Last fall I signed up to take Hospice and Home Care of Juneau's training to become a hospice volunteer because I believe in the philosophy and goals of hospice and wanted to find a way to contribute to the work of this wonderful organization. Soon after completing the class, I learned how valuable the training can also be in preparing us for dealing with the deaths of loved ones in our own families.
The volunteer training was one of the most educational and personally enriching experiences I've had in a long time. As we explored the subject of death and dying, some of our sessions were emotional (kleenex boxes were always on the table), but the talks, videos, discussions and readings were also fascinating, thought-provoking and life-affirming.
Still, much of what I was learning about death and dying during the volunteer training, and in the reading I continued to do afterward, remained somewhat abstract and hypothetical to me until late January, when my previously vigorous 83 year-old father had a stroke, followed by a heart attack, pneumonia and death.
In the days before and after dad's death, I often found myself drawing upon lessons from my hospice volunteer training.
"It is important to try to help the dying person tie up any loose ends and put their worries to rest, so that they may die more peacefully."
My sister was able to get to dad's bedside while he was still conscious. She conveyed messages of love from the rest of the family and reassured him about what seemed to be his only concern, which was mom's well-being after he was gone. After the reassurances that we'd all take good care of mom, dad relaxed and spoke only of his gratitude for the wonderful life he'd had, his great love for his family and his strong faith in God. I'm so glad those conversations took place while dad could still communicate.
"Don't assume an unconscious person isn't hearing what is being said around them. Hearing is often the last sense to go, and a patient in a coma may be able to hear and comprehend."
Although dad was in a coma by the time I arrived, and never regained consciousness, I encouraged the family to continue to talk to dad during the days at his side in the Intensive Care Unit. We hope he heard us, but whether he did or not, we each took advantage of the chance to say what we wanted him to hear, and that was good for all of us.
"Rather than being dreadful and frightening, the time right before death often brings the dying person a sense of peace, warm light and the presence of loved ones who've died before them."
Discussions at hospice training, books I've read since, and a dream my own father had and wrote down a year before his death, all relate these and other pleasant nearing-death experiences. I found it wonderfully comforting to contemplate the positive things dad might be experiencing as he approached the end.
"Advance directives are very important, both to ensure the patient's wishes are honored, and to avoid unnecessary stress, uncertainty and guilt for loved ones."
Dad had long ago completed a living will and a durable power of attorney document. Beyond that, he had written personal letters to each of his children several times over the years reiterating his end-of-life wishes. The letters were firm, warm, loving, and reassuring. As I quickly packed for the trip to Wisconsin after learning of dad's stroke, I tucked those letters in my suitcase. Late one night, after dad had been unconscious and on a respirator for several days, my sisters and I sat in our hotel room near the hospital and read dad's letters. He'd made his wishes very clear. He hadn't asked much of us in his lifetime, but this he had asked; that we make sure his body would not be artificially forced to go on when it was his time to die. In the morning we were surprised when mom came in from her adjoining room and announced she had reached the same conclusion. There was simply no question about what dad would want.
"Being with another human being in the final days and moments of their life is a great privilege, and not something to fear."
Later that morning, after arrangements had been made to discontinue life supports, I was adamant that dad not die without family by his side. While my mother and others in the family felt they couldn't handle being there, Mom seemed relieved that I wanted to stay with dad until the end. "Thank goodness you've had hospice training," she said. At the time I thought that was an ironic comment as I knew the training hadn't provided me with any "credentials" for attending a death, nor had I as yet had any experience with any dying patients, much less with the death of someone so close and precious to me as my own father. But I later realized it was true that my volunteer training had made me less afraid of the dying process and more conscious of the importance of making every moment of the end of a person's life as peaceful, comforting and loving as possible.
Sure enough, dad's death, which came shortly after the machines were turned off, was lovely and peaceful. My sister, our cousin and I were by his side. We assured him that it was OK for him to go, that his friends and family all loved him and would miss him, but that we would take care of each other and we'd all be fine. Dad breathed his last breath just as we finished reciting the 23rd Psalm, his favorite. I felt so honored to be holding his hand at the end of his truly well lived life on this earth. My mother and the rest of the family were glad that dad died surrounded by family love and that we could assure them that he had died peacefully. I might very well have missed that incredible experience if I hadn't been through hospice training.
"My best tip for a newly widowed person is to get lots of certified copies of the death certificate -- they'll need them." (Advice of a fellow member of our volunteer training group)
I spent several weeks with my mother after dad's death. I called upon volunteer training lessons ranging from getting lots of copies of the death certificate, to paying attention to my mother's ability to eat and sleep, encouraging her to keep talking openly about dad, to laugh and remember good times. Now, though I'm thousands of miles away, I try to keep hospice lessons about the grieving process in mind as I stay in touch with mom by phone.
"It is helpful to talk about the dying process, death, loss, and grief with others."
It was apparent during hospice volunteer training, how much a discussion of death, loss and grief can bring people together at a very fundamental level to share personal stories, emotions, and basic values and worldviews.
What has been surprising to me since my father's death, is how this same phenomenon can carry over into every day life if we're open to it. Certainly, the time immediately after a death, with the memorial services, calls, cards and visits, is an important time for thinking and communicating about the life of the person we've lost and, in turn, the meaning and value of life in general. But I've found the opportunity goes well beyond that. The death of a loved one is a significant life event for each of us. The impacts of that loss, both the sadness and the life-affirming lessons of it, supercede our daily routines and stay with us long after the funerals and so on are over.
I've had many unexpected conversations with friends and acquaintances since dad's death. Many who have lost a parent have shared incredible stories about their parent's death, about their views, feelings, or spirituality, that I would never have known had it not been for this new sense of shared experience. Here again, hospice training helped me to see death and dying not only as an important and integral part of life, one to be examined and embraced, but also as a topic that can present opportunities for communicating and connecting with others in important ways.
Mary McDowell is a Hospice and Home Care of Juneau volunteer. To register for the October HHCJ volunteer training, call 463-3113.