Five More Breaths: Be Patient With The Dying

Dear Readers,

It is a pleasure to announce my new book:  Path of Possibilities, 101 One-Hundred Word Stories, available on Amazon.

What is it about? These very short stories (a genre known as Flash Fiction,) are grouped in four sections: 

• Adventuring in nature
• Being human
• 'Bizarro' -- strange circumstances, and
• Consciousness and spirit. 

I enjoyed every hour of writing and believe there is something here for every reader. I hope you'll check it out.

Today, I want to share a story (#100), derived from one of my vigiling experiences; of course, names have been changed.

Five More Breaths

Elsa headed home for supper with the cat. “Bring a jacket back; it cools after dark,” called Rosie, checking Joseph’s pulse. Mouth breathing now, his cage of ribs as delicate as bird bones, lifted slightly. She raised the window sash before returning to Joseph. I sensed a passage for spirits as she coaxed, “You get going now. We love you but those angels are waiting.”

Stillness. Satisfied he’d departed, Rosie removed the pillow, straightened the sheet, and left. I stayed, watchful. 

Breath. Space. I stayed. 

Breath. 

I’m still here, Joseph. Are you? 

Breath. Life’s last emberglow. Breath. 

Lifting. 

Breath. 

Free.

💜💜💜 from Path of Possibilities, 101 One-Hundred Word Stories ©2023 Deborah Rochon Roberts

Author image

Have Patience

This vigil reminded me that, despite the physical signs of active dying, we must be patient! Vigiling is the gift of presence that abides with whatever is happening. We recognize that this is not some quantifiable medical phenomenon.

This is a sacred time in which the dying person is perceiving on another level (yes, even when unconscious,) and they will choose when to leave.

Sometimes called Cheyne-Stokes breathing, there may be slowing, often irregular and widely spaced breaths--just as this story's gentleman experienced. Be attentive...and patient. In another home vigil, the nurse arrived within 30 minutes of our calling; death had occurred but this wise professional checked carotid and radial pulses and then spent a full minute listening to the heart with a stethoscope before pronouncing and noting a time of death.

I always find it useful to step away from my long-practiced experience to remember that we each may have a first time at the bedside of a dying loved one. It is such a profound time, overflowing with a blend of love, sadness, relief, fear, and uncertainty. For these reasons, I return to my blog's urging to share support and comfort with the grieving.There will be time for words and time for quiet presence. If it's been awhile since you were called to confort with condolence, browse this website--there are so many topics-- trust your caring intentions, and begin.

Thank you for caring...and sharing!

 

The Gift of Last Words

Twilight

Twenty-four hours before his transition, weak, and sedated for comfort in his home hospice bed, Raymond called me over and said softly, "I may not be able to talk tomorrow; there are some things I'd like you to write down."  I took the notebook I'd been using to log medication doses, opened to a new page and replied, "I'm ready, Ray. I'll write down anything you wish."

Over the prior three days, once we had found the right drugs to support his comfort, Ray had spent many hours in a twilight of sleep. Disease symptoms still broke through occasionally, but there were longer intervals of peace. I believe, as do most hospice professionals, that end-of-life sleeping is often a time of life processing, healing of psyche, and soul invigoration. 

Detaching

Raymond Chappa
Author Image

While he loved gentle walks in sunny Arizona, my late husband was also a spiritual contemplative, spending innumerable hours reading and meditating: going inward. Detaching is a phase in dying, and can occur even months before releasing the body. It is the phase of acceptance and peacemaking; it may involve time with others, exchanging goodbyes and expressions of gratitude. For many though, detaching from the worldly, social realm is a choice to "listen" to another realm:  the heart space, the space of Spirit, the space of loved ones on 'the other side.' This is well documented and in my own hospice vigiling, I have witnessed seemingly one-sided conversations, or nodded when a glazed-eyed woman pointed to the window and said happily, "Look at the angels!"

Sacred Space

Author Image

Readers of this blog may have read my posts about Sacred Dying. The philosophy encourages creating an environment that recognizes death as a sacred mystery rather than a medical event. Ray and I agreed that in his final days, I would care for his comfort and honor his wish for privacy and peace. He wanted his unencumbered Consciousness free to do its work, free from emotional visitors or phone calls. Yes, it was frustrating for distant family who demanded he take a call, but I was committed to be his guardian angel, bearing a fiery sword if necessary.

Last Words

And so, in a lucid interval, Ray dictated messages as I scribbled. Profoundly aware that he had harvested these words from a very deep place, I cherished each pen stroke.

1. Ray expressed a sentence of thanks to a person who had provided support during a life-changing difficulty many years prior. He asked me to pass the message on.

