Dear Barbara, I am a hospice volunteer and am occasionally with a patient when family members are unavailable to be with a person as they near their death. Of course this is a sad situation for the dying person being alone as they leave this world. Sometimes I arrive to find that family members or friends have arrived. My question is, how can I best support these people at this highly emotional time. I generally let them know that we are there to help if needed and offer to sit in their place if they need to make phone calls or get something to eat. I remind them that they can always call if they need anything else. I then usually take my leave and give them their privacy. But I wonder if there is something else I should say or do that might help? Is it appropriate to ask about their dying relative? Is it helpful for them to speak about the person? Or is it better just to let the family be with their own thoughts?

When I was doing direct patient care in the '80s our hospice goal was to be with the family at the patient's moment of death. The hours before actual death is very scary, a "I don't know what to do" time, for anyone present. Someone who knows the normal natural way a person dies can be like a conductor as they guide those present through the experience. You being there with your knowledge of end of life can have a significant role in turning an often frightening time into a sacred one. So, yes, I think you should stay if people unexpectedly arrive. Explain that if it is alright you would like to stay and be of assistance. Most people will welcome your presence.

I would like to see hospice programs offer trained volunteers to every family, not just to those patient’s that have no family. The person who is actively dying is like a little chicken trying to get out of its shell, working very hard. They are so removed from their physical body that their attention is inward, not outward, so actually whether they are alone or have a room full of people isn't the important issue. The real need is to provide support to the family and significant others who are there with the person who is actively dying. It is those present that need guidance.

Even though the dying person is busy they can still hear so with that in mind here are some suggestions for working with the family:

* Explain to everyone about the “little chick” idea. This gives them a base line for understanding what is happening. You want them to know that nothing bad is occurring. This is how people die and their special person is doing a good job. I often explain the days to hours before death as labor, the labor that proceeds a birth into another world.

* Once you have neutralized the fear of what is happening suggest that each person there spend time alone, talking with the one dying. Life is full of positive and negative occurrences. The person who is dying is processing their life so help them by talking about the good and the difficult times.

* Help those present say goodbye. Because we have limited control over the time that we die suggest that the family tell their special person “when you are ready you can go”. This is not that it is okay but that there is an understanding that their person is leaving.

As I see how much I have written and how much more I have to say. I also realize I have already written a booklet with all of the information in it. I wrote The Eleventh Hour to give just this kind of knowledge to families and end of life helpers. Reading Gone From My Sight which explains the normal natural way that people die and The Eleventh Hour which offers ideas of what to do in the hours to minutes before death occurs gives a solid knowledge base on the end of life process.