As an end of life doula, I sit vigil with dying people. You probably wouldn’t assume it, but lots of these people are alone in their dying. Totally alone, in facilities. I remember sitting at the bedside of a man who was dying from cardio-pulmonary disease. I’ll call him Jerry. He was propped up on pillows, bare chested and rail thin, with shining olive-colored skin, working hard for every breath, a sheet neatly drawn up over his middle. His light blue eyes were open but Jerry was mostly unresponsive. His breathing was fast and shallow and suddenly, he stopped breathing all together, only to resume with a gasp about a minute later and begin the cycle again. As I sat beside him, I wondered to myself, how Jerry had ended up on his own at the time of his death. After all, he was once somebody’s beloved son, most likely, and here he was, taking his last breaths, on his own. I’m a hospice worker, so I’ve been trained to think that dying without company is a sad affair, that no one should have to do it. There’s even an organization called No One Dies Alone that’s dedicated to making sure it doesn’t happen this way, and while I believe this to be a wonderful mission, I can’t help but notice that although Jerry has been on his own during his dying process, he looks very peaceful and untroubled.
Jerry is leaving his body. We don’t know where he’s going, not for certain, but whether one believes in an afterlife or not, it’s safe to say that he’s going to a place where he can’t take anyone with him. Ultimately, we have to die on our own, and so it makes sense that the process of getting to that place is one of gradually turning inward and allowing the outside world to drop away. Like the birth process, dying typically follows a recognizable pattern. The dying person has less energy, spends more time sleeping, eats less and less, stops taking in fluids and eventually slips into unconsciousness where their body goes through the last steps of shutting down. Sometimes it takes weeks, sometimes hours but anyone who’s ever watched someone go through the process knows that for the dying person, things do start to focus inward, and this is perfectly normal.
So what does this mean for the loved ones of the dying? What if you’re the son, the sister, the wife of the dying person and you’ve been right there with them, taking care of them? How do we stay present for our dying loved one and still allow them the space, the privacy even, to let go and die? I often hear stories about a dying person waiting for their vigiling loved ones to leave the bedside, for a dinner break for example, so they can die when they’re on their own. Stories like that make me think about the inherent aloneness in dying, and as I contemplate this, I ask myself, what do we need when we’re dying, and how many of us would actually prefer to be alone for the very last part? I don’t mean alone as in lonely, I mean alone and at peace, with dignity and privacy. Maybe it’s rare that someone would want that. Maybe it’s more common that we think.
When someone we love dies, we may feel profoundly sad and this is natural. Sometimes however, it may be that our sadness becomes a burden to the dying person and can interfere with their ability to die. I think about the movies and imagine a scene where one character admonishes another: “He’s just hanging on for Joanne!” It sounds like melodrama, but what if it happens to you? How can you lovingly serve a dying loved one and also make sure you’re not crowding their dying process? When you work with the dying, you have the privilege of witnessing the psychological aspect of the dying process as it unfolds. The person who’s dying is losing their body and this can be very frightening at first. Actively exploring this fear and reviewing one’s life with a caring witness begins the process of letting go for the dying person. This process looks different for different people, but generally it seems that people die the way they live, another similarity between the dying process and the birth process. Are you stubborn, closed off, effusive, weepy, patient, reactive, wise, fearful, full of humor? All these things will surface as you negotiate your dying. And like birth, the process is inexorable; it’s going to happen, so one way or another, the dying person will most likely come to a place of acceptance. Loved ones have the opportunity to witness this happening and to learn from it.
The dying person’s coming to terms with their own death is the last gift they give to their loved ones. How much of our sadness and terror around a loved one’s death is actually felt by the dying person herself? How much do we project our own feelings of fear and despair onto our dying loved ones? Are we able to have honest conversations about the end of life with the person who is dying? What do we need to ask them? To tell them? The bond that we create by having these conversations can form a new foundation of intimacy and understanding with our dying loved one. If we take the time and summon up the courage to talk frankly about our feelings and ask our dying loved one to share with us what they’re feeling, we may find that when their death draws near and we sense a shift inward, a surrender, we won’t feel so frightened or hurt. We’ll have an innate understanding that this part of the process, this pulling away, this aloneness, is perfectly normal and we’ll be better equipped to stay present as compassionate witnesses and allow death to happen in an atmosphere of love and peace.