2. There was a brief message to his brother, with a final wish for a pending inheritance.

3. Finally, he simply shared: 

"There is no one among you

 that I do not love.

Thank you.

No other words are necessary."

Now, two years after his transition, as my own spiritual studies guide me to new awareness, I remember that I was handed an essential Truth by someone very dear, as he stood in the doorway of eternity. It is a Truth we have read in the world's great sacred books. It is a gift.

Thank you for sharing and caring!

TB or not TB: Volunteering for a hospice

Author image

Courage? Not Necessarily. Encourage? Yes!

 I have been volunteering with hospices for thirty+ years. Last year, I prepared a resume of my experience and was gratified by not only the enduring commitment to this work, but how far I've come in understanding its nuances. It is such rewarding work because it courageously embraces the most powerful reality of life:  our human form will reach an end point or as some term it-- a passage of transition to being without a body. Just being present to someone in the terminal phase of life and then, their active dying phase, feels sacred.

 

Passive and Active Encouragement

Honestly, I don't think 'courage' is required to be a hospice volunteer; instead, your gift is serving as a presence (listening, holding a hand, vigiling,)  and while these are forms of passive encouragement, you may recognize a need for active encouragement. Both forms of encouragement can occur whether the patient is conscious or unconscious.  When appropriate (determined by your skills of observation and intuition,) I believe a hospice volunteer is truly effective to:

Actively Encourage the person who is dying that...

• their life has been unfolding exactly as it needed to.
• they did the best they could with what they had.
• their legacy is principally about love and kindness; money and stuff are secondary.
• they can make peace with unresolved issues by simply doing so in their heart.
• it is now time to let go of this world, but they are not alone as they do so.
• the 'other side' awaits them.

Your Role with Family

A hospice volunteer often has contact with family--be it a spouse, partner, or adult child. Here again, your gift is serving as a presence: providing a respite, listening non judgmentally, quietly companioning during a vigil. Sometimes you will recognize the family member's need for active encouragement and then, keep it caring but simple. You may coach them on what is happening in the dying process with their loved one, but you are not there to counsel or give life advise. Let your heart, spirit and experience lead the way. 

Author Image

Here are ways I believe a hospice volunteer is truly effective in active encouraging:

Encourage the survivors that...

Even when we don't understand its timing, the circle of life ends.

Even if it sometimes appeared terribly difficult, their loved one lived the best they could with what they had.

During the dying process they can find peace with spoken words or a hand held; later, choosing heartfelt peace unfolds with forgiveness, acceptance, letting go.

The 'other side' awaits their loved one.

If you hear of specific concerns for a survivor's future--be it funeral arrangements, family or life matters, please pass that observation on to the hospice chaplain, social worker or bereavement support coordinator. Just say: "I think one of our hospice staff can help with that; I'll let them know."

Encouragement when you work in bereavement support

• death under tragic circumstances changes all survivors: give yourself time to grow into and past the crippling pain by reaching out for strength. It's available through support groups, counseling, clergy and spiritual care, online forums and activist groups.
• the legacy of a loved one has already been given; in time, you will find it in your heart.
• grieving is a personal journey--a nonlinear and fluctuating process of your own making and timing.
• allow yourself space, time, privacy to feel the power of this shared love, grieve its physical conclusion, and trust that in time, life will find a new equilibrium.

Before you begin service as a hospice volunteer

Be assured that you are needed! Volunteers fill essential roles and bring a unique dedication, often with a personal history and sensitivity to needs. It is suggested that you be at least one year beyond a significant personal loss before placing yourself in this type of volunteer role; the volunteer coordinator will probably ask about this. Volunteering in almost any human services setting may require annual testing for tuberculosis (TB) with a simple skin test. The Mayo Clinic notes:

 "Tuberculosis (TB) is a potentially serious infectious disease that mainly affects the lungs. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes."  

So it is a mutual safeguard, along the lines of other Universal Precautions (such as thorough and frequent hand washing, use of mask and gloves at times,) necessary in patient care settings. 

Expect paperwork! 

A reputable organization will require an application, background check, and/or

 references. With the reality of Covid 19, your vaccination status and documentation will be requested. Annual flu shots may be recommended but may not be mandatory for the organization. You'll be asked for a recent photo so that a photo identification badge can be made. 

Expect your own questioning, a sense of wonder, surprise, and even fear. Accept that dying and death are cloaked in profound mystery, almost beyond comprehension; but hold faith in its universality and the fact that humans crave love and companionship-- even when we vehemently express the opposite! To find a volunteer role with hospice, simply search "hospices near me", click on sites' volunteer tab, and consider calling the volunteer coordinator to learn more about the work. 

