Death work and talking to the dead

[talaxandra]

Four years ago I started a thread in the Neuro ICU nurses' forum about nurses speaking to the brain dead (you can view it here). I researched the topic for a Masters, and found the process really rewarding; my thinking on the topic was certainly informed by the responses of nurses to the thread, and I'm delighted that members still post on it from time to time.

I'm now building on that research by investigating why funeral industry workers and health care providers, particularly nurses, who talk to their patients while performing death work do so.

I'm conducting the research through a combination of interviews and written narratives, and if anyone's interested in participating or learning more I'd love to hear from you, just IM me.

I've started this thread, though, to see what you all think about the practice. Do you do it? Do your colleagues? Have you seen doctors or orderlies or anyone else do it? Do you deliberately not talk? Anything anyone think is interesting or routine about death work - I want to hear it!

[Gigglesforall, BSN, RN]

I talk to the dying, not the dead. After they've died, I say a a little prayer (inside my head) wishing their spirit well and free from suffering. During post-mortem care though, I move them just as gently as I would had they still been alive. And I always keep a gown on them once they are zipped up, just for dignity purposes. I have been told by a few RNs not to, as we won't get the gowns back from the funeral home, but I still think it's appropriate.

[nerdtonurse?, BSN, RN]

I often pray (silently) as I do body prep, and the other nurses laugh at me because we'll have the person turned and be cleaning any last stool and they'll look up and I'm patting the person and telling them, "it's okay, she'll be done in a minute" just like I do the living.

The one thing I can't get over is that heavy "thunk" as the body goes into the cadaver transporter.

[Gigglesforall, BSN, RN]

The one thing I can't get over is that heavy "thunk" as the body goes into the cadaver transporter.

EXACTLY! Mostly in regard to the head. Gets me every time.

[Gigglesforall, BSN, RN]

The one thing I can't get over is that heavy "thunk" as the body goes into the cadaver transporter.

EXACTLY! Especially in regard to the head. Gets me every time.

[vamedic4, EMT-P]

I do it. It's my way of getting out what I keep inside. I let them know that they will be missed, that they are loved, and that they will be remembered. I'll do it for a baby who dies in my arms, or an 18 year old lying in the bed. I sing to the little ones too.

I see no shame in it, and wouldn't care one way or the other if someone else did. I am as gentle and caring as I am with my own children, because I know that they belong to someone too.

[shouldhavebeenanunRN]

I totally connected with this thread as i skimmed sentences, such as: I sang to them, I talked to them, etc.. I work in LTC as a new grad; and its no picnic. I also lost my mother the day I graduated with my BSN; and skipped ceremonies to hold my mother in my arms as she died; and I am eternally grateful for the opportunity to look into her deep green eyes one last time; knowing she knew the person who loved her the most on this earth was there with her as she took her last breath and that she wouldn't die alone (her worst fear). FYI, statistically, 97% of us die alone.. according to some research I've read.

Needless to say, the experience has impacted my nursing practice forever.. I could go on an on about my mom, but in reality, I have lost patients as a student and new grad too. I like to believe it prepared me for the loss of my mother to some degree, but to this day, I still work in a LTC facility, and it pains me to see the lack of compassion within my profession for the most vulnerable.. the dying.

However, unlike my peers, I like to believe that I am a pioneer for the reform of LTC nursing practice and palliative care; and I lead by example. I am by no means a "super" nurse, trust me, but I am deeply passionate about what I do. I always go above and beyond, as if serving the needs of Jesus himself; and I hope that in the lives of people whom I touch everyday they can go to God knowing I gave them my best as both a nurse and compassionate human being .

I too have also found myself singing to them, stroking them gently, telling them stories, making small talk, fluffing a pillow, washing the dry crust off their lips, soaking their moldy dentures, or in those last moments, simply giving them eye contact and letting them know a kind soul is there for comfort or last words if that is what they need. I have lost several patients my first few months as a RN who have looked to me in their last moments for comfort/closure in their last moments, including my mother.. However, that may be my personal experience.. but I can't be honored more in this lifetime than to be someone's link to this life and a trusted guide into the next :prdnrs:

With that thought in mind, I thank you --those who take their purpose/profession seriously and may I be so lucky as to hold your hand and look into your angel eyes with my last breath as I seek God's redemption or the next life !!

