I think about mortality a lot because it keeps me grounded not to take everyday moments for granted. Thinking about death also makes me appreciate every single day that I'm still alive.
Ironically, thinking about death isn't sad and depressing. Go research about the Bhutanese, the happiest people on earth. They think about death 5 times a day! I'm not at that level yet though - I only think about death once a day! Haha...
For #1, what are the ways the dying attempt to describe to us what they are experiencing?
- The dying often use the metaphor of travel to alert those around them that it is time for them to die. They also have a deep concern about the welfare of those they love, asking themselves, “Do they understand? Are they ready? Are they going to be all right?” It seems dying people need permission to die. If given, that permission provides great relief; its absence can make the dying process more difficult and lengthy. The dying intuitively know when—and often why—this permission is being withheld, by the behavior of those around them. This withholding indicates that those they love don’t understand their struggle, nor are they prepared emotionally to deal with the finality of their leaving.
- Many dying people tell of seeing a place not visible to anyone else. Their descriptions are brief—rarely exceeding a sentence or two—and not very specific, but usually glowing. They may describe the place as beautiful or lovely, but the response to “Tell me more . . .” often is a dreamy look and a shake of the head or several false starts and then: “I can’t.” Even so a glimpse of this other place seems to bring peace, comfort, and security to the dying person—reactions shared by those able to listen and understand.
- When dying people repeatedly mention significant items used in family occasions but the timing is off, they may be trying to communicate that he/she may not make it until that occasion that's why he/she is already requesting to celebrate it in advance.
Another important thing we need to know - just before they die, and usually without warning, some patients can muster an unusual strength. Unfortunately, some use that strength to try to get out of bed, and subsequently fall. Afterward, the family feels a terrific amount of guilt, and may blame the fall for causing the death. A frightened and tearful family member may say: “Dad just died. He was trying to get out of bed and fell to the floor! We’ve been with him all the time, but I’d just run down to the kitchen for coffee. I feel just awful. It’s my fault; if I’d been there this wouldn’t have happened! How could this have happened, anyway? He’s been semiconscious, barely responsive for the past two days, didn’t even have the strength to hold a glass of water. He was too weak to move at all by himself! How could he get over the bed rails? I don’t understand it! How can I live with this?”
The authors aren't suggesting that it’s all right for dying people to fall out of bed. But what they want to highlight is no one knows the reasons for this phenomenon of reaching out—and sometimes climbing out of bed—in the last moments of life. The fall may not have caused the death; the person might have died at that time, whether he fell or not. The fall may have resulted from his response to something he was experiencing while dying.
That's surprising info for me - that many dying people are able to exercise some control over their deaths - of the time, the circumstances and the people present.
A long time ago, when my dad passed away and I was trying to better understand the grieving process, I read somewhere that one of the stages you undergo is guilt where you try to connect yourself to your loved one's death even if there is no direct connection. It could be thoughts like - if only I did ___ or if only I was there, maybe he would still be alive.
Anyway, going back to the book I read, it's entitled "Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying" by Maggie Callanan and Patricia Kelley. The authors are hospice nurses who take care of terminally-ill patients and after having witnessed so many deaths for 20 years, they were able to identify similar patterns and recurring themes among the dying.
For example, you've probably heard stories of people who passed away right after a family member from overseas came to visit. Or someone who passed away right after a special occasion like a birthday, or after a special milestone was achieved like a graduation of a grandchild. These are not coincidental. It's a recurring theme among the dying across different cultures. It is as if the dying person has chosen when to die. But this is just one, there are several more recurring themes.
Callanan and Kelley say the messages of the dying fall into 2 categories:
(1) Attempts to describe what someone is experiencing while dying.
The experience of dying frequently includes glimpses of another world and those waiting in it. Although dying people provide few details, they speak with awe and wonder of the peace and beauty they see in this other place. They tell of talking with, or sensing the presence of, people whom we cannot see—perhaps people they have known and loved. sometimes religious figures. They talk about the need to prepare for travel or a change, or mention some place we cannot see, or describes seeing a bright light. They know, often without being told, that they are dying, and may even tell us when their deaths will occur.
(2) Requests for something or someone that a person needs for a peaceful death.
Dying persons’ requests are sometimes difficult to decipher. Their recognition of the importance of these needs, along with concern for family and friends, can cause the dying to control the time and circumstances of death until those needs are met. These requests often involve someone else; they may be for meetings or the healing of relationships. Or it's a desire to reconcile personal, spiritual, or moral relationships, and requests to remove some barrier to achieving this peace.
For #1, what are the ways the dying attempt to describe to us what they are experiencing?
