Tuesday, December 9, 2014

Final Conversations: Helping the dying transition from this world

Although entering hospice is a time focused on urgent and immediate needs like symptom management, once the stresses associated with admission abate, more person-centric conversations can take place. They are always meaningful.

The Condolence Coach encourages you to be open to opportunities for these final conversations:
  • Speak with the dying person.
  • If you have a friend with a dying family member, you can plant the same seeds of reflection, by "wondering out loud":
    • "Do you think your mother has any last wishes?"
    • "I'd like to tell her how much I appreciated being invited to stay for supper when we'd play after school."
    • "Would you like us to sing the old Christmas carol duet to her?"

Talking about life accomplishments is an important source of validation and peace.

Arbor Hospice social worker Rebecca Faszcza, MSW, explained:
“I try to encourage discussion about the patient’s life satisfactions and achievements. Establishing a rapport can begin as simply as asking, ‘Tell me about yourself, have you always lived in this area? What did you do for a living? (and if age appropriate) What have you enjoyed in your retirement?’
It is so rewarding when I can facilitate contented reflections for the patient, and deepen the admiration and understanding of their family. Recently, a patient opened up with fond boyhood memories of his parents. He gratefully remarked, ‘It’s so good to remember those times.’ His family delighted in stories of their heritage, saying, ‘Wow- you never told us that!’”

No matter how old we are, acknowledgement feeds our spirit. 

Say it while you can.
  • “You started out with a saw and a hammer, and now the construction company has 80 employees!”
  • “We’re so proud that you were a ‘Rosie Riveter’ during the war years.”
  • “You raised us by yourself and never complained.”

Talking about things left undone may reveal something important.

Some things--like projects or paperwork, can be satisfied by a work session with note taking, sketching a diagram, bringing documents to a bedside and listening attentively!
  • “I never got around to finishing that wiring in the attic.”
  • “I hid some savings bonds in the bottom of my sewing basket.”
  • “I never told you this, but …”


Talking about hopes for special experiences can be part of the end of life journey, too.

Have you asked any of your loved ones if they have a bucket list? A bucket list states actions and experiences sought before death. It may be committed to memory or paper, composed thoughtfully or on a whim. Social worker, Rebecca, likes to help patients honestly face life’s loose threads...and sometimes, there’s a way to weave them to completion.
“If they express a dream to do something that is now out of reach, I might say ‘there’s no fix for that,’ but encourage them to talk more about it, learn about it with movies, pictures, the internet. What’s most beneficial is getting it off your chest by talking about it. Patients really relax and even enjoy the ‘armchair traveler’ experience.”

  • “I thought about riding a motorcycle cross country.”
  • “I always wanted to touch an elephant.”
  • “I wanted to take a hot air balloon ride.”
These conversations should be light, prompt laughter and imaginative musing. Pull out your computer and show your loved one some YouTube videos of those bucket list adventures.

Adults have dreams, too

While children in hospice are often treated to wonderful experiences through Make-A-Wish interventions, Rebecca understands that adults may have a longing for a final visit with someone.

“Many times, a terminally ill patient just wants to see out-of-state family. If physical circumstances allow it, we encourage them-with family help--to make the trip. I will coordinate with a hospice at their destination, to ensure they have support in case of an emergency. And when he or she returns will photos and lots of good memories, they are in a peaceful place.”
If a longing to see distant relatives cannot be physically managed, consider setting up video chat sessions with Skype (for Windows or Android) or FaceTime (for Mac or iPhone).


Tweak the timeline of a special occasion.

Arbor Hospice Lead Spiritual Care Coordinator, Chaplain Diane Smith, has frequently officiated at bedside wedding ceremonies. Though unofficial, the ritual enables a beloved family member to witness a milestone moment. “I support their hopes and ideas. Family cooperation is great: one bride bought a special dress, a violin was played, and mom brought and served cake.”

Is there a final conversation you can have with someone, today?

Remember that sending a note to a terminally ill person is also an option. The Condolence Coach addresses what to say in this post.

Thank you for caring!

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