Helping Someone "Let Go" At Time of Death

[Passion4Compassion]

Hi All,

I am currently a senior working on my RN degree and then plan to move into my CRNA. My nursing and personal life have come together as my maternal grandmother is in the process of death at this very moment. I am going to see her tomorrow and have learned so much about the fact that some folks feel as if they need "permission" to die...reassurance that their loved ones will be okay and that someone is awating them once they make the transition.

One of my professors spoke about end of life care eloquently and made me realize that if I can help my grandmother let go then it is one of the greatest gifts I could give to her. Her eyes are empty. She is 87, suffered first a TIA and then a stroke about a month and a half ago. We moved her from Florida to Vermont, thinking we could take care of her. She was confused and could not be left alone. A week later she was admitted into a rehabilitation facility. Now she is in the hospital and has pneumonia and they are saying she is suffering from some heart failure. Her appetite is gone, she sleeps during the day and is awake all night, fitting, pulling at her foley...just fidgeting.

My mother said that while she was visiting her yesterday that my grandmother was having a conversation with someone as if she was on the phone only no one was there. Also, several times, she reached towards the ceiling. My mom thinks she was talking to my grandfather. She also mentioned that my grandmother's eyes are empty and that she is completely out of it. My mother is trying to prepare me for the sight I will see when I walk into her room tomorrow. I am starting to realize how different it is to care for someone when you only know them how they are as your patient.

The thing I need help with is that I want to be able to support her and let her know it is okay to let go. To let her know my grandfather is waiting for her and is looking forward to seeing her. I got the sense from her previously that she felt a bit of an obligation because my mother and I did so much to prepare a room for her in what was an office at my mother's house. That we put so much emphasis on holidays and how great it would be to have her in Vermont for a change. I will spend the entire day with her tomorrow, trying to feed her ice cream and rubbing her back. I will bring her rosary beads and a photo of my grandfather.

It is so diffifcult when having to do this for someone I love. My mother is emotionally exhausted and this will fall onto me and I want to do things the best way I can for my grandmother. If I can comfort her and she lets herself go while I am holding her then that will be a great privlege. Even if she lets herself go later that evening, I just want her to know it is okay. She is DNR, DNI, only wants pain measures taken...her body is shutting down, how can I help her?

Thanks in advance, I am desparate. Vanessa

[RN1982]

Hi Vanessa, I'm sorry to hear about your grandmother. My grandmother passed away two years ago after suffering from advanced dementia. She was bedridden and could not speak by the end of her life. She lived in Georgia and I obviously by my title lived in Michigan. On her last day here on this earth, I would have loved nothing more than to be at her side telling her thank you for all the loving memories we had together. I would have loved to say "grandma I love you and I don't want you to suffer anymore". My recommendation to you is to sit at her side and tell her all the things you would love to tell her. Tell her how much you love her. Tell her thank you for the memories that she has given you. Just be there with her. That's all.

[Passion4Compassion]

I am in tears, thank you so much. I will keep your words in my mind as I am trying to get through what is going to be a very difficult day. I pulled out my Psychiatric Nursing book and found the death and grieving section. Most important is to: say I love you, say thank you, and to say good-bye. You said it even better than the book. I will thank her for the time she took me to NYC. I will thank her for taking me to Boston. I will thank her for helping me pay for school and for always being so self-less. I will thank her for the riddles she would tell around the campfire and the hawaiian sloppy joes and s'mores. I will thank her for being her. I will thank her for letting me care for her at her most vulnerable time. I will thank her, tell her I love her very much and let her know that my grandfather is waiting...

[CITCAT]

:saint:iempathsize for you and your current situation ,i have only one family member left i have been through alot of deaths.as i get older i find that to die is a release for some, this might sound nuts just be yourself,she can hear you she is holding on something in her mind is undone,why not ask he and maybe help to complete this unfinished business in her mind may i suggest elizabeth kubler-ross book death and dying, the process and the journey dear nurse this was the book that was required reading when i went to nursing school she was the first authority on the pyscholocgical manifestations of the dying process,if i may say our journey as humans on his is just temporal its a transition from one place to another,gently and peacefully that is the conviction of every nurse to attempt to ensure /the hospice credo.as told to me my a senior nurse many years ago when i was just a young nurse.may god or your higher power give you and yours peace,comfort,serenity and wisdom at this most delicate time.

[RN1982]

Ok, now I am in tears. You and your grandmother are in my prayers.

This was my grandmother's favority prayer:

God grant me the serenity

to accept the things I cannot change;

courage to change the things I can;

and wisdom to know the difference. Living one day at a time;

Enjoying one moment at a time;

Accepting hardships as the pathway to peace;

Taking, as He did, this sinful world

as it is, not as I would have it;

Trusting that He will make all things right

if I surrender to His Will;

That I may be reasonably happy in this life

and supremely happy with Him

Forever in the next.

Amen.

[Spidey's mom, ADN, BSN, RN]

Hi - I am right in the middle of "Final Gifts" by Maggie Callanan and Patricia Kelley (Hospice Nurses) which describes exactly the kinds of things your grandmother is doing. It is a theory called "Nearing Death Awareness".

Here is a link:

http://www.iands.org/nde_index/ndes/terminally_ill.html

I wish you the best.