- The dying often use the metaphor of travel to alert those around them that it is time for them to die. They also have a deep concern about the welfare of those they love, asking themselves, “Do they understand? Are they ready? Are they going to be all right?” It seems dying people need permission to die. If given, that permission provides great relief; its absence can make the dying process more difficult and lengthy. The dying intuitively know when—and often why—this permission is being withheld, by the behavior of those around them. This withholding indicates that those they love don’t understand their struggle, nor are they prepared emotionally to deal with the finality of their leaving.
To give the person permission, you could assure him/her that “Everything will be fine” or tell the person “Just let go. I’ll miss you, but I know you need to go now.”
- Dying people, days or hours before the actual death, often interact with someone invisible to others—talking to them, smiling, waving, nodding, or reaching out for someone or something unseen. The unseen person’s (or persons') identity often is clear to the dying. Generally they recognize someone significant from their lives—parent, spouse, sibling, friend—who is already dead. There is often a sense of pleasure, even of joyful reunion, in seeing that person again.
- Dying people, days or hours before the actual death, often interact with someone invisible to others—talking to them, smiling, waving, nodding, or reaching out for someone or something unseen. The unseen person’s (or persons') identity often is clear to the dying. Generally they recognize someone significant from their lives—parent, spouse, sibling, friend—who is already dead. There is often a sense of pleasure, even of joyful reunion, in seeing that person again.
Some see religious figures—angels, perhaps, or spirits. Even when people don’t recognize the figure they’re seeing they don’t appear upset or frightened. They usually were calm as they talked about it, and seemed comforted and more peaceful in the presence of their invisible visitors.
There's one story in the book wherein the patient was an atheist and she saw an angel by her window. It still didn't make her believe in God or angels but she told her mom that it felt good to know that she won't die alone as someone who loves her is waiting for her.
These gestures give us glimpses of whatever dimension exists beyond the life we know.... Knowing that a dying person may be reunited with someone they cared about reinforces our hope that love and important relationships may be eternal.
So when dying people start mentioning of seeing people who have been dead for years, don't contradict them by saying they must be dreaming or hallucinating. Such comments may discourage them from further sharing their experiences. Instead, just encourage to talk more about it like what they see or how they feel, etc.
- Many dying people tell of seeing a place not visible to anyone else. Their descriptions are brief—rarely exceeding a sentence or two—and not very specific, but usually glowing. They may describe the place as beautiful or lovely, but the response to “Tell me more . . .” often is a dreamy look and a shake of the head or several false starts and then: “I can’t.” Even so a glimpse of this other place seems to bring peace, comfort, and security to the dying person—reactions shared by those able to listen and understand.
- When dying people repeatedly mention significant items used in family occasions but the timing is off, they may be trying to communicate that he/she may not make it until that occasion that's why he/she is already requesting to celebrate it in advance.
There is a story in the book where the patient kept telling his wife to "get the sparkler cake now" - the sparkler cake is what their cook bakes for them on their wedding anniversary. But the wife thought the husband was confused coz their wedding anniversary which is 4th of July was still a month away. Every time she told her husband their anniversary is still weeks away, the husband would insist to get the sparkler cake now. The hospice nurse explained to the wife what her husband was probably trying to communicate to her so she had the sparkler cake made and celebrated their wedding anniversary in advance. The husband died on June 30 and was buried on July 4, their wedding anniversary.
The authors say "in ways that are direct, or subtle, or even silent, dying people are showing us that they do know when their deaths will occur, and that they are not distressed by this information. By listening and understanding these messages, we are given unique opportunities to prepare ourselves for their loss, to deal with our fears of dying, to use well the time that is left, and to participate more significantly in this life event."
For # 2, what kind of requests does a dying person need to die peacefully?
The authors say "in ways that are direct, or subtle, or even silent, dying people are showing us that they do know when their deaths will occur, and that they are not distressed by this information. By listening and understanding these messages, we are given unique opportunities to prepare ourselves for their loss, to deal with our fears of dying, to use well the time that is left, and to participate more significantly in this life event."
For # 2, what kind of requests does a dying person need to die peacefully?
They could be (1) Reconciliation - whether with a specific person or God; (2) Removal of a barrier standing in the way of a peaceful death; (3) Unfinished business; (4) Particular circumstances to die peacefully e.g. choosing the time of their death or the people who will be there.
The challenge though is sometimes, their requests are vague or indirect and may be missed or ignored, leading to frustration, anxiety, and sometimes agitation (which often the response is to sedate the patient).
