Nina de Cocq, EOLD, RMT

04/01/2026

03/16/2026

One of the questions I am asked more than almost any other is this: “Why do we stop food and water at the end of life?”

It is a question filled with tenderness, and often, with fear. Families struggle. Clinicians and caregivers struggle. Anyone who has ever cared for someone who is dying knows how deep the instinct is to nurture, to comfort, to give. We equate food and water with love, with survival, with doing right by someone we care about.

And so, when we are asked to stop, or when a patient begins refusing food and water, it can feel like we are participating in something harmful… or abandoning something essential. Some worry they are contributing to suffering or hastening death. Others feel a conflict with their faith, their values, or the core human urge to sustain life. All of these feelings are valid. All of them deserve to be seen.

But there is another truth, one rooted in the wisdom of the body itself. At the end of life, the body does not want food and water. As the systems begin to shut down, appetite and thirst naturally fade. The digestive system slows. The cues in the brain that tell us “I’m hungry” or “I’m thirsty,” grow quiet. The body needs less energy, less input. It begins turning inward, conserving what little is left for the final work of letting go.

When we try to give food or fluids during this time, no matter how well-intentioned, we create discomfort. The body can no longer process what we are offering. Liquids can pool in the hands, feet, and limbs. Food can sit in the mouth or throat without the strength to swallow. These are not signs of neglect. They are signs of a body transitioning, doing exactly what it is designed to do at the end of life.

This is why stopping food and water is not an act of harm. It is an act of honoring the body’s own wisdom.
It is allowing the natural process to unfold without introducing distress.
It is trusting that they are not dying because we are withholding anything, they are dying because the illness has reached its end. And when we stop giving food and fluid at this stage, we are not causing death, we are helping create the conditions for it to be more peaceful, gentler, and filled with far more grace.

The body will actually let go with a little more peace and grace when food and water is not given at the end of life. The body responds well to this. It prefers this. And when we honor the body in this way we can remove or avoid physical suffering which is inevitable when we push or force food and water.

There are ways to offer care, comfort, and presence:

• Offer, don’t force. If someone shows interest, small sips or favorite tastes like ice cream, Jell-O, or a spoonful of something familiar can be soothing. But refusal is communication, and it must be respected.
• Provide mouth care. Moist lips, a clean mouth, and gentle swabs can bring comfort without asking the body to process what it cannot.
• Watch for cues. Holding food in the cheeks, coughing, spitting out food, or drooling are signs the body is not tolerating intake.
• Honor their choices. If they have an Advance Care Directive, their decision about artificial hydration or nutrition must guide us.
• Above all, prioritize comfort. Hospice and end-of-life teams are here to help families and caregivers understand these changes, to hold space for the grief they bring, and to create care plans centered entirely on comfort and dignity.

Stopping food and water at the end of life is one of the hardest things we ask of families and care teams. It challenges our instincts. It touches our fears. It asks us to redefine what care looks like.

But the truth is simple and profound:
Their body prefers it this way.
We are not hurting them. We are easing their way.
We are meeting them with compassion, not deprivation.

This work is tender. It asks so much of our hearts. But when we allow the body to guide us, when we stop forcing what it can no longer use, we give our patients what they deserve: a death held with gentleness, respect, and deep humanity.

And that is the essence of the care we all strive to provide for the people in our care, and for the people we love.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/a-gentle-truth-about-food-water-and-the-end-of-life

03/16/2026

The conversation started with a car sale on Facebook Marketplace.

Within a few minutes, we were talking about death.

I was sitting at an airport bar during a layover for a girls’ trip when the man next to me—who looked to be in his mid-60s—started chatting about which credit card he might use to pay his tab.

Then he told me about the man who bought his car.

“I just sold a car on Facebook Marketplace. The guy who bought it was widowed two months ago. He told me all about how his wife, who had cancer, spent the last few months of her life getting things in order.”

The man at the bar continued, “He said she thought of everything. He even started crying while we were talking and saying how grateful he was that she had taken care of him like that.”

I turned my chair toward this man, who had just spontaneously shared this story with me, and said, “Wow. You must have been a bit surprised that selling your car turned into that moving of a moment.”

We introduced ourselves (his name is Dan) and kept talking.

Dan shared that he was deeply moved by the moment and ended up giving the car buyer a hug by the end of their conversation.

He then said something that caught my attention: he had never really considered what would happen if his own wife died.