Thank you for sharing and caring!

Remember To Breathe

Author image

The Growing Through Grief series

BREATH-- that free commodity which keeps us alive--is easily forgotten when we are stressed!  Rather than reaching for more breath, we reach for potato chips, ice cream, alcohol. What are you reaching for as the world of Covid continues to constrict our lives? We may tighten up with fear and uncertainty: a reaction that creeps into other aspects of living and we find ourselves asking 'who and what do I trust?'

So many of us experimented with finding a mask we could breathe through! Were you more at ease in paper or cloth? Many people chose to wear plastic face shields, and many others defiantly denounced the masking recommendations and rules. In times of powerlessness, the ego--and the survival instinct--drive us to grasp and assert power somewhere. But as we see on the news, vulnerable people often exercise very poor power choices.

Return to simple

Recently, a woman told me her doctor “prescribed” breathing exercises. There was no respiratory apparatus to buy or app to download; her instructions were simple: slowly count to 4 while inhaling, then slowly count to 4 while exhaling; repeat the cycle for ten minutes, daily. 

Breathing is an essential part of yoga. Perhaps you've heard or tried the breathing practices of pranayama or left nostril breathing, both of which have medically proven calming effects.

A few years ago, I learned a short song that delights and centers me:

Breathe in

Breathe out

That special feeling--

That's what it's all about.

When trouble comes around

there ain't no doubt:

Breathe in

Breathe out.

There are various melodies, but why not make up you own, or chant the lyrics, repeating the verse a few times. And of course, practice the breathing in the midst of vocalizing.

Return to trust

Breathing is trusting. Air is free. We do all we can to ensure someone with respiratory challenges is supplied adequate oxygen. As occurs in many patient settings, my late husband, while in hospice care, wore a nasal cannula (the small flexible tubing with two prongs that sit just inside the nostrils.) He grew more comfortable as I gradually increased the flow rate from the oxygen concentrator to a mid range, as his nurse advised. 

Take time to exercise the calming power of breath!

Thank you for caring and sharing!

Journey of the Mind: Co-Meditation with the Dying

 Sacred Journey

Off and on for over twenty years, I’ve been a hospice volunteer and my favorite duty has been sitting with the actively dying. Tough, right? Actually, I view dying as a sacred journey--the counterpoint to the wonder of birth and thus, it’s a privilege to share that space with someone. One afternoon, I was called to visit “Cheryl,” who was quickly declining. Medications had been administered but I found her restless and distressed after a fall and painful arm injury. “I just want to go into the woods and die,” she cried. “Well, you can, Cheryl. Let’s go together,” was my reply.

Author image

Gently stroking her hand, I described our walk from the sidewalk of a noisy Tucson street into the breeze whispering stillness of the woods.
Underfoot, the dense loam of brown leaves and pine needles hushed and softened our footsteps. Pale light filtered through the forest canopy; a squirrel darted by and unseen birds chittered now and then. “The woods smell so sweet; why don’t we sit on this big log for awhile, Cheryl.” In the afternoon stillness, our breathing slowed and words were unnecessary. We had arrived at the doorway to peace, and Cheryl left her body a few hours later.

Author image

Freedom of Spirit

Jack Kornfield, author and a key teacher of mindfulness, calls this experience “freedom of spirit.” No matter what circumstances weigh on your physical life, your spirit--the ‘you’ behind the flesh--is always free. Kornfield reminds us, “your mind is not limited to your head,” so you need only be still and aware to enter unrestricted spaciousness. Older adults often find it easier to settle in a comfy chair, close the eyes, enjoy some full breaths and then float in awareness. The seas and breezes of your being may drift through memory and gratitude, to a place of deep peace. Some people call it a ‘practice’ and use bells and rituals to get here. Increasingly, health professionals are putting down the prescription pads and pointing to quiet places. 

Comeditation

If you find yourself with a loved one who is dying, or struggling with an illness, follow my example of introducing comeditation. It has been proven to calm physical and mental distress. It can be focused on natural, rhythmic breathing without words, but an explanation to the person you are caring for, helps them orient to the calm. It is also important to note that the dying person does not need to be conscious to benefit!

You can make a difference:  pull up a chair, take their hand, and ask: 

If you could be some place else right now, where would you go?

What a wonderful gift to offer! If their go-to place is something you can describe, do so; if they feel able to describe the journey, encourage them to be as vivid and sensory in their description, as possible. But for the fullest calming benefit, don't turn it into a dialogue. Finally, once you both have "arrived" at the place, sit quietly with eyes closed. Let the journey last for its comfortable duration. 

