[Allow Mystery]

Dear Req_read
My condolences on the death of your father, thank you
for sharing your intimate thoughts and feelings, your self
awareness is extraordinary

Dear finn11707
I'm sorry for your stress with the lack of support from your
team, I applaud you in your strive for perfection and your
commitment to your patients, please do not lower your
expectations, but please forgive and continue the hard work

and Leslie, Thank you for your remarkable insightfulness and
your tremendous knowledge and wisdom, you have truly been a guide

[finn11707]

Yes, ALLOW MYSTERY, you are so right--it is much about forgiving and moving on. Not just for those we attend in their final weeks, but ourselves also. Those of us drawn to this work knew, even in the beginning, there is a great learning for us in doing this work. It is beautiful work, but hard work to do if you don't allow for acknowledging and addressing your own issues as they arise, then work to grow and mature with it.
I now see that forgiving a management team who is not always making the best decisions or offering the best support to its team is much like forgiving your family as you grow and begin to recognize their limitations and failings.
I have certainly found wisdom and developed self insights these past few weeks as I have read this meaningful thread since its inception in 2006.
Thanks to all of you who posted, especially to you Michael as the perspectives and wisdom you shared have resonated in me. (And, yes, we probably would make for a great family systems study!)

[finn11707]

I want to share another conscious death experience. J-- was a scholarly man who came from a well educated family. He was dying from advanced liver disease. His questions were few, but his wife had many and listened carefully to all our answers---dismissing some staff as 'not seasoned enough to offer us anything...' She directed our help and supported her husband lovingly and dotingly. (she later admitted she was a retired public health nurse) J-- moved gently through life review, visits with dear friends and family, even made outings to favorite restuarants The day after he asked me to tell him what the end hours might look like, he slipped into a dream like state where he remained for several days. He talked, laughed, made motions of running (he had been a marathon runner in younger days) and eating intermittently throughout these days, still interacting with his wife from his far away place. His end neared, he became quieter, he stopped eating food. One evening, a dear 'adopted niece' came bringing his lovingly prepared favorite meal--lobster thermador with champaigne. He had not eated now for 3 days, but his wife asked him if he wanted to wake up for this special meal and he said yes! That evening, they ate together with candle light and his loved classical music playing softly. He ate with relish, eyes still closed much of the time. He died several hours later that night.

Mary Oliver's poem WHEN DEATH COMES tapped into J---'s wondering and knowledge-seeking spirit. I have seen several patients slip almost same day into thier final hours after reading this poem. He needed very little medication for transition periods that often require more with his diagnosis.

These are the experiences which we reflect back on after dealing with more troubled dying experiences in our patients.

I had a young woman--(younger than myself) who entered hospice care full of angst. She was surrounded by a loving husband and 2 daughters who knew her well and chose to support her wishes fully. She stroked a couple of weeks after admission to hospice and became fully dependent and furious--something which fully broke her spirit. She could barely speak, but loudly made her wishes known to me and to her family "...get me out of here..." we discussed options of supportive care, chaplain, medications for pain and sedation in varying levels for her high anxiety. None of the lower level meds touched her and she shouted "give it to me now..." when we discussed phenobarbital. It took time for the team to meet, discuss and clarify to family and patient what it means to follow this wish. Everything in place, she died 5 days later with family gathered around and at peace in knowing they had fully respected her final wish.

"For the raindrop, joy is entering the river--
Unbearable pain becomes its own cure.

Travel far enough into sorrow, tears turn into sighing;
In this way we learn how water can die into air.

When, after heavy rain, the stormclouds disperse,
Is it not that they've wept themselves clear to the end?

If you want to know the miracle, how wind can polish a mirror,
Look: the shining glass grows green in spring.

It's the rose's unfolding, Ghalib, that creats the desire to see--
In every color and circumstance, may the eyes be open
for what comes.
(Ghalib translated by Jane Hirschfield)

[req_read]

finn…

Thank you so much for sharing. Your experiences are extraordinary!

Much of what is said by dying people, by poets and in religious literature is enigmatic… allegorical… metaphor. One has to intuit the meaning behind it. But one thing is not metaphor at all… it is cold, hard fact. And that is what you & Allow Mystery were discussing; i.e. forgiveness of self and others. The two are inextricably bound together… for the very reason that ‘self’ and ‘others’ are, da-da-da-da… the same. The concept of: as you judge others so shall you be judged… is cold, hard fact… not allegory, but fact.

