Veterans at the End of Life: An Essential Salute

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

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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

From MIA to RIP: A One Year Anniversary Reflection

One of my most frequently read posts continues to be the riveting story, Missing In Action! A Soldier's Sister Keeps Vigil.
After 44 years, in May, 2014, Sue Scott's dear brother began his Final Journey Home.  With the anniversary approaching, I asked Sue to share her reflections.

Doug’s Return, One Year Later

"It has been a year since Captain Douglas Ferguson, USAF, MIA December 30, 1969, was identified and made his Final Journey Home..."

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There is satisfaction and peace that Doug is home and at rest, and that Linda (his widow) has a place to visit Doug, as do others.  One day I too will be able to visit and know in my heart that all has been done and that his marker reflects who he was and how he was cherished!

In this last year, I have allowed myself to feel the pain of losing someone so dear.  I have listened and continue to listen to ‘50s Hits on XM that take me back to our youth and the sweet sorrow of knowing that, even on his 70th birthday, he will never be older than the handsome Air Force pilot who I said goodbye to as he stepped aboard the plane at Lambert-St.Louis Airport in July, 1969.

Though he met our two oldest sons as infants, he never knew them as the wonderful, successful human beings they have become.  He never met our youngest son who was born three years after he was shot down over Laos.  He never met any of their wives or any of his great-nephews and nieces. We never got to know his children that might have been.

He never had to see the pain of our father’s broken heart at his son, of whom he was so proud; or the dementia that ravished our mother’s mind when she could no longer stand the pain of not knowing the fate of her beloved son.

One of the last things I said to her as she passed from this earth was, “Now you are going to be with Doug!”  She seemed at peace!  Or maybe he did know!  It would have been one of his biggest regrets that he might have been the cause.

Even bigger than the pain his plight caused our parents would have been the pain his loss brought to the love of his life, Linda and the years of being together, of which they were robbed.

We cannot dwell in the “House of What If’s”, but we do need to know that we can travel through our grief and find the precious memories that will sustain us the rest of our lives.  Though this has not been the journey I would have chosen, I am proud to say I have kept the commitment, I made in early February, 1970, and that was to bring Doug home.  On that journey I have done things and gone places beyond my wildest dreams.  It was an opportunity to rise from a devastating loss and make a life far “richer” than I ever could have imagined.

Now a year since Doug’s return, I know my journey is not yet complete because too many with whom I have travelled, do not yet have answers, including Captain Wes Featherstone, USAF, the front seater in Doug’s F-4D aircraft.  It is because I know the joy and peace that can be the Final Gift, I still have work to do……to help sustain others so they can continue their search, their quest for the return of their loved ones…..to fulfill the Promise our country made to their loved ones when they left family and friends to serve and to possibly make the ultimate sacrifice for our Freedom.

What great gifts I have been given!  Why me?

I don’t know for sure, but this is what I believe: God has great gifts for each of us!  Our job is to be open to his abundance! That in itself is a life-time journey to learn to trust God for all things!  To know that though I may choose my own way, it is not always God’s way. I may not be ready at a given moment in time, to accept God’s gifts…….think of Moses and his people wandering in the wilderness for 40 years.  They didn't seem to be ready to hear God’s message.  I know I am not always ready to hear and trust in God’s messages either, but for Doug, I am grateful that I was able to listen, trust and therefore find enormous peace.

God Bless You Doug!  And, God Bless each One of You!"

Read treasured memories and tributes, and browse photos of Doug's life and Final Journey Home, on the Forever Missed memorial site.

Sue's strength is remarkable but she has "paid her dues" on that path through grief. The Condolence Coach reminds readers that anniversary notes are a very special comfort. For suggestions on how to compose this note, read: When Little Birds Chirp: Anniversary Notes.

Thank you for caring!

Please Don't Ask Me How My Son Died

2014 National Military Survivor Seminar

Readers may remember my introduction to 

TAPS.org

I explained the compassionate condolence policy enacted by President Barack Obama in 2011. In POTUS Does It And So Should You we explored the importance of reversing a long standing Department of Defense dictum of not sending condolence to families if their deployed soldier committed suicide. 

But the Tragedy Assistance Program for Survivors is dedicated to caring for the families of fallen heroes who died under any circumstance:

"They all thought their loved one would return home from a military assignment. Instead, their worst nightmare came true... We welcome into TAPS anyone who is grieving the death of someone who died in the military - so our families have experienced loss in a variety of ways - from combat, suicide, terrorism, homicide, negligence, accidents, and illness. Our survivors include mothers and fathers, husbands and wives, sons and daughters, brothers and sisters, fiances and other relatives of those who have died." TAPS.org

This remarkable poem was first published on the TAPS Blog, on August 6, 2014.  Written by Karen Mojecki, mother and survivor of a beloved son serving in the United States Army, it raises awareness like nothing the Condolence Coach could write.

Please Don't Ask Me How My Son Died

Please don't ask me how my son died

His mode of death is not germane

He died while serving and defending….