Read more about impermanence and mindfulness:

Impermanence: changing how you cope with change

Read more about mindfulness:

Finding pleasure and peace in slow

Thank you for caring...and sharing!

My Turn to Grieve

The Growing Through Grief series

I am known to many as the one who is easy with matters of dying and death. I can discuss ways to make the end of life sacred, the paperwork of death, funeral options and military honors. I do this with the conversational tone you would use to discuss the price of organic veggies, local car repair shops, or summer travel plans. For over ten years, I’ve been known as the Condolence Coach by a world of readers, but I am long overdue for a new post, and here’s why.

Last fall, when my mother entered hospice, my zeal to discuss death’s details and grief journeys, withered. In truth, it cowered in the corner, shunning all but the most necessary social contact. Sharing the life-altering news became my daily ‘small talk.’ A dog walking neighbor might comment on last night’s wind and I replied: “my mother is in hospice.” Meeting another shopper at the grocer’s card rack, I offered, “my mother is in hospice but I think she’ll make her 90th birthday.” To my relief, people were kind.

Perhaps it’s not accurate to say I lost my 'zeal,' when the real loss was ‘innocence.’ While my experience and knowledge as a hospice volunteer and funeral professional deepened insight and compassion, it was always ‘someone else’s loved one.’ Detachment preserved the innocence of my heart. Now, this was my heartache.

Sadness Selfie

Across the country, heavily sedated with the standard hospice cocktail of morphine and lorazepam, Mother wasn’t taking birthday phone calls. I quelled the panic of her slipping away by reaching out psychically. I imagined her approval and laughter as I played dress-up with the pink paisley poncho she had sewn for me fifty years ago.

Author Image

Digging through my jewelry box, I ringed its neckline with lapel pins she’d given: quirky cat, pine cone, straw dolls, and artsy swirl. Like the young bride seeking her mirrored reflection on the morning after deflowering, I sought mine and took a selfie, seeking to preserve the transforming mystery of my profound sadness. 

Until I was called to serve at my mother’s deathbed, my vigil occurred thousands of miles to the west with intense meditations, journaling, tears, and talks with my husband. I began to trust the truth of a message I’d texted when she was still able to communicate: 

“You are a fabulous woman:  

and will always be so, with or without a body.”

Photo used with permission,
Jim Hunter, Fairbanks, AK

Sacred Grieving

I began reading Grieving- the Sacred Art, Hope in the Land of Loss by Lisa Irish. Long believing death is not a medical event but a sacred one, I embraced the idea of sacred grief. Initially stunned by what Irish calls “a swirl of painful and overwhelming emotions,” I felt validated by her words, accepting that my moments of disorientation were sacramental emotions. Irish promised that if I did not identify grief as ‘the problem’ it would become ‘the solution’ and offer me hidden gifts. 

The first gift was an opportunity to vigil at my mother’s bedside. Though I was not new to this process, the intimate ministry of care for someone I adored was as riveting as it was taxing. ‘Profound’ remains one of the few useful words for this time.

Photo used with permission,
Jim Hunter, Fairbanks, AK

In the months since my mother’s death, I have received more of grief’s gifts: peace, wisdom, and gratitude. Glimpses of siblings’ grief have proven that we all walk personal paths through loss. My long held advocacy of the value of condolence notes, was affirmed. After I shared the news of my mother’s death--along with the narrative obituary I’d composed, the arrival of sympathy cards and supportive emails became an invaluable balm. I shared most of them with my family, thus multiplying their comforting impact. As the Condolence Coach, I reversed my rigid opposition to electronic condolence; for expediency and privacy, it has a place.

Sacred grieving deepened my spirituality. I celebrate my mother’s legacy of preferences and mannerisms. I believe her soul remains within reach through love. I find that memories should be curated-- as enduring or disposable. I strive to avoid regrets-- those shoulda, coulda, woulda’s-- which only sour the sweet gift of recollections.

Am I done grieving? Deadlines and calendar pages have no place in this sacred experience. I have--and will have--days of longing for my mother. 

Author photo

In 2014, I reblogged Elaine Stillwell's article, An Emergency Kit For a Bad Day . She stressed the importance of self-care, and the value of being prepared for the unexpected "black days" that can arise after a loss. My emergency kit also includes outdoor exercise, meditation moments, gratitude for a birdsong greeting, the surprise of a heart rock in the trail, and volunteering in my community. These are the stepping stones for my inner peace, one day at a time.

Thank you for caring!

