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Respecting the Hearing of the Dying
All the passages below are taken from William H. Griffith’s book, “More than a Parting Prayer---Lessons in Care-giving for the Dying.” It was published in 2004.
We are all teachers for one another as we face our own dying as we live, and as we seek to comfort and understand those who, ill sickness or old age, approach their end of days.
SUNDAY EVENING AROUND 8:30 p.m. a page came to me. I was told that a family, through the nurse, had requested that I come as soon as possible. I responded immediately, and in twenty minutes I was walking into the patient's room and meeting her daughter and granddaughter. The daughter shared with me how her mother had not been well, went into a decline, and then rallied that morning and had a pleasant morning with them.
The granddaughter had flown in from out of state because, when she had asked her grandmother if she should come, her grandmother said, "If it isn't too much trouble." That was heard as a strong "Please come." It was the granddaughter who earlier that evening had made the suggestion to her mother that it would be nice to get a pastor to pray with her grandmother.
The patient was a devout Catholic Christian. Her daughter and granddaughter shared with me how throughout her life the woman had practiced a strong faith in God. After about five minutes of listening to their celebration of the patient's wonderful life, I turned my attention to the grandmother, who was not responsive. I cradled her hand in mine and spoke her name, introducing myself and suggesting that she must be pleased as she listened in on the wonderful things that had just been said about her by her daughter and granddaughter. I speak this way with patients who are unable to respond because it is believed that hearing is possible although the eyes and lips can't respond. When speaking to non-responsive patients, I assume they hear me and are comforted by what they hear.
I suggested that we join hands, and I offered a prayer of thanks to God for the woman's life. I prayed for her spirit's soon release from the body. I then offered a prayer of thanksgiving for each of the woman's family by name and for the many ways she had blessed so many lives over the years. I prayed that as she now journeyed through the valley of the shadow of death she would know the strong hand of the Good Shepherd, who would see that she got through to the other side. When I ended my prayer, we opened our eyes. The woman released one last breath and died.
There in the silence of the room, we watched her, wondering if there would be a sudden drawing in of another breath. Finally, I broke the silence and said, "She has just passed through the valley." There were tears of amazement as both daughter and granddaughter began to reflect upon what had just happened. Both concluded that this was surely a "good death." They spoke words of thankfulness to me for my presence and prayer. "Grandma just needed to have one more prayer," said the granddaughter. "It's just one more story we can add to all of our wonderful Grandma stories."
They asked me if I'd ever had such an experience before, and I told them that this was the fifth time in six months that I'd been called to such a situation and the patient died within minutes after my prayer. I was quick to tell them I have no explanation for it, except to say that patients often seem to be in control of the timing of their deaths.
I would like to believe that a patient's sense of hearing in those final hours is more functional than her motionless body and that during that time there is comfort in having someone affirm her faith and encourage her on her journey. I can't help but wonder if the patient doesn't find that measure of strength to finally let go during a prayer. It seems as if, during our prayer, the God to whom we pray has focused full attention on welcoming the one who is coming out of the shadows.
Since this experience has happened numerous times in one of our units, the nurses have humorously given me the title of "expiration therapist." As a staff, all of us know that such an experience is a great mystery and cannot be manipulated by our actions, but we also know that we are used in mysterious ways to partner with God in accomplishing God's will.
Lessons for Caregivers
One of the great mysteries of this life is the timing of a person's death, especially the death of a person who has been in a non-responsive state for hours or days. It is believed that the timing may be related to a variety of factors, one of which is the dying person's ability to hear about and wait for an anticipated event or visit. When a death occurs shortly after a promised visitor arrives, we often conclude that the visitor's arrival is somehow associated with the timing of the death. Of course, there is no way to verify that assumption. When the patient is told who is in the room and who is on their way, he alone knows how important that information is. But the person who made that final visit doesn't need verification; he knows how important it was for him to make the visit when he did.
Caregivers often wrongfully conclude that their care-giving ceases when the patient no longer responds to them. We should instead assume that non-responsive patients can hear, and that they are still capable of exercising their will. Providing end-of-life care for a dying, non-responsive person includes knowing the person and talking to her, telling her who is present and who is on their way, and sharing with her any decisions that are being made on her behalf. We must also be mindful of what we talk about at the patient's bedside. It is not the place to discuss mortuary arrangements, the will, or who's going to get the patient's car.
As family members and caregivers wait for the death to occur, they may care for the dying person best by anticipating what it is that the dying person would appreciate, and, if at all possible, providing it for her. This is what the loving daughter and granddaughter did when they remembered that the dying woman was a religious person who valued the traditions of the church. They felt it would be appropriate for a prayer to be offered so that she could hear it, and it appears that it was the final gift that the woman needed, which in some mysterious way may have allowed her to let go.
By respecting the dying person's ability to hear, we are treating her with dignity during her dying days and providing for her through the very end of her journey.[17-20]
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