Agitation is at its peak if the dying person is close to death and he/she realizes death won’t be peaceful without this reconciliation. This may be what occurs when someone seems to die in pain; rather than physical, the pain may be emotional or spiritual. These types of pain can be harder to relieve, and far too often go unidentified or ignored. Understanding issues that need resolution can enable us to better assist dying people and help us realize the need for reconciliation and completion in our own lives.
There's a story in the book where one day, the patient became restless and anxious and she was complaining “I can’t find the feed for the horses!”. The hospice nurse, to encourage her to explain further, asked "Why do the horses need feed?”. Then the patient answered “I’d never make them take me on this trip without feeding them first!” she answered.
The hospice nurse then tried to decipher with the patient's family what could feeding the horses meant. One of the patient's granddaughter connected it to the farm where her grandma grew up were grandma's family used horses and wagon to go around. Then they tried to decipher what could she have meant by "I’d never make the them (horses) take me on this trip without feeding them first!”. Who could be the unfed horse/s who won't allow her to go on her trip if she doesn't feed them?. They realized the horses may symbolize her children. Apparently, the patient had an estranged son. If there's even one unfed horse, she won't be able to go on her trip. So the family arranged for a reconciliation between mother and son. Since the reconciliation, the patient never mentioned about feeding horses again. The son spent quality time taking care of her mom for the next 2 weeks until the mom peacefully died.
Another important thing we need to know - just before they die, and usually without warning, some patients can muster an unusual strength. Unfortunately, some use that strength to try to get out of bed, and subsequently fall. Afterward, the family feels a terrific amount of guilt, and may blame the fall for causing the death. A frightened and tearful family member may say: “Dad just died. He was trying to get out of bed and fell to the floor! We’ve been with him all the time, but I’d just run down to the kitchen for coffee. I feel just awful. It’s my fault; if I’d been there this wouldn’t have happened! How could this have happened, anyway? He’s been semiconscious, barely responsive for the past two days, didn’t even have the strength to hold a glass of water. He was too weak to move at all by himself! How could he get over the bed rails? I don’t understand it! How can I live with this?”
Instead of assuming the worst, it’s best to ask a few questions: What were the dying persons trying to do? Were they seeing someone or some place invisible to us? Were they trying to go there? Was someone that we couldn’t hear calling them to come?
The authors aren't suggesting that it’s all right for dying people to fall out of bed. But what they want to highlight is no one knows the reasons for this phenomenon of reaching out—and sometimes climbing out of bed—in the last moments of life. The fall may not have caused the death; the person might have died at that time, whether he fell or not. The fall may have resulted from his response to something he was experiencing while dying.
Sometimes people wait for some other reason: perhaps a grandchild’s birth, or a son’s graduation, or a family member or friend who needs to say goodbye. We've heard a lot of these stories - this is probably the most recurring theme we're familiar with. But what's new to me is the information that some people choose to die when their loved ones are away to spare them the anguish of witnessing their moment of death. Some even choose to die alone particularly those who are very private. (Uh-oh, that's me! Wahaha...)
In the book, here's a common story to illustrate when a patient chooses to die when their loved ones are away: Family member/s or friend/s has/have been by the patient's bedside for days or weeks. One random night, the patient tells them to get some rest. That same night, it is when the patient chooses to die. If you've experienced something similar, instead of feeling guilty for not being there, also consider that maybe it is how the patient wanted it to be.
In the book, here's a common story to illustrate when a patient chooses to die when their loved ones are away: Family member/s or friend/s has/have been by the patient's bedside for days or weeks. One random night, the patient tells them to get some rest. That same night, it is when the patient chooses to die. If you've experienced something similar, instead of feeling guilty for not being there, also consider that maybe it is how the patient wanted it to be.
That's surprising info for me - that many dying people are able to exercise some control over their deaths - of the time, the circumstances and the people present.
A long time ago, when my dad passed away and I was trying to better understand the grieving process, I read somewhere that one of the stages you undergo is guilt where you try to connect yourself to your loved one's death even if there is no direct connection. It could be thoughts like - if only I did ___ or if only I was there, maybe he would still be alive.
I like what the authors wrote in the book. They said -
Understand that if the dying person wants you there when death comes, you probably will be there; if he doesn’t, you probably won’t. So keep going about the business of living without worrying about whether you’ll be there or not, and don’t feel that you’ve failed if you aren’t there when it happens. Recognize it as the dying person’s choice and possibly a gift of sparing you.
Beautiful insight, right? Especially after knowing that the dying could exercise some kind of control over their deaths. Thus, if there's some kind of guilt, regret or unresolved feeling that has been bugging you over the death of a loved one, understand that perhaps that was how he/she wanted to go.
So many learnings from the book. Hopefully knowing all these would help us assist those who yearn for care, closure and reconciliation should the need arises.