Beth Surdut: Paying Attention is an Art

(Source)

Meet Beth Surdut: Environmental Artist, Textiles Painter, and Writer. I had the pleasure of meeting this deeply spiritual and deeply earthed woman, during a recent gallery reception for her wildlife art.

Creator of "The Art of Paying Attention," a series of illustrated wildlife radio essays and true adventure stories heard and seen on NPR, Beth is always watching and listening. From the field or face to face, she raises the bar of attentiveness, for each of us. I introduce her today because she understands the journey of death.

Sacred Journey

Let us revisit the concept that death is NOT a medical event, but a spiritual one. It is sacred but often, only the dying person knows this! Beth told the story of painting a silk scarf to be gifted to a woman with terminal illness. "This will help," said the dying woman as the scarf was draped around her shoulders. When deeply asleep, the scarf could be removed and freshened but otherwise, "Where is my scarf!?" the woman demanded. Beth noted: "the healing scarves I make (unless otherwise requested) contain the Hebrew r'fuah  shleimah (complete healing, the short form of a prayer requesting the complete healing of body and spirit), whereas  a tallit-- a prayer shawl-- is for meditation that is not  necessarily associated with distress. Both are made with kavanah (intention) and offer places of comfort."

Beth also explained, for my benefit, the purpose of the Jewish prayer shawl, Tallit. As it is placed over the head and drawn down over the shoulders, the wearer enters a world of soul and God, absolute truth, the ultimate All. Prayer and meditation should be a journey--of seeking and enlightenment.

'Sacred Dying' is a term coined by the late Dr. Megory Anderson, and a ministry I described in my post Silent Night, Holy Night: Sacred Dying is another reason to write condolence. Whether you are a hospice volunteer, friend or family member of a dying individual, your presence at the deathbed can be uplifting if carefully considered. Vigiling is not for everyone, and Sacred Dying mentors stress that behaviors such as wailing and denial at bedside are disturbing to the journey and work of dying. I encourage readers to sign up for the 10 Tips to Vigil & Establish Sacred Presence.

Comfort objects

Clearly, acknowledging the sacred journey with a special scarf such as those created by Beth Surdut is like hanging a welcome banner:  My flesh and my heart may fail, but God is the strength of my heart and my portion forever. Psalm 73:26

As life, ego and cares falls away, a special object of comfort-- if given with great love-- focuses attention on a good death. Do you remember the scene in the 1981 movie, Arthur, where Dudley Moore brings gifts to his dying butler, Hobson?  The seemingly ridiculous gift of a basketball became a true comfort object--an undemanding companion.

[Source]

What would you choose for a comfort object? Is there someone you know who needs one?

Thank you for caring!

Memorial Service Surprise: being quoted because you cared

Photo used with permission:
Jim Hunter, Fairbanks, AK

The memorial service was on Saturday afternoon at 2 o'clock, but my newly widowed neighbor had advised: come around 1:30 because it will get busy.

Our community has a sizable population of seniors. We enjoy varied interests, often volunteer, we have setbacks and sickness, we die.

You know how it is with neighbors

 

You connect with some, others are strangers but you know their car or truck. David was a good guy and being really sick didn't make him a hermit. If you needed a ride or a tool or advice about a snake in your yard--he was your go-to-guy. But he died.

We'd been to his bedside once hospice took over. His grip on my hand was fierce as he searched his weary brain for Bible citations, asking his wife to pull the Good Book down from a high shelf. Lisa opted for an iPad Concordance. Verses were read, but his hunger would not be met by the sagging slice of blueberry pie nearby. David was ready to harvest the crop of his life's sowing.

Led by David's widow to the front row at the memorial, we were greeted warmly before the service, by dozens of the congregation. 'Neighbors' had embarrassingly-exalted status here. Over and over, with handshakes and smiles, I repeated our appreciation for the family we came to support.

The designated speaker, Lamar, shared his own story of David's skill, kindness, and 'righteousness.' This go-to-guy had touched many lives. Reaching for a sheet, Lamar said, "Let me share from a note that Lisa received."

I began to hear my own words..."We were very saddened to not have more time with David. He lived the love-thy-neighbor Golden Rule..."

Photo used with permission:
Jim Hunter, Fairbanks, AK

Writing a condolence note, sharing your thoughts and memories in a sympathy card, is a gesture that touches more lives than you may imagine. It is a wonderful prospect, really: you have written to one person (in this case, David's wife) and yet, all who visited Lisa after the death, read-- and were comforted by-- the cards she had received. This is why a handwritten condolence note is so much more valuable than an electronic message:  it can be shared in a way that resonates with deeply-felt presence.

