 with no past medical history until being diagnosed with cancer. Got a few days of chemo and was doing well. He randomly said he thinks he’s going to die soon. 2 days later he had a change of mental status and died out of no where. Creeped me out

I did hospice for a few years, and people knew. If they told you they were going to die, they were going to. If they told you they were waiting for something, you can bet they’d make it until RIGHT after. I remember a story from a hospice nurse, probably Julie on YouTube, where a woman said she was waiting until her grandson was born. She was unconscious for days before, and they held the phone up so she could hear that he was born. She died right after.

My first patient with this is still the one that boggles my mind. He was going to have a cholecystectomy in the afternoon. He was upset all morning. About an hour before he told me he was going to die in surgery. Based on the way he looked and the surgery I chalked it up to nerves, understandable. Tried to comfort him. And then he did. I still remember his face.

Even kids get this feeling. 5 year old patient with terminal cancer was going into the OR for one last palliative LP and PICC line placement to be able to get discharged that day to home hospice. He was not well and deteriorating fast. Had been through at least a dozen OR procedures before, and wasn't an anxious kid. In the pre-op area told dad several times "I shouldn't do this. This time is bad, something bad will happen." They went in anyway, of course. Within minutes went into DIC, coded, cannulated for ECMO (there's no dying allowed in the OR), transferred to ICU. I think the parents withdrew care the same day.

PICU, I had a teenager (intubated and coded every hour for about 18 hrs) she suddenly woke up, opened her eyes, pointed at the corner of the room and mouthed "MOM MOM MOM" Her mom had passed a few months earlier. I asked if she saw her mom, she nodded yes and proceeded to code for the last time. It was kinda beautiful to think her mom was waiting for her

Reason 200 I’ll never work in icu

The other day I was helping a coworker whose patient was all of a sudden becoming agitated. I was trying to get him back into bed but he kept yelling “I need to poop” “please let me go” and then he coded. He was supposed to leave in the morning for rebab

I was finishing up a discharge on a patient on a med/surg floor. He was literally in the transport chair waiting on a transporter to take him downstairs. He was a good dude. He was a bit frustrated about not being able to go straight home, but ultimately relented and agreed to go to SNF to get a little stronger since it was just he and his also frail wife at home. We were joking and I remember saying “hey, at least we’re getting you out early enough you’ll be settled in over there early enough to catch the ball game. He said “Yeah… I just don’t want to go…” let out a big sigh, eyes rolled back in his head and slumped over. Gone.

(He was a DNR, but had a pulse, so I called a rapid so we could at least try and get him back in bed to get him in trend/check sugars, see if there was anything we could do. I think he was fully gone before the first wave of people even got to the room.)

Fucked me up for a hot minute, but then you just kind of realize/accept how fragile life is and do the best you can with what’cha got.

Mildly unrelated. My dad was in a care home dying. He had the same first name as his roommate. The roommate overheard that my dad [name] was dying and thought HE was the one dying. So he had the nurses call his daughters and he lamented how he was dying and the whole time I’m [not an employee/noticing his daughters aren’t overly concerned-speaker phone] wondering if I should let this man know that he’s not the one currently dying? Idk. I hope he wasn’t too freaked out.

Terrible day all around. Except for maybe my dad. RIP.

I once was caring for a covid patient who was not getting better and wasnt going to. I looked into his religious beliefs, found that he was muslim. I scoured the hospital to find one of the 'call to prayer'/quran audio boxes. I got it and started playing it. 30 minutes later, we terminally extubated the patient. 

I walked by the room 15 minutes later, the patient had not been on any sedation for days, but had never moved, was sitting upright in the bed, in a meditative/ prayer position. It was wild to see. I walked away, looked at the monitor, RR 2...... 1...... Hr 0.... Went back, completely dead. 

This was the only time i cried during covid. I saw so many die, and this was the first time that the person dying had done so in peace.

You'll carry this patient with you for the rest of your life. Respect that you were given a glimpse into the void.

I've had around 5 or 6 eye opening stories over my years working in ICU and Dialysis.

I once had a patient in the ICU tell me very calmly that he wanted to go home that day because he was going to die. I told him I would tell the doctor to come in to speak with him. He replied, “You can do that but I don’t care what the doctor says; I’m going to go home today because I’m going to die and I want to die in my own bed with my wife at my side.” Sure enough, his wife came and he told her he was going home with her to die in his own bed. Later that evening his wife called us to say that he did indeed die in his bed, peacefully with her by his bedside. Sometimes a person just knows and they want to do it on their own terms.

