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.