Don't let the prospect of unexpected readers scare you off! 

My Top 5 Keys for a Comforting Condolence Note
is a reliable aid; using two or three Keys is all it takes for a sensitive and comforting note.

1. I am very sorry.
2. I feel so fortunate to have known (use name) because___.
3. You have been a wonderful ___ (state relationship and cite an example, if possible.)
4. My favorite memory of (use name) is ___.
5. What I admired most about (use name) is ___.

Feel encouraged? Keep reading! 

Why Is Sympathy Sweet?

Don't Rush Your Condolence Note

The View from Downward Dog: Little Observations

Thank you for caring!

Was It a Peaceful Death? Opening the Door to Healing Conversation

The everywhere-ness of life

Source: Image © Michael Jastremski / 2014-04-28

Not long ago, a friend known for her goodhearted nature confided to me that a member of her church had lost a family member; it was announced to the congregation during the routine list of meetings, fundraisers, and children's activities. "Later that week, I saw her in the grocery store, and felt tongue-tied to say anything. I didn't want to upset her." This hesitancy is very common, I explained to my friend. But I assured her that a brief acknowledgement like "I was sorry to hear the news of your dad's death," has great value. I also explained that feelings of grief reside with the grieving: caring remarks do not cause grief.

When I learn of a death during a conversation 

Feather in bush
Author photo

I like to ask questions that immediately inform the family member that I am not afraid to talk about death. I want them to lower the social barrier they've learned to quickly erect; to understand that I care about their experience with this crucial moment of our humanity.

Before you ask a question

You too, can reverence this deeply moving experience by offering cues of invitation. But first, be aware of the situational moment! Are you or the bereaved in a hurry or obviously on the way somewhere? Have you met during a social occasion that dictates a light or celebratory mood? How much privacy do you have? Most importantly, tune into the person who had the loss. Something has prompted her to share 'my husband died in December;" so your compassionate interest certainly begins with "I'm so sorry. How are you [and your family] doing?" 

As you tune into responses and weigh the situational moment, you will know whether to quickly conclude with a hand on a shoulder, a hug, a suggestion to soon meet for coffee or a walk. If you are fortunate to sense the right blend of privacy and interest, you may begin asking gentle questions.

Begin with one question 

The Condolence Coach is not handing out free passes for nosiness. You do not have the right to pry, request medical details, financial arrangements, or confessions of grief's darkest moments. If you do not know the decedent's name, do ask, and as questions are used, include the person's name!

If the death occurred due to tragic or criminal circumstances

Compassionate interest begins by giving the bereaved a moment of control. Your one question should be: "Do you want to tell me about [it] [name]?" 

If the death was of natural causes such as advanced age, disease

Compassionate interest begins by acknowledging mortality. Your one question may be: "Was it a peaceful death?"

I follow up by asking, "Did you use hospice?"  Thankfully, end of life support has become the norm, with hospice providers routinely referred. Hospice is a specialized type of care that may address the patient's physical, emotional, social and spiritual needs; often, many support services extend to family caregivers. It can be comforting for a grieving person to speak about good end of life care because it acknowledges that something went right: one of the many caregiving and health advocacy decisions felt like TLC-- tender, loving, care.

If there was a hospice used, here are a couple followup questions:

Author photo

• What did you think of the hospice? 
• Which services or staff did you find most helpful?

Remember that compassionate interest and opening the door to healing conversation should not feel like an interview. At all times, allow the bereaved person to be in control. Be sensitive to cues of facial expressions, body language. Keep it relaxed and simple. The conversation will come to a natural conclusion like water filters into the ground at the end of a creekbed.

Be thankful

As the conversation ends, express gratitude for the trust and sharing you've been given. "Thank you for sharing this with me" is sufficient. Consider a warm handshake or pat on the shoulder--certainly a hug, if appropriate.

Learn more! Click on the topic links throughout this post to read other relevant Condolence Coach posts!

Thank you for caring!

Veterans at the End of Life: An Essential Salute

Veterans Day: "Some gave all, all gave some."

Source

In the United States, Veterans Day is a federal holiday, observed annually on November 11th. Not to be confused with Memorial Day (remembrance of fallen soldiers,) this is an occasion to recognize the service of men and women who have served in the armed forces. Their service was in a wide variety of capacities, in locations near and far. Some soldiers never used a weapon after basic training, and some rarely put theirs down.

War has shaken the world and mankind, innumerable times, so it is no surprise that Veterans Day coincides with other nations' Armistice Day and Remembrance Day, as well as being the anniversary of the end of World War I. And I use the word SHAKEN, deliberately.

