By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
One of the most challenging events in life is dealing with the pending death of a loved one. How do you prepare? How do you interact? What do you say? I have been through this situation, both as a doctor and as a family man, and would like to share my personal observations with the sincere hope that they may be of some help to you.
Embarking on the “Deathing” Journey
Death is an emotional do-not-enter zone for many, a painful subject to be avoided. At the core of such reluctance is a personal fear of death. However, I look at death differently, without fear. The Tibetan Book of the Dead, the classic eighth century Buddhist description of life after death, informs us as to how we transit into the welcoming energy of the “clear light of the ultimate reality,” – an experience that is the greatest moment of life. The book has been a great source of inspiration for me, and helped me through many emotional end-of-life situations with patients. I truly believe we should value the end of life in terms of a spiritual transformation, a belief significantly reinforced after collaborating on a wonderful near-death experience book (Health Revelations from Heaven and Earth).
The fact is, when we each face up to our own mortality, or the imminent passing of a loved one, the process of dying can be a truly spiritual and healing experience, for both the dying person and the surrounding loved ones. To consciously prepare for death and to lovingly embrace the journey toward death at a loved one’s side is a process called “deathing”.
In Living Meaningfully, Dying Joyfully: The Profound Practice of Transference of Consciousness (1999), the internationally renowned Buddhist teacher Geshe Kelsang Gyatso makes this reality of life amply clear: because we are alive, we will die. His book underscores the importance of living a happy and meaningful life, and the need to prepare for death and to help others who are dying. In this manner, death becomes a positive experience instead of something to be feared or denied.
As a cardiologist, I have been involved in countless end-of-life experiences. Looking back, the image that personally gives me the most satisfaction is that of a dying person at peace, surrounded by loved ones unselfishly expressing their tender farewells and affection in a way that spiritually heals and uplifts all present.
I vividly recall the passing of Joe, one of my patients. Joe was in his early seventies and had battled coronary artery and valvular disease for years. Because of recurrent episodes of heart failure, and the gradual deterioration of his heart, Joe developed renal failure compounded by diabetes. Over time, he grew weaker, and life became a painful struggle. The end was very near.
I instructed Joe’s wife to maintain a vigil at his bedside and direct him to focus on pleasant thoughts and images, even during lapses when he might be unconscious. You see, hearing is an important sense. People often hear even when we think they are completely unaware and unconscious. I also told her to continually touch Joe’s arm, chest or face and to repeatedly tell him to look for the “Light,” all of which she did in a soft, nurturing voice.
As Joe slowly and quietly slipped away, his wife lovingly told him that he had been a wonderful husband and father. He had led a good life. He had given so much, and was now so tired. Softly, she assured him of her acceptance that he could leave his physical body whenever he was ready. She whispered to him gently that he didn’t need to hang on any longer. In essence, Joe’s wife gave him permission to surrender to death.
My years as a doctor have taught me how very important it is for a dying person to receive such permission. Sadly, I have witnessed the inability of many dying patients to give up their struggle because family members failed to release them.
After Joe passed away, I received a letter from his wife thanking me for giving her the courage to face her husband’s death. She also told me that prayer and acceptance, coupled with her supporting role in helping Joe to die, enabled her to experience moments of joy as Joe gradually left this world for the next.
My Personal Story
The holidays are especially spiritual for me because both my parents died around this time. Their passings were very different, and I was intimately involved in both. On the one side there was the heartbreaking experience of my father’s tragic sudden death, followed ten years later by the heartwarming, liberating process of my mother’s death.
Let me try to explain the difference between heartbreaking and heartwarming.
My father died abruptly and unexpectedly in 1988. He had an aortic aneurysm that I didn’t know existed and one day it ruptured. I didn’t get the time or opportunity to say goodbye. I was there at his side, desperately trying to save him with mouth-to-mouth resuscitation and all my doctor skills. I couldn’t save him. Too much blood was leaking into his chest, and his heart became gradually enveloped by so much blood that it could no longer expand and contract.
