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PREPARING FOR TRAVEL OR CHANGE: “I’M GETTING READY TO LEAVE.”

 

All the passages below are taken from the book “Final Gifts,” by Maggie Callanan and Patricia Kelley. It was published in 1992.

 

Contrary to popular belief, or perhaps from wishful thinking--because of our own discomfort with death­--dying people know they are dying, even if no one else knows or has told them. They attempt to share this information by using symbolic language to indicate preparation for a journey or change soon to happen. Travel is a clear metaphor often used to describe this need to go forth­ to die.

Many accept this knowledge of their impending death without anxiety or fear, but may need validation or information about what the dying will be like. Some experience apprehension, often due to deep concern that family and friends don’t accept this reality or may be unprepared for the finality of their leaving.

 

DICK

At fifty-five, Dick was a quiet, affectionate man who’d spent his working years as a postman. He and his wife, Ruth, had raised four children in a rambling three-bedroom house that he’d expanded and kept up, using his considerable skills as a handyman. Never poor, they weren’t wealthy, but times were getting better. The three older children had finished college and had good jobs; the youngest was about to graduate. For the first time, Dick and Ruth were saving money.

One of their dreams was to purchase a sailboat. After careful planning, they bought a twenty-foot craft that they named Our Turn. Every weekend, Dick and Ruth drove to the shore and spent hours there, often fixing dinner in the tiny galley and spending Saturday night aboard. In bad weather, they kept the boat in the slip, and busied themselves varnishing the woodwork and polishing the chrome while they talked of trips they would make when the skies cleared and the seas calmed.

But the better times lasted only two years. At fifty-seven Dick was diagnosed with pancreatic cancer, which had spread to his liver and both lungs. He and Ruth realized his was a terminal illness, but hoped treatment would buy him a little time.

It didn’t buy him much. The side effects of chemotherapy were severe; it didn’t seem to be delaying the cancer’s growth, so his doctor recommended it be stopped. Dick was deteriorating rapidly. He was referred to a hospice program and admitted to the inpatient unit.

Ruth visited daily, going home each night to sleep. One evening, just after midnight, I checked to see if Dick needed anything.

“Well, how is the tide tonight?” Dick asked, taking me by surprise.

“I don’t know,” I said. “Would you like me to find out?”

Dick smiled. “Oh, no, it doesn’t really matter,” he said. “I won’t be here when you come around again, anyway.”

I asked Dick what he meant; he only smiled and looked off into space. I asked if he was trying to tell me something­--that he might be changing in some way. The only response was a gentle smile. I saw no signs that death was near, but believed what he had said might be important. Telephoning Ruth, I described our conversation, and offered my interpretation­--Dick might be letting us know he was changing, and might be about to die. Ruth said she’d have their son Scott drive her back to the hospice unit.

Returning to Dick’s room, I told him I still didn’t know about the tide, but that Ruth and Scott would be there in about an hour. Again he smiled.

I stayed with him until they arrived. During that interlude, he nodded or smiled in response to my questions and comments, but said little. When his wife and son entered the room, he smiled at them and closed his eyes for the last time.

He slept the rest of the night with Ruth beside him and Scott in the next room. Just before 5 A.M. his breathing stopped and he died.

As we waited for the funeral director to arrive, Ruth and Scott told me how glad they were to have been there when Dick died; I gave all the credit to Dick and his brief, simple message.

“But somehow it was just like him!” Ruth said. “He’d want to know about the tide, he’d want us to have a little warning, and he’d want me to be with him.”

 

For their own particular reasons, some families are unable to understand and respond to such messages. It’s important not to be critical, but rather to be sensitive to their needs as well. The dying person still has needs, but in such situations the responsibility falls to someone else­--perhaps the nurse, the minister, or a friend.

 

GEORGE

Charming, articulate, and well organized­ thanks in no small part to a career in the Army, from which he’d retired as a lieutenant colonel­--George was in his mid-sixties. After the service George had built a second career as a consultant.

His first wife had died when he was forty-four; they’d had no children. At sixty-two, George had remarried; his new wife, Joan, had been widowed twice. Only eighteen months after their wedding George was diagnosed with colon cancer. He had surgery and seemed to be recovering well, but the cancer showed up in his liver and was incurable. For six months he deteriorated, becoming so weak that he had to give up the reading he loved; after a headline or two, he’d drop the newspaper, too tired to go on.

We found him a volunteer, an ex-military man himself, who would visit and read to him. That was a relief for Joan, who took advantage of his help to go shopping with her daughter or spend time with her grandchildren.

