Nearing Death Awareness
The witnessing of another’s dying process can be a very profound and life-changing experience. The focus of this issue is to provide you with some insight into the latter phase of this process and to help you become aware of some of the more subtle indicators that your loved may be giving you that he or she will soon be departing this life. Often these indicators are misconstrued as delirium.
Why is such information helpful? The wisdom among hospice professionals is “don’t wait”. It is a normal human tendency to avoid confronting the realities of someone’s impending death. As a result, friends and family members come to see the dying person but don’t say what they really want to say during their visit. They tell themselves “Dad still looks pretty good…I’ve got time. I’ll just wait until next time to tell him how much he meant to me in my life and how much I really love him.” Then before they are able to return for that next visit they receive the heartbreaking news that their father has died. So more than anything, it might help you and others to have closure with your loved one. This is just one example of what can happen as a result of a lack of experience with the dying process. The goal of this issue is to help expand your awareness in this regard.
Nearing Death Awareness (NDA) – this is a special knowledge about, or control over, the dying process. NDA knowledge is cultivated by listening carefully, not making judgments and being open to other interpretations of what you think is really happening with regard to your loved one. Meaningful observations and conclusions generally occur over a period of days or weeks as opposed to something instantaneous. If we are not purposefully attentive then attempts by your loved one to describe what they are “really” experiencing may be missed, misunderstood or just considered to be obscure delirium.
During the final days, weeks or hours of a dying person’s life, they may make statements or gestures that seem to make no sense. Our first reaction is to attribute such confusion to their medical condition or perhaps to their medications. This is not to say that such conclusions may be incorrect, however we must allow for another possibility…that we may be misinterpreting the message our dying loved one is conveying.
What You Should Not Do – unfortunately those without knowledge of NDA may respond unknowingly in a frustrating, annoying or perhaps humorous way. This can create unnecessary stresses, bewilderment and a sense of isolation for the dying person. It is only through compassionate understanding and loving action that we can guide them along their journey in a supporting way. By participating more fully in the events of the dying, caregivers can gain important knowledge about the dying experience and how to help their loved ones achieve a meaningful and peaceful death.
Dying persons’ requests are sometimes difficult to decipher. Their recognition of the importance of fulfilling specific needs, along with concern for family and friends, can cause the dying person to control the time and circumstances of their death until those needs are met. Such requests often involve healing a relationship. These pre-death needs of the dying are universal and have been documented by many cultures for centuries.
The caregiver that is aware of the subtleties associated with NDA and the potential misconceptions that can arise is a caregiver that can bring a level of understanding to the process that is invaluable to all involved.
A Case in Point:
A Case Study adapted from Final Gifts – Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan & Patricia Kelley
The experience of dying frequently includes glimpses of another world and those waiting in it. Although they provide few details, dying people speak with awe and wonder of the peace and beauty they see in this other place. They tell of talking with, or sensing the presence of, people whom we cannot see – perhaps people they have known and loved. They know, often without being told, that they are dying, and may even tell us when their deaths will occur.
Nearing Death Awareness (NDA) often includes visions of loved ones or spiritual beings. The dying may see and speak with religious figures; feel warm, peaceful and loved; or see a bright light or another place.
THERESA, twenty-two, was dying of bone cancer. She was abandoned by her father when she was five.
Four months after admission into the hospice program Theresa was actively dying. Her pain became increasingly severe and the dosage of her pain medicines was increased accordingly. Even though her physical pain was believed to be under control, she still moaned. When asked what might still be wrong her answer was difficult to understand because of her weakness.
But one day, she mumbled, "Dad." She was asked if she wanted to see her father. Again her response was unintelligible. Her mother telephoned the father and explained what was happening.
He arrived and sat down beside Theresa for the first time in 17 years, taking her hand and telling her he was there. He said no more. He looked visibly shaken and upset, but also stiff and uncomfortable with her dying. After only a few minutes he got up and left, not to return.
After he left her moaning stopped, agitation eased and within a few hours she died peacefully. She and her father had reached out to one another to heal their relationship.
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