“The first effects of dying are difficulty in digesting food, swallowing and lifting the arms, legs and head. The breath is short and gasping. The limbs, then the whole body is chilled and nothing warms them. The mind is agitated and thoughts arise uncontrollably.
“It becomes impossible to stay erect. We cannot lift our arms and legs, the head rolls back and there is a feeling of heavy pressure on the whole body. The agitation ceases and is replaced by drowsiness, a semi-swoon. We see mirage-like visions and flickering lights.
“There is dryness of mouth, nose, throat and eyes. Bodily sensations are greatly reduced and alternate between pain and pleasure, heat and cold. The mind becomes irritable and we have visions of smoke.
“Then we cannot recognize friends or family. Sound and sight are confused. We see red dots like fireflies.
“We become totally immobile. The breath is shorter and more gasping, our exhalations longer. Sound and sight blur. Visionary experiences arise according to our karma. Persons whose activities of body, speech and mind have been very negative may see terrifying forms or replay of the bad moments of their lives. They might react with guttural sounds of fear. Those who have been virtuous and kind might experience blissful, heavenly visions and see forms of loving friends and enlightened beings. They would have little fear of death.
“Finally, there is one long exhalation, the ‘death rattle’. This is followed by the closure of sight, hearing, smell, taste and touch as the winds retract toward the heart. Physically one is dead.”
From: Life in Relation to Death, Chagdud Tulku Rinpoche 16
Here is another description of how to determine if death is imminent.Caregiver Revolution :For families, loved ones and professionals who want to change caregiving into a positive, life affirming experience.