The Moment of Death: Timing is everything, or…at least something

February 7, 2011

by Noell Goldberg

This month Noell Goldberg, long time trainer of hospice volunteers and general sage, offers her wisdom on being with the moment of death…or not. Thanks Noell.

Ask my children, and they will tell you I have no sense of timing. I tend to bring up difficult topics at times when they are distracted, upset, or otherwise caught by some emotion that makes it unrealistic to expect they can take in the message I’d like them to hear.

My errors of timing are generally caused by my impatience and egocentric urgency. I have something to say and I want to say it now. I want to do something, and I want to do it now. Or, I am captured by my own emotional tangles and postpone saying or doing something until it is too late. In short, when my focus is primarily on myself, I am limited in my ability to see myself as a small part of a much larger field — the field of my relationship, this particular context, this exact moment.

I know I am not alone. This is a struggle that frequently manifests in work with Hospice and Palliative Care patients. When do we call, visit, offer a suggestion, remain silent, reach out to a family member? Questions of timing abound, and there are rarely clear answers.

To die or not to die?
One of the big questions that our Hospice patients face is the timing of their own exit from this life. Since ultimately we have no definitive control over our own deaths, it is a common assumption that the timing of death is beyond our control. Sometimes, this is certainly true. But many times in Hospice work, we hear a very sick patient say, “I have to live until my first grandchild is born,” and they do. Once, a patient came onto the program, and the next day, her husband died of a heart attack. She told the nurse, “He waited to die until he knew there were people who would care for me. I will wait until his wake, then I will follow him.” And she did, dying the day after her husband’s funeral. We assume the moment of death is beyond our power to control. But the evidence suggests a different truth.

Still,both we and family members too, are concerned when a patient dies without someone present. We feel our timing was off, and it is easy to assume that we have somehow failed the one who just died. After all, they died “alone,” and feeling alone is something we are pretty devoted to avoiding. We see aloneness as a problem, and hey, our patients have enough problems. We don’t want dying alone to be another one, especially when we are so willing to be there.

But here perhaps it is useful to remember that we have accompanied our patient on merely a few steps in the mysterious journey that has been their life. Like everyone else, they have made their journey “alone,” even though they have also been accompanied by spouses, siblings, children, grandchildren, friends, colleagues, parents, and now us. Perhaps if they made that final transition, the moment of death, with no one in the room, this was their preference. When they have spent their last days among attentive and willing caregivers, is it possible to imagine that if they passed away without any of the available people at their bedside, that perhaps this is how they wished it to be?

How much can we help?
It’s been said, “Dying is hard work. The old and the sick should be exempt from it.” Dying — like childbirth and every other transition a human soul makes from one reality to another — is hard work. As caregivers, we help in the work of dying by doing what we can to ease the body, mind, and spirit. But ultimately, the dying person is working alone. And the moment of their exit will probably reflect aspects of their personality that have always informed their thinking, relating, working, living. Was this a private person? Quiet and reserved? Was he more solitary than gregarious? Did this person like her comings and goings to be noticed or did she like to quietly arrive and depart the events in life?

If our patient dies and we weren’t there, or a family member feels guilty because they stepped out of the room, perhaps we can take the larger view, a view beyond how we think things should be. Perhaps the final gift we can give is the honoring of the particular way this soul chose to leave this life. Perhaps we can turn the question of timing over to them, and to the greater Mystery of which we are all so small a part.

Noell Goldberg has been Coordinator of Volunteer Support Services for United Hospice of Rockland for over 11 years. She started a prison hospice program at the Fishkill Correctional Facility in New York where she trains and mentors inmates to care for other inmates dying in prison. She is currently a seminarian in the Ridhwan School, the institutional umbrella for the Diamond Approach, and has studied there for 14 years.

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8 Responses to “The Moment of Death: Timing is everything, or…at least something”

  1. Fran said

    So nice to hear this perspective. I totally agree with you. Both of my parents died ‘alone’ but since they were both exTREMEly private about personal matters, in retrospect, I couldn’t imagine it any other way.

  2. Sandra said

    This was an excellent article. Beautifully
    and sensitively written. Spiritually intuitive
    and truly wise.

    Thank you for the special blessing in my day.

    Sincerely,

    Sandra Jeanne

  3. this is was by far the most sensitive and true description. inspirational.

    thank you.
    lubna

  4. Sally Schwager said

    Hi Noell, thank you for this wonderful article. Nice to read about your work — I am also volunteering at Fishkill, doing restorative justice counseling with longtermers. I’m aware Fishkill has a great Hospice program. Are you working with Reverend Lewis?
    Look forward to re-connecting! Love, Sally

  5. Mary Stoffel said

    Jeanne, thank you for this article. I needed that as time gets closer to my Mom leaving. The staff have said she needs more care, so I’ve been asked to locate another facility. The sad part is, she needs nursing home care and both of our nursing homes are full. I’ve been asked to have her out of the home where she is by the end of February, so I pray that they will keep her until an opening is available.

    • Good luck to you both Mary. Glad that this page helps.

      Jeanne

      • Mary Stoffel said

        Yes it does.

        The one nursing home said no because of her wandering in and out of others’ rooms. She can’t help it that she does that. I’ve exhausted all my resources and have sought out the help of the Ombudsman for Long Term Care.

  6. Carol Rance said

    I have 4,closer to 5 yrs. working as a hospice nurse. I currently now work in pediatric HC. My previous background was 20 yrs. as a psychiatric nurse. Goes without saying that our health care system has changed for better & worse. Way back when, anticipated LOS for in-pt. psychiatric care was 6-9 weeks (prior to DRG’s). As the odiocy of health care humor stands, one has ‘3 days’ to overcome serious suicidal ideations’&/or attempt. I vividly remember going to care plans’ ‘armed’ with evidence of decline in my pt.when looked at for discharge. I fought for this person & family. He was dead in 2 wks. I lost my job getting a pt. into a chronic pain center, he was chronic, not terminal. This drove the census down. I feel I nearly begged the company to read the documentation..it was very clear from the M.D., from myself & out of compliance with Medicare hospice guidelines to continues this benefit. I am not aware of any benefit fought for & granted by the health care system that does not have the potential for abuse. Would love feedback as to others’ ideas as to how we, as nurses, can make a change in the extremes we have been trying to deal with in the changing system. In all my yrs. of being a nurse, I still just don’t believe that ‘all’ of us pursued our career without caring about people. I welcome feedback from all who have thoughts about this.

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