I will never forget my vigiling experiences at the deathbeds of some veterans, who shake in their final hours. Agitation is a common occurrence in the labor of dying; Barbara Karnes, RN notes that "restlessness can be from a lack of oxygen but more than likely it is fear."  Support is frequently dispensed with medication, comfort care and calming words. But when a dying veteran experiences agitation, we can and should offer specialized support.

Scott Field, IL circa.1942. Library of Congress

Discharged from duty

 This summer, along with other hospice volunteers, I attended the Hospice Foundation of America video program, "Improving Care for Veterans Facing Illness and Death." It is important to recognize that not all veterans carry "emotional baggage" or bear a stoic, "battle ready" sensibility. Your patient or loved one's branch of service, rank, and job(s) may or may not impact their unconscious mind. One of the program panelists, Deborah Grassman, ARNP, shared great insights from her career as a hospice nurse at the Department of Veterans Affairs. I encourage readers to follow this link to Grassman's excellent essay, Wounded Warriors: Their Last Battle. She includes a long list of questions suited to end of life counseling when it seems necessary to discharge the veteran from the troubling demons of unfinished duty or guilt. But Grassman cautions professionals and companions:

"don't keep pushing; plant a seed."

"Golden Wings" by Suzy St. John

 Bedside basics

Some of the best bedside skills during an end of life vigil revolve around silence--though soothing or "favorite" music is appropriate at times; calmness in the room and gentle touch also promote a peaceful death. But when the person you are companioning is struggling with agitation (symptoms may include shaking, thrashing, groans or other distressed vocalizations,) beneficial intervention can go beyond medical options.

• If your loved one is conscious, gently ask him or her to share a thought or feeling. 
• Showing one or two service-era photos can prompt expression.
• Symbols touch and access our deepest selves; this is true even when dementia is present. Expressing gratitude and recognition of service through the use of ceremony and symbol is significant. 
• A hospice or veterans organization may be able to conduct a brief Honors presentation "on behalf of a grateful nation." But don't hesitate to step up with your own veteran tribute:  say a few words, play a patriotic or branch-of-service song, and attach a flag pin to their shirt. 
• Often, as death nears (this could be days, hours or minutes) the person is unconscious or 'nonresponsive' (despite movement or talking) and yet, these bedside basics can have a profound impact. I would encourage the Honors tribute even at this stage because the sense of hearing is still active.
• One of the most powerful interventions for agitation, advocated by Deborah Grassman, is the Hand-Heart-Connection: 
• Put your hand on the person's chest,
• take their hand and hold it on your chest, 
• breathe calmly and deeply.

"We are called to be strong companions and clear mirrors to one another, to seek those who reflect with compassion and a keen eye how we are doing, whether we seem centered or off course ... we need the nourishing company of others to create the circle needed for growth, freedom and healing."

- Wayne Muller

Thank you for caring!
Read more about my vigiling experience in Silent Night Holy Night: Sacred Dying is another reason to write condolence

Silent Night, Holy Night: Sacred Dying is another reason to write condolence

My end-of-life work has expanded this year to vigiling at deathbeds.

As a volunteer with a local hospital's No One Dies Alone (NODA) program, I am asked to sit with a dying patient for a few hours. When a family accepts the offer of NODA services, round-the-clock (or specific windows of respite) coverage are scheduled.

Silent Night, Holy Night

During my orientation with Chaplain Diane, I was asked to indicate which 4-hour shifts (in a 24/7 grid) I could serve as a 'compassionate companion.' At first glance, the choices were baffling; my mind quickly shuttled through my commitments and habits and I found myself putting check marks on 4 a.m. to 8 a.m., two days per week. That impulse has been wonderfully rewarding. It is nighttime when most families take a break, go home to rest, give pets attention, and squeeze in other life responsibilities.

Author image

I am called out weekly into what is always a Silent Night, a Holy Night. There are very few vehicles on the roads and it is pure pleasure to descend the ramp to the rebuilt freeway and take my pick of 5 lanes' white concrete streaking by. I say a prayer that my presence be helpful.

It's almost 4 a.m. when I log in at the nurses station. The 4th floor is bright but hushed and I enter the patient room, knowing only his or her name, age, and status for 'universal precautions' (i.e. if communicable infection.) "Hello, Stanley," I say as I approach the bed, "my name is Deborah. I'm going to spend some time with you tonight."

"Doesn't Deborah think about anything else besides death?" Sure, I do. But like anyone else with a passion, responding to a 'calling' delivers unparalleled satisfaction. 

Are you familiar with the dynamic of synchronicity? 