“Honestly, she just can’t die before me—I need her too much.”
After acknowledging how much he loves his wife, I asked, “In what specific ways do you need her?”

He immediately went to practical things.

She pays all the bills.
She keeps track of their retirement investments.
She knows how to operate the TV.
She remembers everyone’s birthdays.
She keeps track of his health appointments.
She does all the cooking, and he can barely make hot dogs.

Let me pause here to acknowledge the load that this wife—and many women—are carrying for their spouses.

I then asked him gently, “You brought up the widower who bought the car to a stranger. I wonder why?”

He laughed awkwardly and joked that he had no plans for any wrongdoing toward his wife—but he was terrified about what would happen if she died. He doesn’t know how to navigate all of these accounts, relationships, and, in general, life.

I encouraged him to ask his wife to write things down for him. I also explored with him what information he might hold that his wife may not know.

Dan shared that their snowblower is too hard for his wife to start. He’s now considering getting one with an electric start so she won’t need as much force to use it. He also noted that he maintains the lawn and the cars and should probably pass along that knowledge.

With his permission, I texted Dan a few resources—including The Death Deck products, an advance directive form, Compassion & Choices’ Dementia Values and Priorities Tool, and Death Project Manager’s Mortality Workbook.

I had to catch my plane, and as I stood up to leave, he stopped me to give me a hug.

“I don’t know how this happened,” he said, “but you just gave me the kick in the butt I needed to take care of this. I’ve been thinking about that conversation for two months and didn’t know what to do about it.”

How Death Literacy Spreads

This was a twenty-minute conversation.
In an airport.

One human talking to another.

There are so many opportunities to educate, support, and encourage conversations about end-of-life topics. It starts with being open to human encounters—which often means taking off your headphones, looking up from your phone, and maybe even smiling at strangers.

We all have the capacity to increase death literacy.

And sometimes it begins with a single conversation.

Dan admitted he had never really considered death before. Yet a random Facebook Marketplace story had been sitting with him for two months, quietly shaping the way he thought about his future.

How many people has the man who bought the car talked to about the gift his wife gave him through preparation?

It clearly stayed with Dan.

And now Dan will likely carry that story into other conversations.

This is how death literacy spreads.
One story.
One conversation.
One moment between strangers.

Be brave.
Be open.
Strike up the conversation.

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03/13/2026

People often ask me, “How do you sit with someone who is dying? What do you say? How do you do this work?”

Many believe there must be special tools, the right words, some kind of wisdom you learn from books or training.

But the truth is much simpler.

This work has taught me that death is not chaos. It is a process. The body knows how to die just as surely as it knows how to be born, and each one does it in its own way.

What death and dying need most is a calm presence.

Our job is not to fix it, control it, or perform something heroic.
We are not magicians.
We don’t wear capes.

After witnessing enough final breaths, something in you begins to settle. Death stops surprising you, and because of that, you stop bringing urgency, fear, or drama into the room.

You learn to trust the body and the process it is moving through.
You learn to slow down.
To listen more than you speak.
To let the moment belong to the person who is dying and the people who are preparing to say goodbye.

You don’t rush it.
You don’t try to control it.
You simply remain present and allow it to unfold.

Because in the end, the body knows how to die. Sometimes what it needs most, is someone who is not afraid to be there when it does.

xo
Gabby
www.thehospiceheart.net

03/08/2026

This morning I returned to something I used to offer others, a mourning walk.

Years ago, I would gather people who were carrying grief and invite them to walk together in nature. Along the path we would collect what the forest had already released, rocks, feathers, fallen leaves, small sticks, dried flowers, never taking what was alive, only what had been gently given. When the moment felt right, we would pause and create something together. A small mandala, a heart, a simple offering placed on the earth. It was never about the shape itself, but about honoring what we were carrying.

Today, I walked alone.

I brought my own grief with me, for family members, friends, patients I have cared for, and for those I know who are quietly navigating their own sorrow right now. On the forest path, I gathered a few small things and made a heart on the ground. Then I stepped away and sat on a fallen tree and simply watched the forest breathe.

People passed by.

Some noticed the heart and smiled. Some stopped to take a photo. One hiker accidentally stepped on it, and another gently called him back to repair what had been disturbed. Then, almost instinctively, they all began adding to it, a stick here, a leaf there, until the small heart I had made was no longer only mine.