Afterward, I realized that the very personal element of farewell had been missing from my side as he slipped away. I wished I could have calmed and reassured him. I wished I could have said so much more.
When my mother’s death was imminent from complications of cancer and diabetes, I was able to deal with the experience quite differently. She had fought bravely for years but had expressed her desire to be free of her physical body. We had time to prepare for her transition.
When her soul did leave this world, it was 3 o’clock in the morning. I’d been sleeping on a couch next to the bed we had made for her in the living room of her home. I awoke as she called me – could I please check her blood sugar? She just didn’t feel right. I checked her blood sugar level and it was fine.
“But I feel so terribly weak,” she said. I tried to reassure her, taking her diminished body into my arms. I soothed her and eventually she fell back to sleep. As I drifted back to my own sleep on the sofa, I heard her talking to someone in words I did not understand. I thought she might be talking in her sleep.
A few minutes later she passed on. I heard her last breath. I prayed that her words had been spoken to those who had come for her, maybe even my dad. Then I took her into my arms again, hugging her with all my heart and soul. I stroked her head. Softly, I whispered to her: “It’s okay. You’ve led a good life. Surrender and let go. Look for the light.” I told her how much I loved her and what a wonderful mother she was to me.
Saying Goodbye with Love
I believe I helped my mother by providing emotional and spiritual comfort as one journey closed for her and another began. I was thankful that I had the opportunity to support her through that journey and was left with a sense of peace, even though I was experiencing profound loss at the same time.
Going through this process made me realize more than ever how much all of us need a ritual to accompany the transition between worlds. It forever changed how I doctored the dying. I realized all the opportunities I had missed to help others. I vowed to change that, and I did.
Joe’s passing was one example. Another was guiding my devoted business manager of many years through the deathing experience as her father slowly succumbed to cancer. I was able to sit with her and her family as they maintained a vigil at the bedside during his last moments. They had never been with anyone who was dying before, let alone someone they loved so dearly. They told me afterward that my guidance helped them navigate an experience for which they had absolutely no bearing other than foreboding and grief.
In essence, I counseled them not to be fearful of the situation or of the dying person and not to hold back their love. Family members should touch the dying person, whether it’s to stroke a hand or a foot, or to caress the head. In doing so, there is a transfer of love, healing, and closure. This is of utmost importance.
A Time to Make Peace
I’ve been in situations where death was preceded by years of anger and estrangement among family members. Sometimes as the end grew near, the estranged individual would appear and forgiveness and reconciliation would provide positive closure. On other occasions, there was no such reunion, and subsequently, regret.
Whenever I coach family members in situations where resentment and anger still hold strong or where forgiveness has not yet been granted, I always suggest looking for opportunities of surrender, and to use the words – “I’m sorry.” There is great peace, transformation, and closure in those few words. They express love over pride and forgiveness over ego. What use are pride and ego in the final moments of life compared to love and forgiveness?
Setting boundaries on who can be present is another challenge that may be difficult for family members to achieve, but remains important for the dying nonetheless. If your loved one is dying in a healthcare setting and you need help setting boundaries with negative family members or other visitors, ask the healthcare team to help you to do so.
To die means not only losing our bodies, minds, possessions, and relationships, but also facing our deepest fears, of the unknown. In this state of vulnerability, a dying person may experience panic and guilt, and may release repressed emotions that include anger or jealously toward those who will continue to live. Again, your role is to provide a framework of unconditional love as you allow the release of those emotions, and even encourage your loved one to express thoughts and feelings about dying without fear of judgment, rejection, or rebuttal.
Even in a coma or a semi-coma, the individual who is dying may be angry because he or she doesn’t want to die, or is regretful about something that happened in the past. Whatever the emotions, whether sadness, anger, or surrender, allow the person to have them without judgment.
In Preparation for the End
The final phase can be overwhelming for loved ones who are present and giving support.
In this role, you need to express your own feelings. It’s healthy to cry it out and garner support for yourself and your own grief. Share feelings about the deathing process with a close friend or relative, spiritual counselor, or even hospital personnel who are available.
