A California hospice nurse has shared what she believes are the three most common signs that someone is within 24 hours of passing away—and she says they’re often far less frightening than people imagine.

Julie McFadden, widely known online as Nurse Julie, has spent 16 years working in palliative care.

Over that time, she’s gained a following of more than 1.7 million people on TikTok by explaining what really happens in our final moments. She’s also written a book, Nothing to Fear: Demystifying Death to Live More Fully, aiming to ease people’s fears and open up honest conversations about dying.

In an interview on the Dr. Karan Explores podcast, McFadden described how some patients seem to have an extraordinary awareness—and even control—over when they will die. She recalled instances where patients told her they would “go” after a certain event, such as a wedding or birthday, and they did.

In one case, a patient who showed no active signs of dying calmly announced, “I’m dying tonight,” and passed away just hours later.

When the end is truly near, McFadden says there are three signs she sees most often.

The first is what’s known as the “death rattle.” This sound occurs when a person can no longer swallow or cough effectively, causing saliva and mucus to build up in the throat and airways.

As air moves through, it produces a rattling or gurgling noise. While the sound can be distressing for family members to hear, McFadden emphasizes that it is not painful for the patient—it’s simply a natural part of the body shutting down.

The second sign is a change in breathing patterns. Breathing may slow, become irregular, or include long pauses.

In the very final hours, some people exhibit “agonal breathing,” which are short, gasping breaths caused by the brain receiving less oxygen. Though this can look alarming, McFadden explains that the person is not in distress—it is a reflexive action, not a sign of suffering.

The third sign is what she calls the “death stare.” The individual may lie with eyes and mouth open, unresponsive, their gaze fixed and unfocused.

While it can be unsettling for loved ones, McFadden says it is often a peaceful state

. Hearing is typically the last sense to fade, meaning that even at this stage, the sound of a familiar, loving voice can still bring comfort.

McFadden stresses that not every person will display these signs—some deaths happen suddenly, while others are more gradual.

But for families who are present, understanding these changes can bring a sense of calm during an otherwise overwhelming moment. “When you know what to expect,” she says, “it doesn’t have to be as scary. It can actually be a time for connection, comfort, and peace.”