Later, a couple stopped beside it. They admired it, sat down next to it, and took a photo together.

And in that quiet moment, I was reminded of something simple and true. We all walk through this world carrying different things. Grief, love, memory, longing, hope. When we leave something of ourselves behind, even something small, others may meet it in their own way. They may protect it, add to it, transform it, or simply pause beside it for a moment.

And somehow, without speaking to one another, we become part of the same human offering.

A small heart on a forest path became grief, care, repair, collaboration, and love, all within the span of a single mourning walk. And it reminded me how gently we hold one another, even when we don’t know we are doing it.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/mourning-walk

03/07/2026

I was sitting with a woman who was days before her death, fully conscious and aware of everything she was feeling and experiencing. She said to me, "can I share with you what this feels like?" I said yes, of course. I am always curious about the hours, days, and moments that lead to the very last breath, and what it must feel like for the person who is dying.

She first asked me to tell her what I thought it might be like, wondering if after witnessing as many last breaths as I have, that I might have my own interpretation, and how it might compare to what she was feeling. I had to think about it for a minute or two, going back in time to some of the deaths I have been present for, especially the ones that stood out most, and while I have seen many, over a thousand, only three have actually shared with me what it feels like. For the others, I based my thoughts on their facial reactions, body movements, and the sounds of their breath as it was slowing down.

I told her that most of the people I have been present for at death are non-responsive, or cognitively impaired and are unable to verbalize what they are feeling with any sense of clarity. So while some have shared with me, most of my opinions relative to what they are experiencing is just an assumption on my part. But whether they can speak or not, I truly believe that there is a sense of awareness that comes to someone moments before their last breath. Perhaps it is an energy they feel, a sense of peace or calm that wafts through them like a soft and gentle breeze. I believe that pain, regardless of how much of a struggle it has caused them, leaves before the last breath is taken, and my reason for that is because I truly believe that when death comes, the body makes peace with it and let's go.

I do think there is a sense of fear that some might feel, but I also think that it leaves in enough time for that person to know it is gone, trusting the journey will be gentle regardless of the path that led them there.

I think it is the ones who are more conscious, and who are fully present for their experience, that feel more deeply what it means to die. I imagine their life flashes by them in slow motion, taking them down their own memory lane, and the life they lived, the people they loved, and the mistakes they made, as though they are asking God, the universe, or spirit to please give them the gift of peace and acceptance as they prepare to let go. I imagine that it is in those last moments when forgiveness, either of self or others, is amongst the last thoughts, hoping perhaps that they are given permission not to take them with them when they go.

I stopped for a moment and paused. She said, "is there more?" I said, "yes... I think when we are that close to death, everything that has caused us distress, whether physical, emotional, mental, or spiritual, is removed, the slate has been wiped clean, and we gently cross the finish line of life taking with us the knowledge that we did the best we could, and that comforts me."

She said, "this sounds to me like all the deaths you have experienced have helped you make peace with your own death, is that true?" I realized that is exactly how I felt. I honestly have no idea what it feels like to die, and I think there is no right or wrong way, just your way and my way, death happens and our lives end. And yes, I have made peace with that, and I am not afraid... I am just not ready yet. I want more time.

And then she said, "and that is exactly how I feel... I want more time, but I am at peace with the time I have had, and like you said, I do believe I did the best that I can, and I have no regrets. My life has flashed by me, you are right about that. I find myself savoring all of it again, mentally saying goodbye to it, the memories, and the people. I find myself feeling gratitude. I am ready to die Gabby, and I want you here with me when I go."

When she took her last breath, I watched her eyes gently close, her skin soften, and her body lean into the ending of her life with such grace. She said goodbye to her life with gratitude and eased into her death with peace. I felt as I always do at that time, what an honor it is to be present for such a sacred moment, and I sat still at her bedside, not rushing anything.

When our last breath is taken, I think the most we can hope for is that we lived a good life, that we let go of regret, that we felt appreciation and gratitude, and that we feel no pain. I believe we take nothing with us when we go, and that all we experienced, the good, bad, difficult, and rewarding stays with the life we say goodbye to. I think in order to do that though, we have to set intention with the way we live our life, and not wait until the last hours to days before we die to appreciate all that we have.

xo
Gabby

You can find this and my other blogs here:
 https://www.thehospiceheart.net/post/when-our-last-breath-is-taken

02/25/2026

The other day I got into my car at the post office and noticed a bee clinging to my driver’s side window. I assumed it would lift off once I started driving. It didn’t. I remember thinking that was strange, surely the wind would carry it away. But I drove to the grocery store, and it was still there. I went inside, came back out, and it hadn’t moved. I drove to another stop. Still there.

