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All the passages below are taken from the book “Final Journeys: a Practical Guide for Bring Care and Comfort at the End of Life” by Maggie Callanan. It was published in 2008.


     “Why me?” “Why now?” “What did I do to deserve this?” “Is God punishing me?” “What comes next?” We call on faith, religion, or other spiritual influences to provide us with answers for the unanswerable, especially in times of crisis. Spirituality infuses every aspect of our lives but intensifies greatly as death approaches, even for those who have strayed from their original faith. It is most often our spiritual beliefs that give strength, meaning, and direction during these ultimately challenging life events.

In my experience, people take great comfort in spiritual teachings that death is not the end. Their anguish and struggle seem to lessen. Spirituality also plays a powerful role in how they face illness, make health care decisions, and deal with suffering and pain. It is very important for friends and caregivers to recognize this.



I had stopped by the hospice inpatient unit to get some supplies when I saw one of my favorite former teammates. Sherry was having a coffee break in the dining room and waved me over to join her. Sherry is an Eastern Band Cherokee of Virginia, and she always wears her native headband. She’s a highly skilled social worker and a bright, enthusiastic person, and patients and families just love her spirit. I let her know how much I missed working with her as we caught up with each other’s life.

Later, as we walked down the hall together, she suddenly grabbed my arm and said, “Let’s go in here. I want you to meet my favorite patient.” As we entered the four-bed room, three of the patients started calling out: “I’m her favorite.” “No, you can’t be, I am.” “You’re both wrong, it’s me who’s her favorite.” Everyone was chuckling.

Then we went over to the quiet little patient in the corner. You could see how beautiful she had been just a few years before. But now, at age forty-six, she was dying of ovarian cancer, and her face was chiseled into deep, sad wrinkles. She was tiny and fragile like a small bird, now dwarfed by the hospital bed that had become her home.

“Maggie, meet Darcy, whose real name is Dancing Sparrow. She’s from the Hopi tribe, near the Grand Canyon of Arizona,” Sherry said. “This is Maggie, one of the pushiest nurses I know.”

“I’m so happy to meet you, Dancing Sparrow,” I said, taking her hand. Despite our laughter, I could almost inhale the profound sadness that surrounded her. “Is there anything I can do for you?”

“Hold me in your heart and pray for me,” she said as her eyes teared up. A bit startled by the intensity she expressed to a virtual stranger, I replied, “I surely will, Dancing Sparrow. I promise!”

As Sherry walked me to my car, she told me Darcy’s story. She had left her tribe and family twenty years before, seeking opportunities in the big city. But she went from one menial job to another, sinking deeper and deeper into debt and depression. She had been in and out of a few relationships, but one partner had been abusive and the others took advantage of her. And as much as she wanted to be back home with her people, even a bus ticket was out of her financial reach.

Now she was just too sick to travel such a distance, and even if she could, there was no one to take her. She had resigned herself to never seeing her homeland again. Sherry told me that Dancing Sparrow feared that her spirit would wander forever and would never be at peace if it was not returned to her native land.

“It really bothers me,” Sherry said. “I just feel like I have to get her back home, and I don’t know how.” The following week she called me, very upset. Darcy had died.

A few months later I was honored and delighted to learn that I’d been named Clinician of the Year by the National Hospice and Palliative Care Organization, and even more excited that Sherry was Social Worker of the Year. Both awards would be presented at the organization’s annual conference in Phoenix, Arizona. I’m not a believer in coincidences, but my first thought as I called Sherry to congratulate her was of our promises to Dancing Sparrow. We both knew that somehow this trip would give us a way to fulfill them.

After the awards ceremony, our supervisor, Cinni, Sherry, and I rented a car and headed for the Grand Canyon. None of us had ever seen it before.

“What are we supposed to do when we get there?” I asked Sherry.

“I’ve brought some sacred tobacco for an offering,” she said, “and I’m sure we’ll figure out the rest. It just feels right to be taking her spirit home.”

We drove around the East Rim of the Grand Canyon until we found an isolated lookout just a brief walk down from a small parking area. We walked to the rim and stood quietly for quite a few moments, awestruck. Then Sherry started to hum as she offered her tobacco to the spirits and the four directions. Her humming got louder and louder as she rocked back and forth. Cinni and I tried our best to follow her, and before you could shake a stick, we were all dancing and singing with the canyon spread out below us. It felt good getting swept up in this ritual.

“Dancing Sparrow, we have carried you in our hearts, but now we send your spirit back to your homeland so it can rest in peace,” Sherry shouted. She scooped her hands from her heart and flung her arms wide to the canyon. “Rest in peace, Dancing Sparrow, rest in peace!” We chanted it over and over.

Finally we stopped and leaned against each other, spent and satisfied that we had fulfilled our promise. As we stood there drinking in the magnificence of Dancing Sparrow’s homeland, we became aware of rapid clicking sounds behind us. There in the parking area was a very large tour bus full of Japanese businessmen, each with a camera aimed our way. We had no idea how long they’d been there or what they could possibly have thought we were doing. Our hearts had been very busy sending Dancing Sparrow’s spirit back to her home.