[Selke]

Hearing is the last sense to go ... when one leaves the body, one does not immediately "disappear" but lingers some time and observes what's going on. The Tibetan Book of the Dead gives an extraordinary account of the stages of dissolution of the self, and the words that the living can say (prayers) to help guide the soul out of this bardo (state between two worlds), to guide the soul (in the book they are referring to monks who are highly trained in meditation states) through the realms of the dead into the realm of their choosing (sort of). I think here, in our secular hospital, talking to the dead and sending good energy can serve somewhat the same purpose, to help the soul let go on its way ... if I was not working in women's health I have thought of working in home hospice. Birth is kind of the reverse process of dying, another form of bardo, in which the newly besouled human comes out of its mother into this world of impermanence and suffering. Newborns need to be talked to as much as the dead, and mothers instinctively do this. A baby hears and knows its mother's voice while in her womb. This helps ground them in this world. Terminations and stillbirths don't bother me because the "vibe" I get from these situations is it simply isn't the right time for this little being to be here now, it's a neutral situation, but is sad for the parents. I talk to these little ones too, if they are still around, and wish them well on their journey and their next embodiment. When a fetus is crashing and we are scrambling to save its life (usually in the OR) I can feel the presence of the angel and of death (will the angel breathe life into the baby, or will death cut the cord and claim it?) and it sends chills up and down me. Larger forces than we are at play here. Peggy Vincent, in "Babycatcher," has a section where her son explains what happens to the souls of babies that die ... I won't tell you what it is, go read the book; this is one very, very wise young man. There are many bardo states in life (think life transitions), and we all need reassurance and human contact, to hear a soothing voice to lead us through, when we are in the midst of them.

[shouldhavebeenanunRN]

i have skimmed the key points of the book of the dead. it is very similar to the reverse of birth, except if i recall.. one of the first after death experiences which determine re-incarnation or purgatory begins with temptation vs. innocence and life experiences; and if successful through the phases/stages of death you choose you get to choose your parents/next life and are re-birthed; if unsuccessful, you remain in purgatory until you figure it out or are lost in purgatory forever?? Amazing!! I believe, the prophet monk who wrote it, also hid it for some 600 years and even named who and the exact date his book of the dead would be found--fearing it was too controversial for the time

written; and it is still being used by Siberian monks today I understand.

I agree with Selke on this one.. it is instinctive to nuture and guide a newborn as they are helpless and innocent, but it is equally important to give our dying support and permission to die; so they can move into the next stage of life....death! Great insight Selke! Thanks for post!

[Selke]

The Book of the Dead, the Bardo Thodol, the "liberation through hearing in the intermediate state", is a Tibetan Buddhist funerary text from the Tibetan Buddhist Nyingma tradition, again bringing up the hearing/voice meme. Here's the wikipedia entry:

http://en.wikipedia.org/wiki/Tibetan_book_of_the_dead

I like the translation by Chogyam Trungpa with the introduction by Francesca Freemantle, who gives a great introduction to the bardo and what does all this mean? These are difficult texts for Westerners -- even for Tibetans -- to understand.

I found Tibetan Buddhism to provide a framework for understanding just these kinds of events we experience in health care -- who else besides monks and nurses even bring up the subject of the benefit of talking to the dying? (Thanks to the OP for posing the question!)

You are close about the Siberian monks, shouldhavebeenanunRN -- Tibet is somewhat close to the Siberian steppes. Actually the indigenous religion to Siberia is shamanism, and Tibet also had its indigenous shamanistic tradition that predated the spread of Buddhism. Tibetan Buddhism incorporated much of this native Bon shamanism into its practices. Shamanism is another ancient religious tradition that acknowledges fluid boundaries between the worlds, in fact the shaman is the one who makes the journey between them, in order to get divine wisdom and gifts from the gods to give to the people of the community. Healers are frequently shamans in these societies -- midwives should be, not sure where they fit in. You can read Mircea Eliade's Shamanism, which was the seminal text on this for a long time. I think of modern Wicca as sort of a contemporary form of ancient shamanism.

Sallie Tisdale is a Buddhist teacher and writer with published books on Buddhism and various other things. I recently found out that she is also an oncology nurse! (If it is the same Sallie Tisdale.) I was sort of surprised (authors must not make lots of money off their books), but not really ....

[shouldhavebeenanunRN]

wow! very deep stuff... got my attention now! I'll have to read rather than skim next time. Thanks

[talaxandra]

I find the idea of nurses as midwives for the process of dying very interesting. It certainly seems as though, for many nurses, the period surrounding death (just before and after) is professioanlly, spiritually and/or emotionally profound. Does anyone have any thoughts about the medical side of things? I ask this because, after never seeing it happen, over the last five or so years I've seen a few doctors talking to dead patients, too.

[marachne]

There is definitely parallels -- and probably at least part of the reason why I've seen a fair number of L&D nurses (and midwives) become hospice nurses.

The other aspect that I find an interesting parallel is that I use the birth metaphor with families who are asking "when do you think/how much longer? I will often ask if they have children. If they do, I ask them to remember what it was like being pregnant/having their partner be pregnant, and how they had all kinds of images about how the birth would go....and how things unfolded in ways completely different then they had planned. I talk about how none of us are in control of the situation, but that it's between the patient,their spirit and powers greater than ours (if I know they're religious in a Judeo-Christian vein, I might say it's between the patient, their spirit and God).

People really get it, and at least sometimes it helps people relax and allow things to flow.