At first, I couldn’t understand it, why wasn’t it flying away? The wind pressed hard against the glass. The air was cold. The world rushed by, and that tiny little bee remained fixed in place. I kept waiting for it to release itself and disappear into the sky, but it didn’t. And somewhere between one stop and the next, it began to occur to me that something wasn’t right. This wasn’t simple stubbornness, it felt like survival.

So, I began speaking to it. “It’s okay. We are almost there. Just hold on a little longer. I will get you somewhere safe.” I found myself driving with a little more ease, as though a smoother ride might matter. I worried about what would happen if the wind finally tore it loose, if it struck a car or fell beneath a tire. That ending felt harsh, I didn’t want that for the bee. I wanted stillness, shelter, a place where whatever needed to happen could happen gently, with peace.

When I finally reached my house, it was still there. Only when I tried to slide a piece of paper beneath it did I realize one tiny leg had been stuck to the glass the entire time. I carefully separtated it from the window, and I placed it beneath a leaf in my flower bed, creating a small, safe sanctuary, and stepped back. Its wings moved faintly. I didn’t know if it was in pain. I didn’t know what a bee in pain looked like. I only knew it was still alive, barely, and that it was no longer alone on a moving car, and it was safe. This mattered to me.

I knew in my heart that I was not just looking at a bee, I was witnessing a life as it was ending.

Later, it died, and as I buried it in the flower bed, I realized why the moment had felt so personal. For a brief stretch of time, it wasn’t just a bee, it was a life slowly changing, a life holding on. It was a life becoming more fragile, more dependent on circumstance, more reliant on whatever steadiness surrounded it. It held on until it reached a place that felt safe enough to let go.

In the work of caring for those who are declining, I have witnessed that same quiet rhythm, the holding on, the gradual surrender, and the resilience that exists beside exhaustion. As caregivers, we do not control the outcome, we cannot stop the wind, but we can offer presence. We can soften the landing. We can create a space where letting go does not feel abrupt, or violent, it should feel held.

Every ending of a life deserves this kind of care... even the life of a bee.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/it-wasn-t-just-a-bee

02/24/2026

I was asked recently, “What is the difference between a natural death and a death with Medical Aid in Dying?”

Having been present for nearly three hundred people who have chosen this option, and more than two thousand last breaths altogether, I have witnessed many ways of dying. What I have come to understand is that the difference is not always in the death itself, but in how the person who is dying meets it.

A natural death, for lack of a better word, is what most of us are familiar with. A diagnosis is given, or age takes its toll, and the body begins to decline. There are symptoms. There is caregiving. There is the long stretch of watching and waiting. And when the last breath comes, it is a loss, and it is heavy.

A death with Medical Aid in Dying unfolds along that similar path. The diagnosis has already been spoken. The body is already changing. Treatments have been tried. This person is dying, and the reality of limited time has already settled into the room. The difference is not whether or not someone is dying, they are dying. The difference is that with Medical Aid in Dying, they are given a choice within that reality.

I advocate for this option because I have witnessed the waiting. I have sat beside people whose bodies were not going to recover, whose strength was fading, whose suffering, physical, emotional, or quiet and internal, continued long after acceptance had arrived.

We always want more time, of course we do. Loving someone means wanting one more conversation, one more hug, one more memory to make, and one more day. But when someone you love is already dying and suffering in ways you cannot fix, love can also mean not holding them back from peace.

Medical Aid in Dying does not change the outcome. It does not create death, death is already happening. It offers autonomy at a time when so much has already been taken from this person. It allows someone to say, “I am ready now,” and to be met with respect rather than resistance.

Death is hard. Watching someone you love die is hard. But watching someone suffer while they wait can be harder still. No one should have to suffer when they are dying. We treat our animals more humanely than our humans, and I struggle with this.

If this choice matters to the person in the bed, it should matter to us. My hope is always that they are offered dignity, autonomy, and the freedom to make their final decision without it being overshadowed by our own fear or judgment.

It is still goodbye. It is still death. It is still love. And it is still hard. But sometimes, it can also be mercy.

xo
Gabby
www.thehospiceheart.net