Making Sense of Last Words

We don’t have role models on what the last hours to moments before death are like. What we have is television and movies portraying someone dying. The scene often includes the dying person saying something important or profound then they shut their eyes and are gone. This seems to be the role model we have developed.

We used to have real life role models because Grandma died at home with the family present. Dying and death was a natural part of life. We silently watched and supported each other. We didn’t really talk much about what happened. When Grandma was gone, we grieved.

Then times changed. Grandma wasn’t at home when she died. She was in the hospital with no one there or she was in a nursing home. She died alone and we were called in the middle of the night and told Grandma had died. Too often the next time we saw her was in a coffin at the funeral home wearing make-up, glasses on, and dressed in a special outfit.

Come the late 1970s, the hospice death and dying movement arrived and some of us started thinking about “a better way” to address how a person’s life ends.

So now more and more people are actually present when someone is dying BUT we still don’t have accurate role models. Which means many of us watchers think something pathological is happening. The facial expressions, the random movements, the smells, the awkwardness, the wetness, the tear, the sounds sometimes present with real life dying are interpreted as something wrong, something bad, something oh so NOT normal ——after all, it doesn’t look like that in the movies.

What are realistic death bedside expectations? Again, not normal is the dying person says something important and then they stop breathing. A person is generally not going to say “I love you” and then die. Maybe, very rarely (I’ve learned to never say something will never happen), they will say something meaningful but it probably won’t happen.

What is normal is the person may be talking BUT they won’t be making sense. They may be talking to people you don’t see or hear. Yes, I believe our loved ones who have gone before us come in the weeks to days and hours before we die to help us get from this world to the next. It is common to hear talk of those who have died before us. You may hear random words, see random facial expressions, uncoordinated arm, leg and body movements. You may see a frown, a grimace, a tear. You may smell bad breath and the release of bodily fluids (pee and poop). Their eyes are partially open, non seeing. All this is how death generally comes.

What I have described is the real labor of dying. It can be messy and hard to watch. It isn’t calling out our loved one’s name and then peacefully dying but it is a meaningful and, yes, a beautiful part of living. 

My concern is when we glorify the movie scenes of dying we create false expectations of what dying is like. False stories and mental images cause undue suffering and mental anguish in those of us left behind. The false images of tranquility makes us concerned that our loved one “didn’t do it right,” that something bad happened.  

I want us to see dying for what it is, for how it happens, that it is a sacred experience where nothing pathological is happening. Sad, very sad, but not bad. 
Something More... about Making Sense of Last Words
For anyone who is caring for someone who is facing end of life, I encourage you to use my booklet, GONE FROM MY SIGHT: The Dying Experience and watch NEW RULES for End of Life Care. These two resources reduce the fear that we all have about the dying process.  For end of life professionals, I encourage you to watch THIS IS HOW PEOPLE DIE, my comprehensive 3 hour dvd set.  This training tool helps keep your team caring consistently for your families and patients. 

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Anne McNulty Paine

Thank you!

Shelia Harris

Wonderful book
I read this book almost daily while my husband was in hospice care.
I underlined phrases as his time passed. So helpful

Patricia Reavis

Very grateful for the information you provide. Thank you!

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