One day when I arrived, she greeted me sadly.

“Well, he’s out of it now,” she said. “He doesn’t make any sense at all.”

I asked why she thought that.

“He keeps asking me to get his papers, his passport, and his ticket,” Joan said, looking troubled and twisting a handkerchief around her fingers.

I mentioned that talk of travel often is a way that dying people talk of death; I asked if she thought that might be so with George.

“No, no,” Joan said. “His mind is wandering, he’s thinking about all those trips he’s taken over the years.”

I agreed that George probably was remembering previous travel experiences, but suggested that he also might be revealing that he was ready for a different journey­--dying­--and wanted to talk about it. Joan would have none of that, repeating that he was making no sense. She wouldn’t even come into George’s room with me.

I could see that Joan was emotionally exhausted. She’d buried two husbands after caring for them through illnesses similar to George’s, and was taking refuge in the conviction that he didn’t know what was happening or who was with him. This let her put some distance between herself and yet another brush with an emotionally painful experience. She agreed that it would be all right if I asked George what he meant, and if there was anything else he needed.

When I went into George’s room, he seemed anxious, but greeted me as he usually did.

“How are you doing today?” I asked him.

“Well, I’m not eating much,” George said. “I feel weaker, but I went out for a ride in the garden in my wheelchair, and the pain’s not bothering me. But I can’t find my passport. Do you know where my ticket is?”

“It sounds like you’re planning to go somewhere,” I answered. George nodded.

“Are you going on a journey?”

Nodding again, George said, “I don’t have my papers.”

“Are you talking about a different sort of journey?” I asked. “Maybe about leaving here? Maybe about dying?”

George responded to this suggestion with relief. He nodded, opened his mouth as if to speak, then shrugged.

“If you’re talking about that journey, you don’t need a passport and tickets,” I said. “Are you wondering what you do need? Are you asking me what it will be like?”

This time he nodded more vigorously. He smiled and said, “Yes, I have to get ready.”

I sat beside him and began to explain what he’d probably experience. Stopping frequently to make sure this was what he wanted to know, I described as simply as possible how his death would probably come. He’d continue to grow weaker, I explained. He might become so weak that he wouldn’t be able to move, to talk, even to swallow--at which point his pain medicine would be given a different way--injection, suppository, or liquid under his tongue--rather than pills to swallow. His breathing would slow, become soft and quiet, then stop.

“Will it hurt?” he asked. “Will I suffer?”

No, I said. He’d move into light, warmth, and peace; none of this would cause him pain or fear. My words seemed to allay George’s anxiety. I asked if there was anything he thought he needed to do to get ready for this journey.

“Joan doesn’t know about passports and tickets,” he said.

“Are you wondering if she understands that you’re dying?” I asked.

George nodded in assent.

“I think she does,” I said. “But I’ll explain it to her again, if you want me to.”

Again he nodded, smiled to me, and in an instant went back to discussing his changing appetite. He lived ten more days, sometimes asking about his passport or papers, but without distress. He seemed to be checking to see that all was in order, wanting to be sure that arrangements for his last journey were as smooth as possible, and that Joan was prepared for his departure.

Though she appreciated the support we gave her, Joan never could talk with George about death; however, she was at ease when someone else did so. She was able to show her love and concern for him by helping with his physical care.

 

Like Joan, some families have needs that prevent them from understanding or responding to a dying person’s symbolic language. In such instances, others may need to intervene. Joan needed empathy and support; George needed information.

It may seem strange or cruel to say to someone who’s dying, “I think you’re going to die soon; this is what it’s probably going to be like. . . .” But most dying people know they’re dying. They aren’t bothered by such openness; on the contrary, they welcome it. They’re usually afraid, not of death and what comes after, but of what will happen before they die. They often want confirmation of the fact that they’re dying, and a description of what it will be like for them. For those who seek this information, receiving it is less frightening than the unknown. In the same way, reassurance that their relatives know that death is coming, and are prepared for it, provides relief to the ones dying.

 

The following family was not only quick to grasp the concept of Nearing Death Awareness, but also excited by the opportunity to understand important messages from their dying husband and father.

 

PAUL

Elise described her husband as a “genius,” and in many ways she wasn’t exaggerating. A successful and respected aeronautical engineer, Paul was hired at an early age by NASA to work on various space shuttles.

“Paul always has a dozen projects going. He can fix or build anything. He loves being active,” Elise said.