I'm sorry but when your patient says shit like that you already know it's about to be balls deep in terror

I've seen it a bit for sure. I never discount it. You can also tell the difference between someone who is just anxious and someone with impending doom if you're paying attention.

Anxious people are just anxious pretty much all the time. Impending doom you'll have a normal patient who just flips the script out of nowhere. Sometimes they're even calm when they say they're going to die. Those are the ones that get me on high alert.

My mother was dying. She was in terrible pain and we gave her a lot of morphine. Suddenly she bolted straight upright ( from being unconscious) looked right at me with fear in her eyes and said “I’m dying” and went back out. She died 4 hours later.

I watched a few videos about death and how back in the olden days they hust viewed it as a natural process in life. It helped get me comfortable with the process.

I saw the sense of impending doom in a patient who had a reaction to phenergan and went into cardiogenic shock. BP tanked and wouldn’t come up with two liter boluses of NS running simultaneously. He just told me he was feeling weird to start, and then “Ive got the heebie jeebies, man”. Glad I checked his vitals. He went to cath lab that night.

ETA: Geez, I just looked over my comment and realized my phone autocorrected phenergan to pentagram. Fixed it.

I’ve had at least 3 patients in my 20yr career “tell me” it was time and pass shortly after. Freaked me out each time.

My mother, who was terminally ill with a dx of pulmonary fibrosis, began telling me in January of 2017 that she "wont be here, and that she was "going home" for her next birthday, which was in March.

She coded several days before she passed, and my sister and I were sobbing as she spoke to our deceased father while pointing to the corner of her room. "I love you David," she said. "I need you! Will you marry me?" Our dad had passed away in 2015; they had been married for almost 60 years.

My mom lived for approximately one more week following that code. I had spoken to her at her bedside the night before, for what was ultimately the last time, and she asked me "will you be mad at me if I go home?" I of course told her no, I wanted her to come home! She shook her head no, and pointed towards the ceiling, saying "heaven." She passed away peacefully the following day. The date on the white board was March 5th, my mothers birthday was March 8th. She knew she was going home before her next birthday, and she was right 😢🙏💙

Words like “my sister was here to visit”, “will you be sure that the flowers get ordered”, “I’m so cold”, “who is the little girl sitting on my bed” are worth paying attention to.

My patient told me he was dying as I rushed him out of the ER to the cath lab. I assured him he was not. He died on the cath lab table 15 min later.

I had a patient with a hip fracture, awaiting OR. She was calling all her friends and family to say goodbye since she wouldn’t survive the surgery. I tried to talk to her about worrying her family and trying to reassure she’s in good hands. She never seemed anxious… it was just fact.

She was right. She died intraop.

I had a similar experience. An elderly patient was made comfort care on my unit. She had been unresponsive for at least a day or two. Then she woke up in the night, sat up in bed and called out for help. She asked when she would be leaving and when I told her that she was in the hospital, she said “oh, I thought I had died.” She almost seemed disappointed. Then she asked me for a snack, happily ate a little ice cream, and then laid back down and went to sleep. She ended up passing the next day. 

I've seen it as a Hospice nurse.

This is why “sense of impending doom” is considered a clinical sign. Crazy stuff!

I think decreasing/poor perfusion causes that sense of impending doom. That usually precedes death, so we get the examples of when the patient is right. But, we often correct the perfusion deficit, making things feel ok again.

Any time someone starts calling for their mom with impending doom …quite intense

My mother had a similar experience when she worked as a sitter. Her patient was an older man who very restless, and he wouldn’t let go of her hand the whole night. Once her shift with that patient was over he thanked her and said he would never forget her kindness before he goes. After she had already switched to the next 1:1, hours later she found out that patient died. My mom relayed this to me like it was sweet (and it was) but I was MORTIFIED. I’ve heard similar stories from some of my other family members as well and they all freaked me tf out. I’m sorry you had to experience something so grim firsthand.

Had this happen once in acute care setting. Pt had a dx of anxiety and panic attacks and MD was rounding and assessed with no overt concerns. We even discussed at the nurse’s station that it seemed to be more than her typical anxiety/panic attacks and I said “it’s like impending doom” and the doc asked me what the ED would think and laughed me off. We were coding her within 15 min and her nurse was looking at me wild eyed saying you called it. It’s something I hope I’m never right about again. We weren’t able to bring her back.