No matter how sick people are, even when you think they are in a coma, assume they can hear you. I cannot tell you how many times I have had patients share what they overheard at their own bedside once they became conscious again.
Keep talking to your loved one, even if he or she is unconscious. But be sure to speak only positive, hope-filled, loving words and touch them gently. You can hold a hand, stroke a head, rub feet, place a hand over a heart or whatever you feel moved to do. Quiet prayers and music can be reassuring and comforting, as can soft, natural fragrances like roses.
Make sure that the positive vibes at the bedside extend to conversations with doctors and nurses. I have heard nightmare stories, even about organ donation discussions that happened within hearing distance of an unconscious person who was not expected to recover. Whenever possible, organ donation is a topic that should be discussed long before someone is hospitalized. Bottom line, any conversations that may upset a person, even if you think they cannot hear, should always be conducted outside the room.
When the Time Is Near
As your loved one moves through the process of dying, become aware through gentle questioning, as appropriate, of the predictable body sensations that signal death’s arrival: a sinking or floating sensation; alternating feelings of hot or cold; a softening of the body or heaviness in the body; shallow breathing; a sense of peacefulness, dizziness, or disorientation; and odd images and visions that indicate the body is surrendering. Although these sensations can be overwhelming, don’t focus on them. Rather, continue to remind the dying person to remain calm, to have no fear, and to look for the light that will come. When you believe the moment of death is at hand, speak loving words from your heart.
In situations of imminent passing, the late Rabbi Zalman Schachter-Shalomi, founder of the Spiritual Eldering Institute, encouraged mourners to send their loved ones onward with blessings rather than to become distracted by grief over their imminent departure. In his book, From Age-ing to Sage-ing: A Profound New Vision of Growing Older (1995), the rabbi shared his parting words with someone who suffered from a long, debilitating illness:
“Dear Friend, I send you loving and supporting thoughts for the journey ahead. Do not be afraid. It is a shock to drop the body, but it is not the end of your existence. Now that you have abandoned your old, worn-out body, go forward to your new life in anticipation of a pain-free, comfortable existence. Go in trust and peace, knowing that friends and God will appear to help you through this transition.”
Helping a loved one die with support, respect, dignity and, above all, love, is one of the greatest gifts you can ever give. Unconditional love is the key. Just like the birthing process, the deathing process can be one of the most beautiful experiences in our lifetime.
Throughout the documented history of man, all religions share one deep and common element – a belief that there is life after death. Since the time of Greek philosopher Socrates (469-399BC) and his student Plato, we have numerous formal accounts of man’s speculation about having a soul. It is reported that on his deathbed, Socrates was quite calm, and attributed that state to his belief that he was going to a better place. Plato described conversations with Greek soldiers who had “died” on the battlefield and then came back. He said that “all earthly wisdom is but a rehearsal for that great awakening, an awakening that takes place upon death.”
Reports of near-death experiences may seem like something alien to you, but I believe they are pieces of relevant evidence, chronicled throughout many centuries, that provide instructive perspective in man’s search for life’s overall meaning. I find the near-death literature utterly fascinating. If the subject is of interest to you, you may like to visit two fine internet resources: www.near-death.com and www.iands.org, the website of the International Association for Near-Death Studies.
Everybody has a fear of death. However, as a result of my experiences with the dying, along with all I have heard, and read – I can tell you from my heart that I have no fear of dying.
References & Resources:
- Sambhava, Padma, comp. & Thurman, Robert, trans. The Tibetan Book of the Dead: The Great Book of Natural Liberation Through Understanding in the Between (Bantam Books, 1993).
- Geshe, Kelsang Gyatso. Living Meaningfully, Dying Joyfully: The Profound Practice of Transference of Consciousness (Tharpa Publications, 1999).
- Schachter-Shalomi, Zalman and Miller, Ronald. From Age-ing to Sage-ing: A Revolutionary Approach to Growing Older (Time Warner Books, 1997).
- Near-Death Experiences and the Afterlife
- International Association for Near-Death Studies
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