Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

Pay attention to everything the dying person says. You might want to keep pens and a spiral notebook beside the bed so that anyone can jot down notes about gestures, conversations, or anything out of the ordinary said by the dying person. Talk with one another about these comments and gestures. • Remember that there may be important messages in any communication, however vague or garbled. Not every statement made by a dying person has significance, but heed them all so as not to miss the ones that do. • Watch for key signs: a glassy-eyed look; the appearance of staring through you; distractedness or secretiveness; seemingly inappropriate smiles or gestures, such as pointing, reaching toward someone or something unseen, or waving when no one is there; efforts to pick at the covers or get out of bed for no apparent reason; agitation or distress at your inability to comprehend something the dying person has tried to say. • Respond to anything you don’t understand with gentle inquiries. “Can you tell me what’s happening?” is sometimes a helpful way to initiate this kind of conversation. You might also try saying, “You seem different today. Can you tell me why?” • Pose questions in open-ended, encouraging terms. For example, if a dying person whose mother is long dead says, “My mother’s waiting for me,” turn that comment into a question: “Mother’s waiting for you?” or “I’m so glad she’s close to you. Can you tell me about it?” • Accept and validate what the dying person tells you. If he says, “I see a beautiful place!” say, “That’s wonderful! Can you tell me more about it?” or “I’m so pleased. I can see that it makes you happy,” or “I’m so glad you’re telling me this. I really want to understand what’s happening to you. Can you tell me more?” • Don’t argue or challenge. By saying something like “You couldn’t possibly have seen Mother, she’s been dead for ten years,” you could increase the dying person’s frustration and isolation, and run the risk of putting an end to further attempts at communicating. • Remember that a dying person may employ images from life experiences like work or hobbies. A pilot may talk about getting ready to go for a flight; carry the metaphor forward: “Do you know when it leaves?” or “Is there anyone on the plane you know?” or “Is there anything I can do to help you get ready for takeoff?” • Be honest about having trouble understanding. One way is to say, “I think you’re trying to tell me something important and I’m trying very hard, but I’m just not getting it. I’ll keep on trying. Please don’t give up on me.” • Don’t push. Let the dying control the breadth and depth of the conversation—they may not be able to put their experiences into words; insisting on more talk may frustrate or overwhelm them. • Avoid instilling a sense of failure in the dying person. If the information is garbled or the delivery impossibly vague, show that you appreciate the effort by saying, “I can see that this is hard for you; I appreciate your trying to share it with me,” or “I can see you’re getting tired/angry/frustrated. Would it be easier if we talked about this later?” or “Don’t worry. We’ll keep trying and maybe it will come.” • If you don’t know what to say, don’t say anything. Sometimes the best response is simply to touch the dying person’s hand, or smile and stroke his or her forehead. Touching gives the very important message “I’m with you.” Or you could say, “That’s interesting, let me think about it.” • Remember that sometimes the one dying picks an unlikely confidant. Dying people often try to communicate important information to someone who makes them feel safe—who won’t get upset or be taken aback by such confidences. If you’re an outsider chosen for this role, share the information as gently and completely as possible with the appropriate family members or friends. They may be more familiar with innuendos in a message because they know the person well.

But even when people are too weak to speak, or have lost consciousness, they can hear; hearing is the last sense to fade.

The cancer had already spread to Laura’s liver and, considering her age, aggressive treatment wasn’t recommended; the doctors said she had about six months to live.

hiring a home health aide, who wound up spending nearly as much time and energy helping Joe as she did Laura.

A terminal illness doesn’t belong only to the one who is sick—it affects family members, friends, neighbors, coworkers. Not unlike a still pond disturbed by a falling stone, an impending death sends ripples through all the relationships in the life of the dying. Each person involved has his or her own set of issues, fears, and questions.

Many people assume that terminal patients, especially those with cancer, will have pain. That’s not always so; some have no pain, others have mild to moderate pain that can be controlled with ease. A few people have pain so severe that expert assessment and care are needed to bring it under control.

The resulting dehydration usually isn’t troublesome, and actually can increase a dying person’s comfort, by reducing the incidence of some uncomfortable symptoms such as vomiting, pain, or difficulty in breathing.

Life is eternal; and love is immortal; and death is only a horizon; and a horizon is nothing save the limit of our sight. ROSSITER WORTHINGTON RAYMOND

Dr. Kübler-Ross expanded on this theme in her 1961 book, On Death and Dying,

Unlike earlier generations, they don’t learn how to be at ease with someone whose life is coming to an end. Illness and death have been moved out of the house and into the hospital or nursing home. Professionals provide the care; relatives and friends become spectators watching something occur—not in a continuous stream of emotions and experiences from which to learn, but in awkward chunks of time, determined by official visiting hours that leave them uncomfortable and unsatisfied.

Instead of a last-gasp sprint, death can be a marathon.