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My father was in kidney & liver failure and he was suffering from diastolic heart failure. When my father fell ill, he returned home and I cared from him until his last breath. We set up home hospice who made him as comfortable as they could with Morphine, Ativan and oxygen. Four days before his death, he could no longer speak but he could feel discomfort if moved. Three days before his death, his eyes glazed over white. They had a marbled table top pattern. I could no longer see the color of his own eyes. I asked the nurses who seemed confused about it. And were only familiar with a cloudy/glassy eyes. A day before his death, he shed tears a few times. But the day of his death, no tears. His blood pressure before death was 50/20. His breathing was shallow and spaced out by 16-30 second apart. When he past over, he didn't gasp for air; he took one last breath and his pulse didn't stop until 2 minutes after that last breath. A minute into his last breath, he clinched his hands and his chest tightened. His face didn't grimace but seemed to tighten. My fear is he was suffering. That he felt he couldn't get enough air. I keep having nightmares of my father in pain... he keeps dying in my dreams and it always starts off good with us believing we beat this and then he's dying again. I can't stop thinking of his death. I feel darkness. What does the clinch mean? With a blood pressure so low, could he still feel pain? What does the marbling of his eyes mean? Can anyone help me, please?

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MissUdaddy, since you were using Hospice, chances are your Dad didn't feel any pain. Probably what you were noticing was the body shutting down and different physical reactions were happening which were normal in some cases.

As for the eyes, I found this question from a few years ago that might be helpful.
https://www.agingcare.com/questions/someone-near-death-eyes-change-157085.htm
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What you saw in the eyes was pupils fully open (dilated) so the color band is not visible. The marbling is a reflection of the retina and it would appear whitish if his blood pressure was extremely low. The muscle clenching (spasms) happen in many different ways. Some raise their arms or kick their legs. It's a normal action when the body is shutting down. It does not mean he was in pain.
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We are not to know if he as in pain or not, but rest assured, the nurses job is to ensure that a patient is kept comfortable, that is, not in pain. Some of those things that you noticed with your father are things that happen as a persons body is shutting down. Your father is at peace now, you need to be at peace too. You have some lovely memories of him. Arlene Hutcheon
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