Carl Jung, a 20th century pioneering psychoanalyst, believed in significant connections between thought and occurrence. What we focus on may manifest itself in coincidences that may provide insight, aid and opportunity. I have often expressed that just as we consider birth a momentous occasion, death [and dying] should be honored for its mystery and significance.

Thus I synchronistically found myself in the Dewey Decimal stacks of 291.38. 

Allow me to detour for a moment and explain that the Call Number 291 is Comparative Religions. I do not believe books on dying should be bogged down by religious proscription, shelved A to Z between Atheism and Zoroastrianism. I certainly wouldn't want to find books on dying in Call Number 616, Diseases. May I respectfully suggest a reclassification to 269, Spiritual Renewal or the crux Call Number 218, Humankind. Can I get a Comment from a librarian, please?

I felt at home when my eyes laid on the spine of 291.38A Sacred Dying, Creating rituals for embracing the end of life. This is Megory Anderson's attempt to provide both "testimonial and handbook" on how to "reclaim death and dying for the person going through it." She acknowledges that the hospice movement has returned the family to the farewell, but cautions that solicitous concerns about grieving divert loving attention away from the person actively dying.

A theologian, author, educator and liturgist, Dr. Megory Anderson is the founder and executive director of the Sacred Dying Foundation in San Francisco.


Readers will be inspired by Dr. Anderson's skill and experience in creating meaningful rituals. With her insights and passion for "honoring the final hours of a person's life," she has created a set of tools which family members and caregivers can employ, mindfully, to enhance the transition from physical life. The Sacred Dying Foundation also offers Vigil Training for individuals and institutions.

Sitting Vigil

Sitting vigil is the term for companioning a dying person. It may be a time with or without an exchange of words. In many cases, my patients are in advanced stages of dying, unconscious, in a pain-managed dream state, generally unresponsive. Rhonda Macchello, MD, adjunct faculty medical advisor to the Sacred Dying Foundation notes:

 "Fundamentally, dying is a spiritual process and not a biological one."

That tips over a lot of our assumptions. Whether a dying person is conscious or comatose, comfort measures for the body are secondary. However, it is crucial to create a structured focus on the person dying, and it is imperative to assume full  function of hearing:  auditory input--whether discordant or soothing, has an impact. When caregivers, family and friends surround the deathbed with their veil of sorrow, a good transition is impeded.

Take it outside

It's true:  with few exceptions, the sense of hearing remains to the end of life. Conversation and squabbles among bystanders about medical care and decisions, expenses, funeral, wills, property, estates, fears, resentments, tiredness, inconvenience--and even sorrowful crying--are burdens to the spirit of the dying person. Step out of the room and out of 'earshot'.

Gifts for the dying

Death is sacred because of its mysteries and profound emotion. Stay focused on that. Enhance the reverence with soothing touch, peaceful music, pleasing scents, soft glowing light...
Forgiveness, gratitude, love...

"Rituals transform one state of being into another."

 Dr. Anderson uses the examples of blowing out candles on a birthday cake and rites of passage such as a first driver's license to describe the ritual triggers for thought, insight, and transformation. She acknowledges that religious rituals and symbols can be a part of vigiling if they are meaningful to the dying person, but suggests that personalized rituals will often address deeper issues. A special memento, a favorite toy, a religious article or often, the creative repurposing of an everyday item can be used to exercise the psyche in resolving concerns. The desired outcome is always a readiness to let go of the body, to 'leave'.

I loved her story of taking a sheet from a hospital's linens shelf, and tying knots to represent the concerns of a dying person. As each topic is discussed and 'let go', a knot is untied. Finally, the sheet is liberated to become a huge sail, its four corners held by family members who joyfully loft it overhead. And though this ritual is for the dying, the symbolism of freeing their loved one's soul is deeply comforting to family.

The Music of the Night

On a Silent Night, Holy Night (a vigil), one of the first things I do is turn off the television. Though there is a channel with calm music programming set to nature scenes, the digital broadcast is unreliable. Our NODA program equips a Comfort Cart in each room with a CD player and case of discs. My current favorites are Angel Symphony, Memory Road, and Walk in the Woods.

The melodies take me to deep ponds of gratitude for the person's life:  their humanity, kindness, and courage. I assume the best. I consider them teachers. I forgive their shadows and encourage the true glory of their soul to burst forth from a tired shell.

On a Silent Night, Holy Night- everything is possible.

Sacred dying is another reason to write condolence because life is a spectacular thing. It is note-worthy.

Thank you for caring!

Final Conversations: Helping the dying transition from this world

Author image

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!