The process of dying is so long sometimes that the body becomes conscious of it. My grandfather had advanced dementia and wasn't eating much. I saw him 2 days before he passed. He was the most lucid I'd seen him in years, but was also saying that long dead people had visited him. I knew he was going to die soon (though I didn't share this with my family because I knew it would upset them. My aunt didn't even want to give him end of life morphine. She would have flipped if I told them). He passed as they were putting him in bed 2 days later. I feel bad because he was scared at the end, but he passed quickly and without much pain. Even though he wasn't aware enough of himself to know he was going to pass, I did. Sometimes you just know.

I had two pts recently got hit by a drunk driver, wife was driving and her husband was very critical. The last thing he said to her was “I’m dying” and he was right. Several hours later post op in the ICU he died and she was injured enough that she couldn’t see him or even know what was happening before he died. I still think about them often.

I think this comes with experience to the people saying it never happens. Of course everyone says they’re dying. Patients are dramatic AF. I’ve seen it twice in 13ish years and it really creeped me out afterwards. Both patients acted exactly the same. No signs the patients were actually going to die in the next 24 hours and … they did.

I had a patient the other day who I admitted for AMS and she was diagnosed with DKA but came out of DKA within 8 hours. Still confused. With neuro checks she was only oriented to self, but the thing is she kept telling me “I’m going to die”. Quite literally the only full sentence she would say. I’m a new grad so I flipped the fuck out thinking it was a premonition. I’ve seen all the trends, so all I said was “girllll you are fine let’s get some sleep.” She had SBP in the 180s but besides that and the AMS she didn’t need to be in the ICU, head CT clear and she ended up having transfer orders for 2 straight days but every other patient on the unit got the beds. Almost like something is keeping her on the unit. I had her again last night and she told me again “I am dying”. I’m genuinely spooked what do you do in that situation, stay on high alert even though them dying out of nowhere wouldn’t make sense?

When my dad was winding down to his last couple of hours, he would say in disbelief "I'm already dead." Have never had a patient say that.

I’ve seen this a few times. The first one was a guy who said “If there’s any parts of me you can use, go ahead and use ‘em.” Three minutes later he was gone. It was wild.

Oncology and hospice here. Patients definitely know, and you can tell the difference between them just being anxious and it being the real deal. Also interesting to note: in my experience, most of my patients die between 0200-0400. I’ve worked both days and nights, and that’s what I find a little creepy.

I’ve seen the Lazarus effect on a patient while we were doing brain dead testing on a patient. At the apnea part of the test, they reached sat straight up and started to reach up for their ETT. I probably wouldn’t have been quite so freaked out in the moment (though still pretty freaked out) if the attending physician who was an unflappable badass from Indian hadn’t freaked as much as she did either. Obviously we had to pause the test.

Poor baby. He should have been on comfort care 💔

I had a patient one time who needed to be intubated for airway protection. She kept telling us to call her son and tell him she loves him because she’ll never come out of this. She just kept saying she wasn’t going to be okay. We reassured her and tried to calm her down but she wasn’t having it. They started the intubation and seconds later she literally coded and died. She knew!

I know from personal experience that this is real and I was in my mid 40s when this happened.

I started vomiting in the afternoon, had a fever and basically thought I had a virus. Called out of work around 9 PM tried to sleep but woke up every few hours to throw up bile throughout the night, I was alone btw. I woke up around 7 AM went to throw up again and after I did I just started getting dressed and called 911. If I’m asked this question a hundred times my answer will never change, I don’t know why I called 911: something just told me I needed to.

I got to the ER and they did an MRI or a cat scan, I never remember this part. Then a nurse came to me and asked me the name of my surgeon, my appendix had burst and I had to have emergency surgery. I said I didn’t have a surgeon, when I called my boss ( I’m in the medical field) to explain my appendix burst all she said was, tell them you want Dr. Shreedhar. I was about an hour from sepsis and possibly death. Dr Shreedhar had to cut out part of my stomach because of gangrene, this all happened on a Wednesday and I was home, with 13 staples in my stomach on Monday. I was incredibly lucky.

I always tell patients, it’s all connected, the brain knows when shit is going wrong, so listen to those instincts when they come.

I truly believe in the feeling of impending doom and it saved my life.

Had a patient tell me that her husband (who had passed away) was going to take her on a date Tuesday night. She died Tuesday night. They know when it's their time to move on.

Cath Lab RN here. STEMI patient was asking for a priest. Doc said, "Well fuck. Go ahead and set up for Impella."

For the non-CICU people, Impella is a percutaneous LVAD.