In the proverbial “end” we judge our self. God doesn’t… He loves us regardless. The dying words of Heinrich Heine, poet, were…
“God will pardon me, that's his line of work.”

Precisely.

Questioning whether God loves us is absurd. The real question is whether… or not… I love me. And whether… or not… I love me is marinating in how I judge others… because we are all one.

Therein lies the great spiritual mystery… the great spiritual truth. And that great truth was passed on to us in the one, simple sentence that goes (roughly): As you judge others, so shall you be judged.

Which explains an awful lot of what we call “terminal anxiety.” The outward focus of our judgment is suddenly (during dying process) turned inward. Yee Hah! Ouch! Oy! Oy! Oy!

Judgment is a necessary thing. We have to do it. But it is well to be mindful… it is like playing with hand grenades. One must be very, very careful.

And when, as people who have chosen the profession of assisting the dying, we must be very, very compassionate and cognizant of the extraordinary difficulties of what they are going through. Of course the best way to do that is to taste of it voluntarily… to look honestly at our self… consciously… voluntarily.

Yee Hah! Ouch! Oy! Oy! Oy!

Then we can know how they feel.

Ativan anyone?

Michael

[finn11707]

Req Red--"Much of what is said by dying people, by poets and in religious literature is enigmatic… allegorical… metaphor. One has to intuit the meaning behind it. But one thing is not metaphor at all… it is cold, hard fact. And that is what you & Allow Mystery were discussing; i.e. forgiveness of self and others."

So Req Reader, may I ask you to expound further on this subject of religion and the metaphorical/allegorical like interpretation led by poetry and religion. If one forgives another, led by a self-accepted understanding of "the devil made me do it..." is it truly a forgiveness of self and others that can bring peace in living relationships and in those dying? We all have heard of death bed conversions; end of life acceptance of God's forgiveness, and so self forgiveness, even after many years of living a very hurtfully and 'wickedly'. In the end, when eyes are opened by life review and the nearness of death, can all the pain associated with a life of troubled relationships just fall away? What about those left behind?--the injured or abandoned family and friends?
Seems to me I have seen quite a few troubled end of lifers who had led a devoted religious life, but seem quite troubled, frightened and even questioning of their faith at their end. How can the fix bring relief to 'the wicked' in just a moment of awareness and acceptance, yet trouble and attach suffering to that 'faithful servant' of god?

Oh the human mind and what we do to ourselves!

Yes, I do believe religion can be an addiction in life to some; a saving grace to others. A way to wall off real connection and relationship to others, or a way one can believe they have something of worth to offer others. In the end, I see it is often a cause for individual deep searching...perhaps it hindered a real knowing of oneself? to go deeper into the pain of living and experiences and find acceptance and forgiveness. Too much of a buffer of any kind is not good for the soul I fear. And now I am rambling...

Yes, extraordinary amounts of call for compassion and cognizance --for our patients and ourselves.

THE GIFT by R.S. Thomas

Some ask the world
and are diminished
in the receiving
of it.
You gave me only
this small pool
that the more I drink
from, the more overflows
me with sourceless light.

[req_read]

finn…

One of the primary reasons why dying process fascinates me so much is because it separates the wheat from the chaff… it shows what life styles and coping mechanisms work and which ones don’t. That being said, figuring out what a person actually thinks or believes, as opposed to what they merely SAY they think or believe, can be extraordinarily difficult.

Somewhere back in this thread I mentioned a family member who was a life-long church goer who confessed to me he did not believe in life after death… the old “when you’re dead you’re dead” story. That was my father. His sister and her husband told me the same thing (they have all died in the last year.) They were all intelligent, educated, successful and respected life-long church members. Any pollster conducting a survey would have classified them solidly under the heading of “Christian.” However, not one of them believed perhaps the most basic tenant of the Church they had attended religiously all of their lives. So you cannot tell what a “Christian” may or may not believe… deep down… by simply asking. I also mentioned previously a Church minister who confessed to his son that he did not even believe in God (his son told me.) So when people speak in generalities about what “Christians” think, I know from first-hand experience that there are about as many interpretations of Christianity as there are Christians. There are also social groups that call themselves a “Church.” But to actually study… seriously… human consciousness and spirituality? That is something anyone can do, anytime, anywhere… and some of the richest ground in which to conduct such a study is with dying people.

