The Final Journey --
Complete Hospice Care for Departing Vaisnavas
by Sangita devi dasi (Susan Pattinson, RN, CHPN, Certified Hospice Educator)
Excerpt from Chapter 3:
What is Holistic Care?
If asked, most hospice professionals will tell you that caring for terminally ill patients and their families is not so much a choice, but a “calling.” I have met nurses working in this specialty that felt differently and soon left for another type of nursing. The ones who have persevered for many years tell me that although it is physically demanding, mentally and emotionally exhausting, and, at times, spiritually challenging, they stay -- not so much out of want, but out of need.
They know their patients have no hope of being cured. They know many of their patients that are afraid to die but are more afraid to live in pain. They know they will not be able to heal those in their care, but they need to comfort them anyway. These nurses need to laugh with their patients, cry with them, talk to them, and listen to them. And when their dying patients are feeling abandoned and alone, they need to sit in a quiet room and hold their hands. It is nurses like these who administer holistic care that keep the ever-expanding hospice movement closely connected to its roots. In fact, many families become so fond of he hospice nurse that after the death of their family member, they experience a “secondary loss” due to no longer receiving visits from the nurse who lovingly cared for them as well.
Hospice care encompasses holistic care. It is a personal approach to the total care of one who is facing impending death. Hospice professionals view the patient, family, and caregivers as one unit to be looked after and comforted. They care for the physical pain of the patient, the emotional and mental anguish of the patient and family, and the spiritual conflicts that often arise within the patient and family members. As caregivers, we also have the opportunity to perform the same service.
Relieving the patient’s physical pain is foremost. Only when pain is relieved and symptoms are controlled can other level of consciousness be soothed. One who is experiencing excruciating bone pain from cancer, for example, cannot concentrate on why she is afraid of dying. Once she feels some relief from the physical pain, her other work can begin.
As a caregiver, in-depth communication with your patient cannot begin until he is physically comfortable. It also cannot begin until you have started to examine your own thoughts and feelings about the situation that is confronting you. You may not reach concrete conclusions at this early stage, but it is here that the journey begins. Whether you are caring for a family member, friend, senior Vaisnava, godbrother or godsister, you cannot help but experience a sense of loss as each day passes. Once death occurs for the devotee, you will no longer have his personal association. That sense of emptiness and grief begins to unfold a long time before the devotee passes away. By Krishna’s grace, we are allowed this time to prepare for the unavoidable. Because the Lord promises to carry what we lack and preserve what we have, He strengthens us for when we need it the most.
What is Spiritual Pain?
Because grieving starts a long time before the actual death experience, the patient, family, and caregivers may experience what is called “anticipatory grief.” This occurs when family members and close friends realize that death for their loved one is unavoidable. This occurs for the patient when he realizes that his life will end much sooner than expected. Anticipatory grief is sometimes referred to as “pre-death” bereavement. As a caregiver, you need to give your patient, as well as yourself, permission to grieve.
Spiritual pain can be intensely private and can manifest itself in many ways. Perhaps the dying devotee did not accomplish what he wanted to in life. Perhaps his children are not yet grown and he worries what will become of them or if they will even remember him. Perhaps there was a particular service he wanted to perform for his spiritual master and now that is impossible. A devotee may regret having wasted so much time when not engaged in devotional service. When someone is very ill, with month -- or even weeks-to live, remembering one moment that was wasted can cause mental anguish, guilt, and regret.
Unexpected emotions can often manifest in one who is facing imminent death. The patient may even vacillate between feeling spiritually strong one day and emotionally weak and vulnerable the next. This is common. When someone is experiencing spiritual pain she may cry, become anxious, or exhibit anger at seemingly inappropriate times. She may even joke about dying, which is often a way to mask her fear and anxiety.
We can help by becoming good listeners. Being in the presence of a sensitive listener will enable the devotee to release some of her anxieties, even if that anxiety stems from fearing the pain associated with the dying process. We must not hear with judgmental minds, but with compassionate hearts. We can help by creating an atmosphere of safe boundaries so the devotee, if willing, can comfortably reveal her mind and reach emotionally sound and Krishna conscious conclusions.
(To be continued.)
(Click here to learn more about Vaisnavas CARE and how to order The Final Journey.)