We learned at university that if a patient tells you this, to take them seriously lol

I’ve seen/heard of this once. Older gentleman was admitted for dehydration. A & O, Vss, assessment unremarkable. Another pt was admitted to the 2nd bed (semi private room) toward the end of shift. This patient was also older, A & O, pleasant, accompanied by his son who was a minister. I went back in the morning to find that my first pt had died during the night. Also found out that he had appealed to the minister to “stop those men. They were coming for him and he didn’t want to go”. It’s been over 25 years and I still get chills when I think about it

Same thing happened to me about 2 years ago but the patient wasn't mine because I knew them personally. I was standing outside the room waiting to say hi while the assigned nurse was assessing some chest discomfort that radiated to the pts back. Suddenly pt sat straight up in bed calmly said "That's it, I'm dead" and laid flat on the bed and into bradycardia and went unresponsive. Immediate life saving measures taken but no rosc achieved and was pronounced 40 mins later, she was only 47. That was the first time that happened to me.

I think it's DMT already flooding their brain that causes it.

It's a look in the eye that is looking past you and a tone that is different from panic or anxiety.

Wow this one is chilling 

My “favorite” is the fun twist of instead of impending doom they just turn to you and say “I’m ready to go now” before they DC to JC

I hear this all the time in the ICU. Sometimes they die, most the time they are just feeling sicker than they’ve ever felt, are in an unfamiliar place, in a scary situation. I don’t really buy the “impending doom” means imminent deterioration. I’ve had to explain to several patients that just because they are having a “heart attack” doesn’t mean they’re death is imminent even though they are 1000% convinced they are going to die.

With that being said, I do think anxiety contributes to outcomes, and I wish it was taken more seriously.

I was here the other day with a patient. 30 years old, impending doom, prognosis wasn't great as it was rare circumstance but death didn't seem like a likelihood to either the physician or myself. Sure enough, died.

I experienced this firsthand myself when I developed severe postpartum preeclampsia and got readmitted w/ borderline syncope and a BP of 220/120.

I was having severe anxiety attacks and chest pain which is not the norm for me and I was convinced I was going to die. No one took me seriously until the BP cycled lmaooo.

Very much a very humbling moment. One should definitely take their patients word when they say they’re gonna die.

Had a resident tell me she was ready to be with god. Was 100% at her baseline the days and weeks prior to this. No indication anything was gonna happen whatsoever until her O2 Sats dropped. I monitored the O2 Sats all night, she remained lucid the whole time. Refused any kind of medical intervention, got her family to make hospice arrangements. Passed away 3 hours after my shift ended while my coworker was prepping her first dose of comfort meds.

I went into anaphylactic shock from rocephin and coded. Right before I coded, I said “something’s not right. I don’t feel okay. I’m going to die” and then the last thing I remember is the code call. It’s definitely a thing.

I had a man with dementia screaming "They keep wanting me to go down but I keep telling them I want to go up! Tell them to get that red light out of my face!" 2 minutes later he coded. He was brought back, but it's not looking good for him when the final time comes... 😳

This happens a lot where I work. Most of the time, it is rather calm and peaceful when they say it. For some, not so much

Yep,see it in hospice all the time.

I knew a guy who was within a couple of hours of dying. During the process he said, “why is this taking so long “?

I went septic from mrsa on my hip in my 30’s. I was still at home, I’d been given Septra then rocephin at urgent care and just kept getting worse, I had a streak going to my groin nodes, woke up with 105 fever and just knew I’d soon die. I said to my husband at 5am, “I’m going to the ER now or I will end up dying today.” He said I’ll drive you and I said no, I can drive. I drove myself there, checked in, they rushed me back and started vanco. That plus honey dressings to the site on my hip saved my life. I was hospitalized for over two weeks. When I was first admitted I remember the MD, a hospitalist, coming in my room with a panicked look on her face. She thought I might die as well. You do know. You know it in your bones. I had a calm certainty about it that morning.

Black chick in ICU. non responsive, found down in field. stuck on levo. Been on levo so long her skin starts to slough off. Looks terrible because there's no melanin in underlying skin so She's at best "spotted". Sister keeps saying "I'm not going to cause her death by giving up on her". Patient sits up, says "Look at what you're doing to me" in the most I'm going to haunt you forever tone. Lays down and never moves or says another thing. Sister signs paperwork to deescalate care and never returns. To this day, every time we get BS assignment, or pharmacy doesn't have our meds, We look at them and go "Look at what you're doing to me".

They always know.

I know that the sense of doom occurs with a push of adenosine. They are legit dying there. Maybe we can just sense that when our brains aren’t getting oxygen.