Actually I did attend Church services last Sunday (for the 1st time since I can remember) because my stepmother sang a solo… but I have no plans for a repeat performance any time soon. As my wife & I entered the Church we were beset by some gal who was determined to get our email so she could send us all of their program postings. Oh brother!

My father attended Church every Sunday, but did not believe he would survive death. I do not like Churches and seldom set foot in one, but I am absolutely convinced I will survive death… and that Christ is very special… in some way that from my current perspective I cannot grasp (notice I said “is” special, not “was” special.) However, it is rare to run into a self proclaimed “Christian” not loaded down with hidden agendas. I have often said, “Christianity would be a fine religion… if not for all the hairy-legged Christians.”

I am a student of human behavior… which inevitably includes the rather broad subject of addiction. We talk about “addicts” as though it involves “them,” not “us,” and certainly not “me.” Just like we talk about those who will die as “them” and not “me.” That attitude fairly guarantees a lack of understanding. We are all bozos on this bus. We all have our addictions. If you don’t know what yours are, then you are not paying attention… not very self-aware. We all have them, but yours might not work for me… nor mine for you. We have very definite preferences about our addictions. What works for you might be my worst nightmare. And it’s funny… an awful lot of the contentions and frictions between people has to do with their different tastes in their preferred addictions… their drug of choice. You would have to hold a gun to my head to make me go to Church every Sunday, and if that happened, I would go stark raving mad! It just doesn’t work for me. But it does for lots of people… my sister for one. Go figure.

But when I was working directly with the dying and their families I was fascinated with finding out what they thought… what they REALLY thought, not just what they said… and how that played out in how they died. Anyone can say, “I believe in life after death,” but when you are with someone when they die, that is when you find out the truth.

So how does one distinguish between an “addiction” and a mere “preference?” One way is to discern whether that person thinks of the object of their desire as something that makes them immune to their emotions or simply helps them deal with their emotions. Heroine can make a person immune to feeling sadness and fear (for a little while anyway). And if a person keeps using heroine for that purpose, they are addicted. Ativan, on the other hand, can help a person get through their feelings of fear and sadness. During the Terri Schiavo (sp?) debacle we all saw preachers coming on the news declaring such absolute balderdash as, “Christians do not fear death.” Oh brother! Now THAT is addiction! Bald addiction. It is no more enlightened than declaring that drunks don’t fear death (which I suppose may be true… as long as they stay drunk.)

But sooner or later the mask comes down, the truth comes out, and the results can be truly shocking.

Finn… you touched on quite a few topics but I already have a reputation for being long-winded. Zero in on one at a time.

Nice poem by the way. You are a collector of poetry… I collect quotes. It is one of my preferred addictions… that and song lyrics… which is a form of poetry I suppose. These things create a momentum… rather like playing ‘snap the whip’ as kids. You get a long line of kids whirling about, then “snap the whip.” The kid on the end gets hurled off… away… beyond the limitations of the group… beyond the limitations of language… into pure knowing.

The dying speak this language… if you listen. Poetry and the dying… now that’s a pair to draw to!

Michael

[req_read]

P.S. Here’s a little dying people’s poetry.

Last week a client of mine sent me an email. She said her father was dying and one of his remarks was: “Why do Raymond and I have to share the same bed?”

You see… Raymond was one of the dying man’s 10 children. He died 4 years ago.

Michael

[finn11707]

