The beat of drums came from the private hospital room. The passing nurses rolled their eyes. When I entered, four young women were in a circle on the floor slapping congas, trying their best to keep the volume down in consideration of others in the hospital. Meanwhile, the grandmother was on her bed restlessly trying to sleep. I pulled aside the granddaughter, Caitlin, to ask about the drums.
She explained that someone had told her about a Tibetan practice called the phowa (po-wa), and I groaned inwardly. Tibetan monks spend their lives learning this intricate process in which the consciousness of the dying is received into the monk and transferred into the next incarnation. As Caitlin described what she hoped to accomplish, it also dawned on me that she was confusing the Tibetan phowa with a Native American powwow, hence the drums.
I didn't explain the mix-up. Instead I gently put the drums to one side. “Perhaps,” I said, “You might want to sit around the bed and chant softly to your grandmother. It would help her relax.”
Indra, a Hindu, looked around the hospital room where her young husband, Ramesh, was dying and saw that it was not very comfortable, nor was it conducive to prayer and meditation. But she could do something about that. The side table became an altar, with flowers on it, some religious statues she brought from home, and some sandalwood paste. She closed the curtain to give them both a feeling of privacy, then moved a chair around to face Ramesh so that she would feel closer to him in her meditations.
Friends dropped by during the day to visit, and seeing what was happening, sat quietly, praying each in his or her own way.
One of the nurses came into the room, looked at everyone, smiled, and silently changed the IV bottle. As she headed out the door, she stopped, turned around, and came back to the foot of the bed. She bowed her head and stood quietly for a few moments. She crossed herself and then slipped noiselessly out of the door.
The room and everyone in it had been transformed.
The Bulk of Us
“I hate hospitals,” declared Sarah, as she prepared to visit her favorite cousin, who despite
recent surgery for breast cancer had received a negative prognosis.
“I’m not going,” she pouted as she put on her coat and gloves. “l never know what to do or say, so I just won't go.”
In the hospital parking lot, Sarah was still protesting, so I took her hand and spoke quietly. “This is a very difficult experience for your cousin. She's dying. Why don't we take a moment and think about what she's going through and what help she may need from you.”
Sarah paused a moment and then, voice quivering, said, “I feel so helpless. I know she's going to die, Megory, and I don't want to lose her. This really hurts.” Tears began falling down her cheeks. I held her hand and let her cry it out.
“You're right, though,” she said finally, taking a deep breath. “She's the one who's dying, not me I should be there for her. Tell me what I can do.” So I gave her some simple suggestions, and she became quiet for a moment, struggling with herself.
“I'm not sure I can do that, but I'll try. I want to be with her, no matter what.”
Sarah is certainly not the only person afraid to be with those who are facing death. Nor is Caitlin unique in having her good intentions expressed in bizarre ways. Our society tends to make the elderly and dying invisible, pushing them away from sight, into nursing homes and hospitals. We panic at the thought of confronting a loved-one’s death, often more afraid for ourselves, anxious about how we will handle this encounter with the unknown.
The experience of dying is often difficult, filled with fears and anxieties for both the dying and for the surviving loved ones. But death is also a mysterious and wondrous process. It involves both body and soul in the greatest transition we are ever called to make. I have sat with hundreds of dying persons, and I have learned that we don’t have to be fearful or intimidated.
My own training is in theology, comparative religion, and ritual work. I spent four years as an Anglican nun in a monastic order and have been on the staff of so many churches I can barely remember them all. I also have a chronic illness, and when it was at its worst several years ago, I contracted meningitis and remember vividly the place where I was sure death would come. It was awe-filled. For me there is no comfort or ease in that in-between space. But I am not afraid of death anymore.
I didn’t plan to get involved with vigiling with the dying, but several years ago a friend’s brother, Tom, was in the final stages of AIDS, and I got a call in the night. My friend said there were no priests available, just answering machines, and it was clear that her brother would last only a few more hours.
“Okay,” I said, “I’ll come over. We can still break bread and make this a holy death.” So we sat with him. We washed him. We anointed him. We created music around him. I asked if he felt there were things holding him back, and he went on to talk about the things in his life that had pained him, all the little things built up over a lifetime. As I sat and listened, I realized how very small the things are that weigh us down. But they do get in the way, and over time they become too heavy to carry. It was time for Tom to put them down.
Tom’s dying lasted all night, and was a truly powerful and holy experience. I also learned that, given the extended time it takes for a person to let go of life, neither doctors, nor nurses, nor priests, nor hospital chaplains can be expected to keep vigil throughout it all. So I volunteered, and my name got passed to people in need. I began keeping a journal of these experiences for myself and later for a book, Sacred Dying: A Spiritual and Ritual Guide to the End of Life. I’ve found that there are many ways to sit vigil with the dying, and often the little things mean the most.
Visiting the Dying
The first and most important thing we must remember is that dying belongs to the person going through this experience. Our attention, our thoughts, and our actions, should be centered on what is most helpful to the person dying. We are only the bystander in this most important of life’s transitions.
The second thing is to remember that it is possible to bring the spiritual into the physical act of dying. Depending on the individual, this may encompass a wide range of beliefs and traditions. For some, it may mean a traditional religious ritual. For others, it may mean a less conventional approach. For others, it may mean a spiritual expression of the world around us.
It has been my experience that spiritual practices or rituals can help a person die a peaceful and sacred death, bringing reconciliation and acceptance to both the loved ones present and to the person dying.
What to do:
The way I prepare myself before doing rituals with the dying is simple. I wash my hands and face before entering the room, and I take a few moments outside the door to breathe in and out while saying a prayer. I ask for the Divine Presence to be with me, giving me a sense of compassion and love. I imagine that I’m the person dying. What would I want? Acceptance and love, no matter what was happening.
