The sacred moment of death - that is the goal for those of us who work with end of life. Guiding, supporting and teaching those present what is normal in dying and what is not. What is fixable and what is not. What is painful and what is not. What to do and what not to do. What to say and what to be silent about.
All the work we do leads up to the moment of death. Our goal is to guide and support those present through the moment the last breath occurs.
How do we do that? How do we support and guide? We first give information. We teach the signs of approaching death. Teach what is normal and what is more challenging. We give guidance as to what families or significant others can do while labor is progressing.
Here are my thoughts:
In the hours before death, when the person is not responsive, suggest that each person present spend time alone with the person who is dying. To talk with them, tell them everything they have wanted and need to say, the good, and even the challenging.
Sit by or on the bed, hold a hand, lay down in the bed, cuddle, whatever your heart guides you to do. This is their gift as well as a gift to the person who is dying. The opportunity to address “loose ends,” to say those things that were never said.
The person that is dying is processing their life. By sharing innermost thoughts and feelings with them they are giving their special person more pieces to their puzzle of life.
Now is the time to talk with those present as to what is about to occur. Explain how the breathing changes, about the sounds they may hear, the words that won’t make sense, the often strange and unusual facial expressions they may see. All that is part of the labor of dying.
By guiding them you are showing those present that nothing bad is happening, nothing pathological is happening. This is how people die. Dad or grandmother or friend or husband are expressing the effort to release them from their body.
Once death has occurred encourage those present to say goodbye to the body again before calling the funeral home. This will be the last private time they will have with their special person, give them that opportunity.
Through this support and guidance you are creating the sacred experience for those present and that experience will become their sacred memory. They will carry that memory with them forever.
This is the work we do. This is the goal, the culmination of our time spent with families and significant others. This is the gift we can give them.
Something More... about The Sacred Moment of Death
For those who are educating staff, students, new hospice workers, end of life doula programs, I encourage you to use my comprehensive DVD THIS IS HOW PEOPLE DIE as a training tool. Our new hires don't understand that caring for a person at end of life is different than caring for someone who will get better. When the whole team is supporting families and patients with consistent care, the morale rises as do CAHPS scores.
8 comments
I wish we had had end of life help with my Daddy. We were all thee with him and I talked to him and told him who all was there by name. I know he heard me.
We lost our only child on 6/18/17, Matthew at 28 1/2 years old. He was diagnosed with Duchenne Muscular Dystrophy right before he was 5 and went in a wheelchair at 15. He could drive until he was about 22. He loved cars and driving around was his independence. Matthew and I were Mother and son soulmates. He was my life. He was in stage 4 of congestive heart failure when he started coughing up blood and within 4-5 months. We had many long talks during those last months. He was coming to the realization of losing his life. He said, “but I’m only 28”. We cried and cried. He said he thought he had 1 maybe 3 years left, but in 4 shorts months he was gone. We read on WebMD about CHF, but I guess our hearts and minds were protecting us. We went to see Journey in concert on 6/11, and 4 days later he said call 911 and we went to the ER here in Union, SC. They used positive air flow to try to get the fluid off his lungs, but he wanted to take the mask off, he said, “but Mama I can’t breathe”. They gave him Ativan and then Valium to try and relax him to keep the mask on so they wouldn’t have to intubate him. The helicopter medics came in and was getting him ready to take to Spartanburg Regional Hospital 30 miles away and they closed the curtain and took us to a room. His heart had stopped 3 times and they got him back 3 times, which was a miracle because his heart EF was only 20%. There was no brain damage I found out afterward. He slept until the next day. He opened his eyes but couldn’t move anything. He only had facial expressions. His muscles were weak and being intubated made him weaker. I just kept say I love you and told him to squeeze my hand which he couldn’t. On the 2nd day when I said sweets my hand he moved his thumb 3 times very slowly as I held his hand. On the 3rd morning he was still intubated but he looked up and smiled several times as if he say loved ones and then he looked up higher and opened his mouth and had facial expressions of “awe”. I know he saw Jesus and Heaven. That day around noon they took the tube out and about an hour later told us the fluid was building back up on his lungs. After talking with both doctors we told them DNR. Matthew didn’t want to be confined to a bed or be on a breathing tube he had told us before. We had a time with the main nurse, if it wasn’t for the RT I don’t know what we would have done for emotional support. Matthew passed away that day at 3:12pm on Father’s Day. His Daddy had told him it was ok to go that we would be ok and tears rolled from his eyes. There’s so much I wish I’d said but I was protecting him not telling him what had happened and my mind was protect me I guess because even though I knew what the doctors said I didn’t think it was the end. I’m crying as I write this. He were both at his bedside and I was hold his hand saying I love you honey. His was almost squeezing my hand and I asked his Daddy would his muscle tighten up because he’d not done that before and I know he heard me say that. I let his hand go and said honey I’m going to get our things ready because they’re going to move us to another room. And it wasn’t 2 minutes until the RT called his name out and he was gone. It took me 2-3 years to realize he was holding on to me because he was about to go! My heart is forever broken. He was our only child. We prayed for him and I’m so glad God let me be his Mother. He was a precious soul. I know he is in Heaven and I can’t wait to see him again. I haven’t missed a day 5 year and 9 months visiting his gave. I will never be the same! Oh how I wish we had had end of life help!!!
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BK Books replied:
Oh Mitzi, thank you so much for sharing your and Mathew’s journey with me. He indeed sounds like a special soul who came to share a bit of lifes’ time with you and your husband. Let how will you go on living be your gift to him. My blessings are with you. Barbara
Dear Barbara,
I may not respond to all of your wonderful postings, but please know I read them when I make time and appreciate every single one of them.
Thank you for your continued support and caring.
Sincerely,
Lolita Silicani :)
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BK Books replied:
Hi Lolita, Glad you find my posting helpful. Blessings! Barbara
I lost my mom 8/29/2022 to dementia. Unfortunately, I did not come across your books until afterward; and that is okay:) I was able to lay next to my mom around 6:30 a.m. the morning of her passing to tell her it’s okay to go when ready; and how much I love her and I will be okay. She expired at 8:15 a.m. As emotional as it was to watch her take her last breath; I am ever so grateful to have been there with her. Miss her so much:(
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BK Books replied:
Hi Barbara, You and your mother created a beautiful gift that you will be able to treasure forever. Blessings! Barbara
Beautifully expressed, especially about the dying person “processing their life.” It is so important for others to unselfishly support this inner work. Despite grief, love and forgiveness should perfume the room.
Loving blessings to all readers
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BK Books replied:
Thank you Deborah. Blessings! Barbara
I love and have found so useful everything I have read of yours. Continue your good work. We all need you.
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BK Books replied:
Thank you Marie. Blessings! Barbara
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