Because of his prostate cancer and the resulting severe weight loss, Paul had blood pressure so low that each time he tried to stand up it would fall even lower and he would faint. Consequently, he spent most of his time in bed, or in a reclining chair in his room. Despite various medications, we were unable to improve this condition.

“This just isn’t his style. He won’t put up with this for long,” Elise said.

When Paul showed early signs of confusion, I explained the concept of Nearing Death Awareness to Elise and their daughters, aged twelve and sixteen. I suggested they listen carefully to everything that Paul said. They seemed fascinated and enthusiastic about it.

“We should be good at this. He’s so smart, I’ve spent my life trying to figure out what the heck he’s talking about!” Elise laughed.

Paul had a fascination with astronomy--especially lunar eclipses. And one was to take place in a few weeks. He spoke often of how much he wanted to witness it.

“Fix this damn blood pressure, so I can get on my feet to see it, okay? This might be my last chance to see one,” he said.

But his blood pressure didn’t improve enough for him to be more active. Realizing his request was futile, Paul became sullen and withdrawn, seeming to have lost interest in what was going on around him.

The day after the eclipse, his older daughter said, “Guess what? Dad dreamed about the eclipse last night. Even though he couldn’t watch, he had lots to say about what it looked like and where it was. I told him it sounded like he had a ringside seat. He just smiled. My little sister said, ‘Maybe he did!’”

A few days later, Elise called.

“I don’t know­--he seems weird today,” she said. “But he won’t tell us what’s wrong!”

I agreed to come and check him. A quick physical examination indicated no significant changes, but his brows were furrowed with concentration. His normally peaceful demeanor had changed; he seemed busy, preoccupied, almost annoyed by our interruption.

“What’s happening, Paul?” I asked. “Is something different?”

“I’m trying to figure out how I can take the house and everything in it!” he said.

“Take the house where?” I asked.

“With me!” he said, seeming irritated and indignant. Elise’s eyes widened.

“Take the people in the house, too?” she asked.

“Of course!” he said.

“Is there anything we can do to help?” I asked.

“No, I have to do this by myself!” he said. Then he rolled over on his side and went to sleep.

In the kitchen I asked Elise and the girls what they thought this all meant.

“I’m glad he saw the eclipse, “cause he really wanted to,” his younger daughter said.

“Maybe he doesn’t want to leave us or this house. Did you know that he built it himself?” the older daughter asked. We agreed that was possible.

Over the next week, Paul spoke to his family often and in great detail about his plans for taking his family and his house with him when he died--he’d dig up the foundation, seal off the water and gas lines, store food, and build a self-contained heating system.

Then one day Elise found Paul very quiet, having little to say.

“What’s the matter, Paul?” she asked. “You’re so quiet! Is something wrong?” His eyes filled with tears.

“It’s neither practical nor possible,” he said.

“I know,” she said, holding him close.

“But we’ll never forget how hard you tried,” she went on tearfully. “We’ll work together to take care of each other and your beautiful house. We love you and we’re going to miss you. It’ll be hard without you, but we’ll be okay.”

From that conversation on, Paul stopped speaking. His only responses were a nod or shake of his head, but he seemed very peaceful. By the next day, he’d slipped quietly into a coma; a few hours later, with Elise and the girls at his bedside, he died.

At his funeral, Elise and the girls told the story to some of Paul’s coworkers.

“Isn’t it just like Paul to try to do the impossible?” Elise said with a chuckle. “If anybody could have figured out a way to take his family and his house with him, it would have been Paul!”

The gift of sharing, love, and concern Paul had given his family already was helping them deal with their loss and grief.

 

The way the messages in this chapter were offered reflects the personalities and experiences of the senders. Some messages are long, detailed, and stated often. Others are brief and fleeting. Some are obscure, others are crystal clear. All gave the message “I’m getting ready to leave.”

Dick, who loved boats, simply asked once about the tide as he prepared for his last voyage, while engineer Paul dove into the complex and ultimately insoluble problem of taking his family and house with him.

George, ever the precise military man, reminded those around him of his need for his papers and passport.

At the core of each such message is the news that dying people know they are dying­--perhaps before anyone else. Instead of anxiety, that knowledge may be accompanied by a need for information about the process of dying or concern for those they love. Simple, brief, and concise information helps to allay those fears. The family’s reassurances­--that they’ll be all right and they know what’s going on­ often bring the peace a dying person needs. If possible, such comfort should come directly from the family; if impossible, a third party ca--and should­ attempt to reassure and comfort the individual.
 

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