Tuesday, September 20, 2011

TRANSITION: Nearing Death Awareness

Grief Work usually refers to the survivor’s efforts to rebuild, to create a new normal. At Adagio until Grace’s passing we also used the term Grief Work to refer to our participation in our resident’s passage from life to death.

Two Hospice nurses have coined the phrase “Nearing Death Awareness” to describe the stations a dying person travels through to achieve the end of the line. We adopted this change in verbiage as we become aware of Grace’s transition points, gestures, statements, visions. 

A friend gave me the book Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan and Patricia Kelley. They write “As nurses who care for the dying, we see ourselves as the counterparts of birthing coaches or midwives, who assist in bringing life from the womb into the world. At the other end of life, we help to ease the transition from life through death to whatever exists beyond.”  Our goal is to help our dying residents achieve comfort, peace and perhaps even joy.

Callanan and Kelley affirmed us with case studies describing similar experiences to our own. Each of our residents have reported or reacted to seeing loved ones who had died before them, a brother, mother, friend. Some would call this vision a hallucination. I was uncertain, but now am open to the possibility that they were met by important, caring people. These visions brought them comfort that they would not make the crossing alone. I leave it at that.

With our first near death experience I thought our work was the respect we owed someone who had contributed much to family, church, country during his life. I have since learned that expressing appreciation for and confirmation of their life was probably heard since hearing is the last sense to go. Speaking his name, the names of family members, organizations, assuring him that he had done well, he had been a good and faithful servant. He could let go. Speaking his name and assuring him, a confessing believer, that God knew his name and loved him slowed his breathing and I could visibly see him relax. Singing his favorite song in the emergency room calmed him into acceptance of the nursing staff’s physical ministrations.

My husband and I had learned through the years that people may be hanging on until their family gave them permission to “go home.”  They were fearful that they were abandoning their obligations. They may be struggling against death until a family member reunited with them and spoke of their love and perhaps forgiveness. Final Gifts affirmed that experience.

Our dying residents are not our only concern. Their families come in all stages of preparation and acceptance.

 “Patient and family exist as a unit—interacting and struggling together in what can become a perplexing maze of distress and anxiety. The solution to this maze requires attentiveness and willingness to listen and understand.” (Page 28)

Thank you to the Hospice professionals who have attended us at Adagio. Nearing Death Awareness…work we all will come to do at the given time.

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