Reflections on Sitting Vigil in the SNF

December 8, 2009

By Jeanne Denney

The first time that I sat vigil with someone near death I walked into a room with a tiny woman named Gertrude in the run-down nursing home that I frequent.   It was afternoon.   Gertrude was curled in her bed with her toothless mouth open and her eyes closed.  Part of her foot had gangrene.   Across the room on a very loud TV were two women ripping off their shirts, shouting and fist-fighting on the Jerry Springer show.  The door to the room was open and sounds from the hall filtered in.  Beeping, alarms, telephones, the loud voices of frustrated aides calling directions to the hard of hearing.  Angry and desperate residents in wheelchairs calling for help.  The full din poured in without obstruction or deference, settling near her thin, white nest of hair.  Add to this the smell of cleaning fluid, pee and instant gravy comingled. 

I tried to imagine what it would be like to be Gertrude dying alone after such a long, long life, in a place offering  few filters between her delicate soul’s process and the wide world of suffering.  Most significantly, no one seemed to be aware that these were Gertrude’s final hours.   Last week a similar scenario unfolded with a 104 year old patient that I have been visiting for 3 years.  Margaret was dying to a loud episode of “Dancing with the Stars”.   She had lived as a fixture in the hall for something like 16 years, longer than most staff had worked there.  As one resident aptly put it on day as I returned her to the hall,  “She belongs under the clock”.  Still, despite her own long vigil, when Margaret’s death was approaching there did not seem to be an institutional sense of it, or of her life or death’s significance. 

Contrast this picture with another one that I happened into a month or so ago in a different facility.  I was called late in the day to the bedside of a middle aged African-American woman dying of about ten diseases at once.  She had lived there for about 10 years.  I arrived at around 9:45p.m. to sit vigil, a new comer to this nursing home.  I was understandably met at a locked door by nursing home staff who asked protectively who I was and who I was looking for.  When I told them I was from Hospice, they immediately knew the patient and said knowingly “Oh, yes, she is in room 257 on the second floor”.   I sensed that they knew her condition, that my presence was welcome and considered meaningful. 

When I arrived on the second floor, staff checked me out at first, wary of a stranger arriving, and hovered to see what I was up to.  Since Hospice is not so commonly used in this facility, the experience of a vigil volunteer was a new one for them.  Still, it was clear that everyone on the floor knew that Kate was dying and that their protective gaze was upon her.  One by one they dropped into her room to  check on her and do this thing or that, all of which seemed to be their way of saying goodbye to someone who was like family to them.   One stroked her hair and allowed herself to feel her sorrow “Well, death is part of life” she said wisely, reflecting on the teachings this patient was offering her.  I talked to each one of them about their relationship with the patient and they hid their tears.  Or not.  Though the physical conditions of this nursing home were no better, the human environment could not have been more different.  As I left that night I was touched by the aide letting me out of the locked door as she asked me almost urgently “How is she doing?” “She is dying” I said.  She shook her head and muttered a few words in remembrance.  Kate’s passing apparently was affecting everyone as a meaningful event.  A community event.   

Unfortunately, the first scenario has been much more the norm than the exception in the places that I frequent.  I show up, turn off the proforma loud tv (in some rooms there may be 2 and 3 competing loud tv’s), and try to do what I can to make the places of dying sacred and worthy of a final passage.   I pull curtains, move chairs in the overcrowded spaces, close doors, lower lights and set up music in the room. I bring aromatherapy oils, a pendulum (which helps me evaluate their state), a prayer book or some readings.  I introduce myself and tell the person of my intentions to just support them with my presence.   I sing if I feel moved.  I pray.  I meditate.  I try to “find” them in my mind’s eye.   I know little or nothing about their life story except what I glean from pictures, cards, the staff or the person as I find them.   Sometimes there is a sense of peacefulness.  Sometimes the person that I meet is thrashing and agitated as if engaged in a deep struggle.  Sometimes I feel right at home in their presence.  Sometimes I feel awkward, as if I had walked mistakenly and uninvited into the most intimate scene in the movie of their life.   Sometimes as I sit I write about these experiences so that I am actively engaged and curious about my own experience in the moment.  Most of all I try to love and reassure.  I never assume that the patient is not aware of everything that I say, think and do.  Largely I experience these moments as extraordinary privileges.

Though my own experience with the patient is usually satisfying, I am often aware that it could be so much better for everyone.  Much might especially be done to help the culture of nursing homes honor death.  Without a sense of meaning being brought to dying as a familial or community experience, the fear and stress of everyone in a care facility is increased.   One clearly underutilized resource in this shift is that of the residents themselves.  A number of times as I have been in vigil I have been joined by someone in a wheelchair peeking in, curious about what I am doing.  I invite their presence.  The sweetness, curiosity and gentle care of roommates or other residents when I have told them that a patient is dying soon, even and especially those with dementia,  has  supported my idea that staff and residents need to participate in the dying of their peers and contribute to the sacredness of the event .   For them as for me, the patient can become a great teacher delivering a much needed final lesson.   

In such spirit, Megory Anderson, in her book  Sacred Dying, speaks of a nursing home that puts a candle on a small table outside a room where someone is dying so that a community can be a part of the passing.  When I think of this, I think of how far this is from the Jerry Springer show.  How far we still have to travel.  And yet, like the day in 1960 when everyone took off their hats, the day we decided that public smoking wasn’t cool, or that water was better than soft drinks, I know that the collective consciousness can shift suddenly, almost overnight.    For this shift of consciousness and for that of all of the Nursing Home X’s of the world, I anxiously wait, continuing my vigil.

Jeanne Denney is a therapist and hospice worker in Rockland County, NY.  She directs the Rockland Institute for Mind/Body Education and Kairos, an organization for helping professionals. (See www.rocklandmindbody.com)

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One Response to “Reflections on Sitting Vigil in the SNF”

  1. Susan O' said

    Jeanne,
    Your description was so heartfelt and moving to me. I give thanks for your willingness to write about these precious experiences, which makes visible our need as a community and society to engage and experience them as a sacred aspect of a full life.
    Blessings,
    Susan

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