I lost my grandmother recently - it is difficult.

steph

[kmoonshine, RN]

I too recommend the book "Final Gifts".

It sounds like you are helping to give your grandmother a "good" death. I'm sorry for what you are going through, and I wish you and your family the best.

If you like celebrating holidays, why not pick one to celebrate with her? Which holiday was her favorite? For example, if it was christmas: bring in a little fake tree if you have one and wrap up some boxes filled with meaningful items that you and your family have. Pick items that have significant meaning to her (such as a wedding picture of her and your grandfather), open presents, and enjoy the time you have left together.

Does there seem to be a reason that she would want to hold on (such as someone's birthday coming up)? Tell her its ok to go, and you will miss her but you will make sure that your mother (her daughter) is taken care of.

[husker_rn, RN]

Michigan RN you said it all !! I lost my beloved grandma many years ago and miss her still. While I am sorry that you are going to lose a loved one I envy you that you can see her in her last days and tell her what a blessing she was in your life. What a gift to both of you.

[dolphn545]

I agree with the previous posts, thanking your loved ones near the end. Also just by telling them that "it's ok" is something that they need to hear. It's ok to let go, and that you will be alright. You will meet with them again someday, when your "chores are through". That's one of the last things my grandmother said to my grandfather.

In my grandfather's case, all he wanted was "peace & quiet" (he had 10 kids, and numerous grandchildren/great grandchildren -- so no such thing as peace & quiet!) But the morning that he passed, most of the family had gone out to breakfast, get some air, etc. He waited until there was only a few of us there, and got his peace and quiet.

When someone is ready to pass on in the LTC facility I work at, even if family is there, I will tell them that it's ok. They have lived a good life (hopefully they have). I will also ask the family if they told their loved one that it's ok to let go, or if there's somebody tht didn't get to come in for that last visit.

Just my 2cents.

[CT Pixie, BSN, RN]

My beloved Gammy passed almost 15 years ago and I miss her each and every day. (that was our name for her instead of grandma). Many times in the last 15 years I have picked up the phone and dialed her phone number to talk with her and give her good news (the news that I was getting married, the news of our 1st home, my 2nd pregnancy, getting into school..things like that) and once the phone rings, I realize that Gammy isn't there to answer it.

Gammy had pancreatic cancer and had decided that enough was enough, she wanted no further treatment for her terminal disease. On a summerday on a Wednesday, we had a HUGE family reunion at her house. Family from all over the country had come together. It was one of the best days ever and Gammy looked great and she looked so happy to see all the family together. (She was due to go into Hospice that coming Monday) That weekend, my Gamps called to say Gam wasn't doing well and that we should get there quick. My mom, myself and my sister got there and my moms sister was there. I went in and was talking with her but she was semi-conscious. I know she knew we were all there because as each of her grandchildren (7 of us) went in, she would open her eyes, look at us and try to smile at us. We were all waiting for my Uncle, who was a long distance truck driver. Gam kept calling for "Joey", and my gamps would go in since his name was "Joey", and she would get agitated, for it wasn't Gamps she wanted, it was her son "Joey".

Gam held on but I knew she was only hanging on to see her son one last time. He was hundreds of miles away. Before I left I went in, told Gams it was ok to go, that we'd all be ok. Before I left for home to shower and come back, I told my Mom, Gam isn't going to let go until she sees/hears "uncle Joey". Once at home, my mom called quite upset, Gam was very agitated, calling for Joey and they didn't know what to do. I told them, when she calls for Joey again, have Gamps go in (at this point Gam wasn't opening her eyes at all) and tell her that he was Uncle Joey. Thats exactly what they did, when she called for Joey again my gamp went in and said "i;m here Mom its ok, you can let go now". She squeezed his hand, and within minutes she finally let go. People might find fault with us for deceiving my Gam like that but she was in terrible pain and we knew she would continue to fight until her son got there. He was days away from getting there. We didn't want to see her suffer one minute longer than necessiary.

I guess what I'm saying is, tell your Grandmother you love her, thank her for all she's done, and give her the permission to go that she most likely so badly wants. My gam was looking for her family's ok to let go, but she wanted to hear her son allow her to go to. Once she got the ok from all of us, she did just that, she let go.

You and your family are in my thoughts. Losing a beloved family member is always hard.

[leslie :-D]

(((passion))), i just came across your thread.

i'm sorry to hear about your struggles w/your grandma.

when you do speak w/her, try to do so when/if she is lucid.

most times, pts are reluctant to die if they sense their family is not coping w/their terminaltiy.

or, even if the family is ok, they worry about who they're leaving behind.

that's where the permission comes in.

telling the pt that everyone will be ok, is a huge relief.

while it's true that when actively dying, they often don't hear all sentiments being expressed, your physical presence can be the most comforting act of love.

with others, many choose to die w/o family present.

it has been my experience, that our elderly have little problems w/the dying experience.

their bodies, souls and spirits are very tired, and are ready to move on.

finally, the spiritual component of dying is acutely heightened, and while you should tell them how much you love them and thank them, they indeed, can sense your emotions...

so, truly being able to give permission (versus just saying it) to let them go, is one of the greatest gifts of love.

wishing all, a peaceful journey.

leslie

[SuesquatchRN, BSN, RN]

Just remember that she can hear you, and will know that you are there.

I wish you all peace.