The Value of Spiritual Traditions

When life is at its most difficult, our spiritual traditions provide us with ways to feel less victimized. We can pray, others can pray for us, and we can attend religious services and ceremonies. We can observe certain traditions, surround ourselves with important symbols, and be comforted by the sense of a caring and supportive spiritual community around us. All of these things serve to help us realize that our suffering is a recognized and shared condition, and that we are not alone.

The tenets of our particular spiritual tradition also provide a framework of information and beliefs for making the painfully difficult decisions that may arise in a terminal illness. Consider the question of what determines physical death. Some faiths recognize death as the cessation of brain function, and even specify which parts of the brain must be involved—-whole brain, upper brain, or lower brain. Others identify death as the cessation of the heartbeat.

Understanding these differences offers insight into why some people are adamant about choosing CPR. They believe that there is life as long as the heart can be made to beat, even if there is no brain function. What may seem to be an illogical choice in a hopeless situation is an important part of their religious beliefs. Their choices must be respected. Religious beliefs also impact choices such as when to use or forgo life-sustaining treatments; whether to request or refuse an autopsy; and postmortem care, burial, and mourning customs. Spirituality is a supportive structure, providing positive guidelines so we can be sure we “did it right.” This relieves guilt and provides comfort even long after the patient has died.

When conflicts arise over issues of care or treatment, a clergy member can be of immeasurable help in clarifying for patients and families what is approved and not approved within their faith. This giving of permission is one of the many reasons why having a spiritual representative as a member of the care team is essential. A hospice chaplain plays a key role in the following story.



“I was born in the old country,” said eighty-six-year-old Mary. Her brogue was so thick that I thought she might have immigrated yesterday instead of sixty-six years ago. “I was brought here by my wonderful husband, Mar-tin Mo-ri-ar-i-ty.”

It made me smile to hear how those two names always ended up as seven distinct musical syllables. Entering the Moriarity house was like stepping onto the auld sod of Ireland.

“Mary, my dear, would you care for a cup o’ tea?” Martin would ask. “Indeed I would, Mar-tin Mo-ri-ar-i-ty, and thanks to you for asking,” she would reply. This lovely formality continued throughout their married life, long after he’d rescued her from a life of abject poverty.

“A gift from God is what he is,” Mary told me on my first visit. “He was educated fancy-like here in America, at Harvard. But he came back to his homeland and married me, who had nothing more than a sixth-grade education. He saved me from a life of sorrow.”

Her unabashed gratitude intensified as her life was drawing to a close. She was a timid, unassertive woman who seemed to need direction for everything she did, and Martin tenderly obliged.

The rheumatic fever that was inadequately treated in childhood had left her with a severely damaged heart and weakened kidneys. As the doctors had recommended back then, they never had children. And with Mary’s unquestioning trust and adoration of Martin, their relationship seemed more like parent and child. He treasured her with a fatherly vigilance and respect that was touching to see.

As her heart slowly failed, Martin and Mary prayed together—-not for a cure, but for comfort and trust in God’s plan. Their religion was the backbone of their lives, and prayer threaded through each day.

One day I arrived for a routine visit with Mary to find Martin enjoying a cup of tea with our chaplain, Jim, a priest who visited regularly and gave them great spiritual support. They both loved Jim, so Irish himself, and he and Martin were deep in conversation. After I checked on Mary, I joined them in the kitchen.

“I am stunned that Mary is still here with us,” I told them. “You remember last week when we talked about all the signs she had of an imminent death?”

“Oh, indeed I do,” Martin said sadly.

“She still does!” I said. “Could she be lingering for some reason? What do you think?”

Martin nodded. “I think you’re right. I hate to see her hang on like this. She’s barely conscious most of the time. She stopped being able to eat or drink two weeks ago, just after Father Jim gave her the Sacrament of the Sick. Just like you told me, I sat with her and told her that I’d miss her terribly, but I’d be all right without her, and I’d join her in heaven pretty soon—-after all, I am eighty-seven myself! But she still just seems to linger.”

“Let’s go pray with her,” Father Jim said. We gathered around Mary’s bed and started praying. There was only a flicker of recognition in her eyelids. Father Jim spoke eloquently of what a grand wife, devoted member of her parish, and caring friend and neighbor Mary had been.

“You have lived a good life, Mary. Your work is done here on earth. Now it’s time for you to go home to God. And as today is the Feast of the Queenship of Mary, your patron saint, I think today would be a grand day for you to go home to heaven.”

I held my breath in shocked surprise at his forwardness. And then, together, we witnessed Mary take her last breath. I could barely believe my eyes. She died as peacefully and simply as she had lived. Certainly there were tears of sadness, but they were mixed with prayers of gratitude that she finally felt safe and free to go—-not only with Martin’s blessing but also with the guiding words of Father Jim. As simple as that, he gave her permission to go, and she went.

What we sometimes view as a physical problem may actually be an unfinished or unresolved spiritual matter. Again and again, I’ve seen the dying choose to leave when they are surrounded by the people they love, with their priest, minister, or rabbi in attendance, and all praying together. We waste our words on so many unimportant things in life—-praying together with the dying (if appropriate) can be a very positive way to use our words.



Spiritual needs and influences intensify as death approaches. Addressing these needs appropriately is critically important in the holistic and compassionate care of the dying. [176-183]


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