End of Life: The Final Word

23 Words matter all the time. It’s just that at the end of life, there are so few of them left, that we must count carefully to make sure there is no waste. That awareness keeps us from using them foolishly. As we leave the bedside of the dying, may we carry with us the desire to use our words carefully, every day, not just on the final ones.

End of Life: The Final Word

"If anyone is never at fault in what he says, he is a perfect man, able to keep his whole body in check." James 3:2

I reach down to touch Anne's* hand, my own fingers still chilled by the outside morning air. Her eyelids flutter, letting me know she was aware of my presence. I speak gently, trying to not disturb the threads of silence that hang heavily in the room.

"How are you doing?"

She does not voice a response, but the furrowed brow tells me that she is thinking of how to answer my question.

As a hospice nurse, I come on the stage of life when others have played their parts and now stand silently in the wings, witnesses to life and death. The chemo team is gone, the transfusions are mostly over; the doctors with their serious pronouncements have faded into the background. Standing beside the bed are the one best friend, two of the six children, and a few others that come and go to leave their gifts of steaming soup or fragrant flowers, attempts to brighten the long journey home.

Anne's eyes open and she looks at me, focusing through the curtain of pain and the blessed numbness of opiates.

"I'm ok," slides out in a whisper.

I stand by, struggling to find the best words, the question that might help her along the way, the voice that will not hurt, but instead help. At times like these, everything matters and the burden of that knowledge, keeps my mouth still, waiting for the Holy One to fill it with direction.

The others leave the room. I hold her fingers in mine, while palpating her pulse, assessing her color, monitoring her respirations, checking her skin for signs of breaks. As I wait, the question spills out, "What is the one thing that bothers you the most about all this?"

A single tear, creeps down her tissue dry cheek and she answers, "I'm afraid of leaving the children. I'm afraid that they will grow apart after I am gone. I won't be here for them to come home to." She speaks with some effort, but as the words well up, expressed from her spirit, they also relieve some of the pain, pent up in her aching heart.

I have no response. None is needed. Saying the words and shedding the tear, seem to ease the crack in her heart. Her respirations even out, her eyes close, apparently more focused on the beyond.

Words matter all the time. It's just that at the end of life, there are so few of them left, that we must count carefully to make sure there is no waste. That awareness keeps us from using them foolishly. As we leave the bedside of the dying, may we carry with us the desire to use our words carefully, every day, not just on the final ones.

Dear God, Grant me your words today. Let me be silent or let me speak only at your prompting. Give me a renewed awareness that words matter. Amen.

*Name changed to protect privacy.

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jeastridge

About jeastridge, BSN, RN

(Columnist)

Joy has been a nurse for 35 years, practicing in a variety of settings. Currently, she is a Faith Community Nurse. She enjoys her grandchildren, cooking for crowds and taking long walks.

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Specializes in Nephrology, Cardiology, ER, ICU.

Great article and so true that listening is sometimes the best skill a nurse can develop!

Thank you.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thank you for this inspiring article. I'm sure your background as a Parish Nurse has helped you to deal with hospice patients in a very caring and effective manner. Sometimes it is not necessary to fill the silence with words but rather to fill it with listening and loving care.

Thank you for being there for this patient and being a very important part of the healthcare team.

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Very poignant and well written. I have limited experience in Hospice (CNA) but it was memorable. Your post made me remember the times when I did not say anything for fear of saying the "wrong" thing to friends and loved ones who went before me, that weighs heavily upon me. I enjoyed your post and thank you for your service.

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I have been in the medical feild for over 16 years in some shape way or form and the hardest lesson i have learned is to be able to be there for a pt at those last moments but be able to separate urself from the situation to some point. Not saying i dont feel like everyone else but its a very hard lesson to learn

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Specializes in Faith Community Nurse (FCN).

Yes, you are right, but isn't it wonderful that we can accompany someone as they go down the road on this last journey? We can come alongside our patients and just be there, giving the gift of presence.

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Well written article. I love the last question that you asked...it gives an opportunity to reassure the patient that everyone is going to be ok. I work primarily with the elderly and the greatest gift has been to be able to be by their side in their final weeks, days , hours and minutes... especially when their their other family members are not available or able to do so emotionally. It is a bond that is indescribable..love between two human beings. Thank you for writing this article.

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Specializes in Faith Community Nurse (FCN).

Thank you for your kind comments and your insights. Loving one another is what it is all about, right?

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Wow! Such emotion in such few words-very well written- I feel that hospice staff are truly called to do what they do day in and day out!! Thank you for your care during such an emotionally charged time!!

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On 1/20/2015 at 7:50 AM, jeastridge said:

Words matter all the time. It's just that at the end of life, there are so few of them left, that we must count carefully to make sure there is no waste. That awareness keeps us from using them foolishly. As we leave the bedside of the dying, may we carry with us the desire to use our words carefully, every day, not just on the final ones.

Dear God, Grant me your words today. Let me be silent or let me speak only at your prompting. Give me a renewed awareness that words matter. Amen.

This...touched my heart. My own mother passed away recently. Thank you for these wonderful words of peace. I am forwarding this to my daughter who is a fellowship trained physician in palliative care and hospice.

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