Wednesday, May 15, 2013

Saying Goodbye

My family lost our matriarch and most senior member this week, as my grandmother passed just a few weeks short of her 100th birthday. I was glad that she could complete the end of her story, thanks to the wonderful hospice nurses who helped make it possible. She died peacefully in her own little apartment at the senior assisted living home which has been her home for a number of years.

Spending time with my grandmother this last month made me reflect on lessons I  first learned in my late 20s and early 30s, when I was doing hospice social work early in my career. This week's events just made those lessons about losing a loved one much more personal. Here are a few lessons about helping yourself and other loved ones let go and say goodbye when the time comes:

Loss is a part of life. It's a part of the family life cycle.

Exits and entrances into the family and out of the family are pivotal moments for everyone in the family. This includes deaths, but also divorces, births, adoptions, and marriages . They are nodal life events that cause adjustments.

People are generally happier dying at home if at all possible. It's more intimate.

Our sense of hearing becomes more keen in the days before we depart, so even if a family member is unresponsive you can talk to them, reassure them, let them know that its okay to leave this body and make their transition. Some of our family at a geographic distance got to reassure Grandma by phone even when she was in her last several days.

Death can sometimes provide an opportunity to mend fences between family members. Sometimes you've had a conflicted relationship with the dying person and it may be unrealistic to think you are going to resolve all your feelings before they pass. Try to accept it.

Include younger family members in ways that seems appropriate, but not scary. It felt especially meaningful to have my young adult daughters come and say their own goodbyes. In some ways, including younger family members in suitable, age-appropriate ways helps them be a part of what the older family members are dealing with. It's also good loss education for younger family members who will have other losses to cope with and mourn in future years.

Ask questions of the hospice nurses or other medical staff. It helps to know about the dying process and what is happening as change accelerates in the final days and hours. It's calming to be reassured about what's normal.

Palliative care helps keep a patient comfortable and out of pain. Since supportive, hospice care lasts for only a few days, weeks, or months, we are not concerned about addiction in a dying patient. Hospice and end-of life care is all about comfort measures and helping the patient to make a peaceful transition.

People seem to choose their own timing. Try not to feel guilty if you aren't present at the time of the death. Hospice nurses often notice that family can be holding constant bedside vigil for hours, leave for a moment, and the patient will often die as family are not in the room.

Make peace. Say anything you need to say to your family member; don't regret not saying it later.

Our civilization and culture is not as advanced in terms of dealing with death and dying as some others. It's okay to use the words death, die, etc. Some patients will want to talk about it, but aren't sure the family is up for it.

Tears are good, and healing. Real men cry, too, if they feel like it. I respect a man that can cry.

Loss is often experienced based on your degree of attachment to the person you are losing.

Different family members can express their grief differently.

Loving touch can be the right way to connect with a dying loved one.

Each loss is unique. It's not useful to compare them. Losing an elderly grandparent who lived until almost 100 is not all the same loss as losing a child or a person in the prime of their life, or still with small children. All losses do put us in touch with the temporary nature of this life, the power of connection at all stages of life, and the way that families need each other in times of loss. The finality of loss makes me aware to tell the people I love how I feel about them frequently, and not to let my appreciation of other people go unspoken.

Goodbye, Namo. We'll miss you.

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