Hospital rooms or sick rooms in the home tend to be taken over by practical medical paraphernalia and debris. Clear some of it away (being careful of things that may be there by design). Think of a baby’s nursery. The brand-new room parents prepare for their baby is centered around the crib. The bed of a dying person needs to hold a person safely in the same way. If a hospital bed is used, bring in extra pillows and blankets that are soft, warm, and familiar. Containing the space also allows for privacy and intimacy. In a hospital room this can be done using blankets or curtains. Sometimes I use candles or lamps or even chairs to define the space. Bring things in from home—photos, knickknacks, small things that may have special meaning for the patient. Think of what you would want around you for emotional comfort and peacefulness.
Many times the air in the room is musty or stale. The symbol of air and wind as the Divine Spirit is part of many faith traditions, so opening the windows and letting in fresh air can become a simple ritual that is extremely helpful. An air purifier or ionizer can also help.
One Jewish woman I sat with asked her family to bring in her prayer shawl. She was too weak to put it on to pray the traditional way, so I wrapped it around her pillow. She pulled the pillow close to her body, and as her tears soaked the silky shawl, she whispered the traditional prayer, “Shema, Israel, Adonai Eloheinu, Adonai echad.” “Hear, o Israel, the Lord our God, the Lord is One.” Later that day, her family wrapped her body in the same shawl, as they prepared her body for burial.
Tell the person dying how much you care for him or her … I believe that words spoken in the love at this moment are always heard and understood
A person’s faith tradition and beliefs are rarely more important than at the end of life, and having symbols of that faith nearby can be extremely important for the dying. Symbols you may consider are things such as rosary or prayer beads, icons, statues, holy pictures, or any personal religious item. I have seen small altars assembled in hospital rooms allowing both patient and family members an opportunity to pray as often as they wish.
Consider small religious items that can be cradled in the hands, or items that can be placed on a nearby table and easily seen. Bring in spiritual books and read to the patient. Don’t be afraid to pray with the dying person.
Music is wonderful for bringing a sense of calm to a room. Bring in some tapes of relaxing or inspiring music. Sit with the patient and listen to the music together.
When Kate, a close friend of mine, was dying of cancer, our women's group came to see her in the hospital. She had been in bed for weeks, and her body was clearly suffering. When we asked her how she wanted us to help her, she replied, “You know what I really want?” Her eyes began to fill with tears. “I really want my body to stop hurting. It’s not so much the pain anymore; it's the aches and it's the soreness. I feel grungy, from my hair, or what's left of it,” she chuckled—rubbing her badly grown-back-in head of hair—“to my legs and feet. I just feel crummy.”
We asked her if she would like us to clean her up.
“Oh yes!” she exclaimed. “My hair first,” said Kate. “Please! It's been weeks!”
We all laughed. There is nothing worse than that unwashed-hair feeling. Managing a shampoo was a bit awkward at first but we made it work. Kate was ecstatic.
“That feels so good. Please don't ever stop!”
When Kate's hair was rinsed, two of us toweled it dry. We went through a couple of towels, massaging her scalp and neck and shoulders.
“Does it feel good?” I asked.
I could hear Kate moaning to herself in pure pleasure. There are things you want to last forever.
For those who are dying in a hospital or medical facility, the body is invaded and abused constantly. Pain is an everyday occurrence. There are ways to help make that easier, and almost every one of them involves gentle touch.
Try a massage, either the hands and feet, or as much of the body as possible.
A cold cloth on the forehead and face often helps the patient feel better.
Hold hands and reassure the person dying that it will soon be better.
What to say:
It’s all right to talk about dying and what lies ahead. Oftentimes patients want to talk about it but are hesitant, thinking it may be too hard on the surviving loved ones. Rather than asking bluntly, “Do you want to talk about dying?” you can phrase it a bit differently. Saying “Tell me what you think the afterlife is going to be like” can open up a way for a discussion on the experience of dying, of fears of the unknown, and of what lies next.
Tell the person dying how much you care for him or her. If there is something between you that needs reconciliation, don’t be afraid to say you are sorry. Things done and left undone are always on our mind at this point. Now is your opportunity to put things right. But remember that what matters most is how much you love each other.
Some people at the point of death may be quite alert and communicative, but often people are sleeping deeply or even unconscious. In my experience, it doesn’t matter. I believe that words spoken in love at this moment are always heard and understood.
One family, gathered at the deathbed of the matriarch of the family, was hesitant to disturb the sleeping woman. Rather, the relatives all stood talking to one another in hushed voices, fidgeting and unsure what to do. I suggested that they circle the bed, and, one by one, tell the dying woman how much she meant to them and their family.
As they formed a circle, the family members instinctively joined hands. The daughter who began speaking first took her mother's hands in her own. The sisters on either side of her joined hands behind her so that the two could be inside the circle together. It created a beautiful image of family love. Did the mother hear every word? I don't know. But I am convinced that the love, compassion, and words of her family helped her die a more peaceful death.
And above all else …
Hospitals are not usually known for their stillness, so during a visit it may help just to sit quietly with the person who is dying. Creating a peaceful atmosphere is not always easy to do, but it begins with those visiting. Patients easily pick up the energy and emotions of their visitors.
Take a moment before entering the sick room to center yourself. Leave your own agenda or problems at the door. Greet the patient and ask if she or he would like you to sit there quietly. Try to block out the distractions of the room or the hallway. Close the door, and pull the curtain around the bed. During the quiet, meditate, or do a visualization that brings peacefulness into the room. Visualize a peaceful letting go for your loved one.