Had a patient arrive by ambulance from a rehab facility, was there after lengthy hospitalization. Can’t remember what she came in for but VS were stable per EMS report. Pt very calmly says “I hope I don’t die here”. We reassured her and in the moment there was no reason to think she would. Labs came back atrocious—total metabolic disaster, she is suddenly hypoxic and going on Bipap. Glucose keeps dropping despite multiple amps of D50 and then she codes in front of me. Did not get her back and I was just like “Well holy shit, she knew”. Chilling in hindsight.

A few years ago I had a nursing home patient like this. We started discharge planning and she was basically like “I would rather stay here if my insurance allows it because I’m going to die soon.” She would tell this to basically everyone and she wanted to go on hospice but she didn’t qualify. She died 3 weeks after admission. Sometimes people just know

Repost from a previous comment I’ve made;

The first week I was off orientation, I had a patient who was a semi-frequent flyer but VERY cool. Never asked for much, very very kind man. We all enjoyed being a part of his care. He was downgraded to me in a step down, which was my first job.

His wife was leaving for the night, and out of nowhere he just FREAKED out. He BEGGED his wife to not leave. Completely out of character, it was truly bizarre. Both myself and his wife helped convince him everything was going to be fine. After about 30 minutes we were able to get him calmed down and his wife took off.

Later that evening a coworker helped me put him on a bed pan, and he vagal’ed down and coded. We coded him for about 20 minutes before we got a pulse back. He died later that morning once we moved him back to ICU. Him and his wife never got to speak again.

I know the wife decided to go home, but I can’t help but feel guilty. She could have stayed the night, but I played a large role in telling him “she’ll be here first thing in the morning”. It’s not something I’ve forgotten.

I had another guy, brutal trauma with a bowel repair. He was doing pretty well, went in for a secondary procedure, then that night he was totally different, very quiet. I went in to check on him at one point, and he was in the middle of ripping out his PICC, pulling off his leads, and throwing himself on the floor. This guy was like 6’4”, +300lbs, so there was no way I could stop him.

He laid himself onto the floor and started screaming that he was “infected” and kept screaming “don’t come near me! I’m infected! I’m going to die don’t touch me!”

We got him calmed down and back in bed. We ordered a bunch of scans and work ups, but it was towards my last shift of the week, overnight, so I didn’t get an immediate feedback on what was wrong.

When I returned a couple days later, the story was a surgeon actually hit his bowel without knowing it, and it was leaking into his abdomen, vitals were totally fine (at the time). He was septic and knew it before we did. I do believe he eventually passed.

Sense of impending doom is extremely real.

I had a liver biopsy scheduled with twilight sedation and I had the most intense impending doom feeling beforehand. The nurse in preop before I went to IR let the dr know to try to give me something and the doctor declined. My twilight sedation didn’t work, the DR couldn’t get to my liver, BP was 200s SBP, and I felt every single thing and was wide awake while the dr yelled at me for not being calm and the nurses were trying to hold me still while I was writhing in the most intense pain. I was crying and screaming on the table.

Now I have some gnarly PTSD and I will never do a twilight procedure again. Not the same thing, but personal history with intense anxiety makes me take every patient seriously when they voice concerns themselves.

I work hospice. Totally happens.

I’ve worked in major trauma for almost 2 decades, so a lot of patients have thought they were going to die and it was valid b/c they were. However, I’ve had relatively “stable” for a trauma hospital, but still very sick patients, grab onto me while we’re putting them to sleep and state in some form that they know the are going to die. Sometimes they’re quiet with only a flash of panic in wild eyes, sometimes they are outwardly frantic. I ALWAYS take them seriously. We all do except maybe the newbie docs or RN’s but if they’re smart they are already scared and paying attention to the direness of the sitch. I’m OR so it’s sometimes only minutes if they aren’t already intubated, but people KNOW. Just as animals know. Always listen. Worst case, you overreact, but I guarantee one day you will be the key to saving a life.

Had this happen to me. Clocked in at 7p, my patient was frazzled, disoriented and kept saying “I’m going to die, I’m going to die”. I was in the room from 7-10 trying to calm them down. I stepped out to go to the bathroom after finally being able to soothe them a bit. when I was done saw my charge running down the hall to my patient’s room saying “their rhythm changed”. As soon as I walked in the room I knew they were gone. Coded them for over an hour and got them back.

When a patient tells you they are going to die, believe them. Always.

I’m a CVOR nurse. My first patient death in the OR, the patient asked if she could record saying goodbye on her phone to her family to which we of course allowed her… she died on the table, cardiac massage and all. It was fucking trippy. I still remember closing her up and then comforting her family when they said their goodbyes.. the patient knew.