My mom died when my daughter was 3 1/2. My daughter only knew grandma as a rather ill person, but she received lots of cuddles and "I love yous" each time we went for our turn helping to care for mom. When mom died, we had just returned from several weeks of caring for her. She seemed fine to me..but I hadn't worked hospice yet either. I had planned to go home, take care of some business, then return to spend more time without my daughter. My brother called to say mom had turned suddenly. He and his wife had been out shopping for half the day, unaware. Dad was at mom's bedside when they returned. One glance told them she was dying. Within an hour of their return home, mom was gone. They believed she waited for their return.
They called me just after mom crosses. I was getting my 3 1/2 yr old to bed. I knew how upset she would be-at bedtime and all' and I needed some time alone--so I chose to wait until morning to tell her grandma had died. Next morning I wakened. Then remembered, and lay in bed all sad and comtemplative--thinking about what I would miss most: her hugs; her calls with newsy news; her cards with notes sent for every imaginable occasion. Remembering long talks, comparisons of what it was like to be a nurse then (when she was) and my version of 'now'. I would miss her soft, assuring voice "Don't worry about it Honey...it will all work out..." was a phrase I had heard so often throughout my life. It still resonates in my head.
(More dying people poetry...heard by only a child)
My daughter's cheery voice called me to her room as she wakened next morning. "Mama, grandma came to visit me last night!" My heart skipped a beat. "You mean, you dreamed about grandma?" I had not been raised to believe in departure visitations) "No, I don't think so..." So tell me why grandma came to see you." "I don't know...she was in my doorway...all shiney...then she sat down on my bed and said she loved me...That's all."

Yes, the dying and the very young see more, clearer, further than the rest of us. We only get to see glimpses, through their eyes. But it is enough for us to know there IS more than what we see. When we are present with those who are "seeing", we feel it as something of inexplicable value.

Is that one subject, or two? I'll stop now, since I had a long day of work. But I am still mulling over your thoughts regarding chosen addiction.

[req_read]

finn…

What an absolutely wonderful story! Interesting… of all the things your mother could have said to your daughter she said the simplest, cut-right-to-the-point, most important thing.

Here’s another dying person’s poem. This too was emailed to me last week by a client. I did respond… emailed her back… but won’t include my reply… yet. First I would like to hear your thoughts (finn or anyone… we’re all hospice nurses here.)

“My father passed away Sept. 1 at the age of 85. He died at home with hospice care. The night before he died he began talking to me. It was surprising to me because he had not spoken to any of us children for a few days. He kept repeating to me that he "wanted out of this contract". I didn't understand what he meant so I questioned him. I asked him if he wanted to go back to the hospital and he said no. I asked him if he wanted life after death and he said yes. I then asked him if he wanted to go with Jesus. He said no and then said that I didn't understand what he meant. He told me he wanted to "come back as himself".

I'm wondering if you could give me some insight as to what he may have meant by this.”

What do you think?
Michael

[finn11707]

"He kept repeating to me that he "wanted out of this contract". I didn't understand what he meant so I questioned him. I asked him if he wanted to go back to the hospital and he said no. I asked him if he wanted life after death and he said yes. I then asked him if he wanted to go with Jesus. He said no and then said that I didn't understand what he meant. He told me he wanted to "come back as himself".

Michael-
I think I would understand his words to mean this: in his 'quiet days', he journeyed deeply, looking at his life in review; glimpsing the next; seeing what he could not see before. Finally, understanding that he would journey on, after crossing to the next life. He would be himself, but different--"come back as myself...under a new contract". In those few words, he tried to tell his daughter that he was ready. Transitioning through the final stage before crossing; acutely aware that he was himself, but different, and would live on, though changed, after crossing.

Wow! I love that kind of communication at the end! It is exciting being present to that kind of seeing and transformation. Are there any books for families to intrepret dying patient's words? There should be. Sort of a Carl Jung interpretive manual to the dreams of the dying.

I had a dear patient with a sweet reclusive wife. He had been a commercial fisherman for 20+ years, during which she had accompanied him on the boat! Years before, when his family was still young, he had a dream in which he was out hunting. A man in the woods told him he would die soon. He told the man "no, it is not possible for me to die yet, I have a young wife and family I need to care for..." 2 weeks later, he was hunting and was accidentally shot in the side, puncturing his lung. The doctors told him he never should have gotten out of the woods and lived.
When he was transitioning, a man came to him one night while he slept and told him to get up "...it is time to go for a hike..." He followed the man outside. His wife wakened and found him on the front porch, clinging to a post. He was looking out over the river they lived on, unsure how to cross. His wife guided him back to bed and called the next day for me to visit. He told me to call his family to tell them it was time. I read him the poignant Mary Oliver poem "When Death Comes". He listened carefully to the words, then said "I need to get to my boat". His wife and I helped him to his bed. He slipped in and out dreams for 2 days, visiting with his sons and daughters, then slipped away peacefully.