Our way of life and liberty

He was upholding Army values

Of honor…commitment…integrity…

Your question rewinds my journey

To the "knock" on my front door

Two officers wearing uniforms

Were waiting on our porch

Their message was not wanted

They spoke those dreaded words

This son I had once sheltered…

I was not able to protect...

It hurts for me to think about

His pain, his wounds, his death

The grief begins again anew,

When someone asks me how he died

I do not want to name the projectile

That was the cause of his demise

Or how the medics tried to save him

Before he breathed his last -- and died

Perhaps others can recount those facts

I find them too horrid to describe

So please don't ask me how he died….

And replay that moment once again

Understand this painful journey

With compassion in your heart

Those final minutes were just a fraction

Of a unique and greater life

If you want to know about my son

His traits, his values, his loves

Then listen as I remember

And help me to celebrate

The life of this exceptional man

And exactly how he lived!

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2014 Good Grief Camp for young survivors

Karen's request that we "not ask" about death circumstances is excellent advice. Being supportive is simple: just be present to the bereaved. If you are around when a thought or story or tears flow, just be there. Truly, that is enough. 

I know a military mom who lost her son, and whenever I've been in her company, she talks with pride about all the people his life crossed paths with, and how much he was loved. She has had those "circumstance" conversations--with the military, with the medical examiner, with her surviving children. That's enough for her lifetime, don't you think?

This is strong validation for the use of good memories and pleasant stories in our condolence notes. 

Refresh your thoughts on these condolence writing topics:

POTUS Does It and So Should You: Condolence After a Suicide

Keys to Comfort Explained  (sharing a memory )

Replacing Painful Memories With Good

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Curb Your Enthusiasm? Not in my condolence!

I was recently asked to take an exclamation point off of an obituary sentence. 

The family had written and emailed me their dad's obituary to be used on the funeral home website. I routinely apply certain formatting to ensure that arrangement details are easily understood. I also tweak grammar, spelling, sentence structure and redundancies because 99% of the time, families ask me to save them embarrassment by polishing their under-stress composition.

Statue at Omaha Beach, Normandy, France
by Mark Lawson, unsplash 

Here was a profile of a remarkable man! Orphaned, eager to enlist for wartime duty, he fibbed on some facts and, served courageously in Normandy, before the age of 18. He sustained injuries and was awarded a Purple Heart.
It was a pulse-quickening read--the kind that becomes a great movie--volleys of exclamation marks were firing in my brain. I added one exclamation mark to the story and posted the obituary to the website.

A short time later, the phone call came:  "Please remove that exclamation mark."

I confessed my enthusiasm, but complied, and it took awhile to shake off the cold water that was thrown on my zealous respect for this man.

I firmly believe that our memories are richest when they have !!!! -- that is the great blessing of a life well lived.

Around the time of that encounter, I discovered a true champion of obituaries. Susan Soper, a career journalist, states:

"You are unique, and so is your story. You don't have to be rich and famous to have tales to tell."

Susan transformed her passion for life stories into a guide for everyone: the ObitKit.  Writing a memoir is daunting work but this easy to use book interviews your loved one. It is intended to be used by a family before death shuts the door on asking questions! I encourage readers to visit Susan's site.

Obituaries and condolence notes are vitally connected!

Whenever possible, track down and read the obituary of the deceased, before writing your note. When you make a habit of this, you will become a connoisseur of those which are beautifully written, but more importantly, you will gain numerous facts for written reflection.

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I challenge you to read five newspaper death notices and or obituaries...and write a sentence or two for each one. Do this exercise with lean (little information) and lush obituaries. Your remarks can be:

• sorrowful
• appreciative
• admiring
• remembering
• connecting generations

Yes, it is challenging to make observations from a lean death notice, but it can be done. You may need to postpone your note until you have had an insightful conversation, viewed photos, attended a memorial gathering or service. I address these methods in my post, Don't Rush Your Condolence.

Thanks for caring and sharing! 

Don't Rush Your Condolence Note

You're ready to hop in the car and go the wake or service but-- darn-- you haven't bought a card.

RELAX. DON'T RUSH YOUR CONDOLENCE NOTE.

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It is not necessary that you walk in with a card. I would even like to suggest that putting a little time between the funeral and writing your note can be very helpful for you-- and your grieving friend who is, at the moment, overwhelmed with details and caring people.

POTUS Does It & So Should You: Condolence After a Suicide

We look to leaders for direction, strategy and goals, project reviews and (dis)approvals. Sometimes, our leaders provide inspiration ... and sometimes they are called upon to provide sympathy. It is not a task to be delegated, as the President of the United States (POTUS) recognizes.

The circumstance of the loss--even suicide, does not discount the need for sympathy.

In 2011, President Barack Obama reversed a long-standing Department of Defense policy of not sending condolence to families of soldiers who commit suicide during deployment. To remove the stigma associated with the unseen wounds of war, the President set the example of staying with the core concepts of why we write condolence notes: