The average person knows very little of death; it is a feared topic and not openly discussed. We misunderstand the process, do not know what to expect, and there is great mystery surrounding the end of life. The authors saw a much-needed chance to educate the public, to allow them to learn from death, even to appreciate it as a natural part life. The patient does not know what they are facing, and are burdened with extreme fear. Many have unresolved issues in their lives, and these can be the source of great agitation and even panic as they approach the end. The caregivers, both family and the medical team, use medication to ease physical pain but this is often not enough to produce peace. The authors know from experience that helping the patient requires more then simple pain management. One must listen and interpret what is happening, to help alleviate any concerns the patient has. Callanan and Kelley share the wisdom and the “gifts” patients offer in death, by approaching each situation with “open hearts… and minds” and celebrating the patient’s life. (Callanan & Kelley, 1992)
The authors coin the phrase “Nearing Death Awareness” to summarize the dying process. (Callanan & Kelley, p.21) The dying have an “awareness” of what is happening to them, and possibly even a glimpse into an afterlife. With some basic education, families are taught to care for loved ones, making them comfortable, which change to look for. The dying should be given the choice on how and where they will spend their final time. They most often choose the familiar setting of home, surrounded by loved ones. Hospice nurses and other medical professions are available on site, giving care and support not only to the patient, but also to the family. Death is portrayed in our modern society as dramatic and painful. Often family members become simple spectators, playing no role in providing comfort leaving everything to the medical staff. (Callanan & Kelley, p.38) Callanan and Kelley seek to make families and friends more involved in the dying process; providing care and comfort. They understand what their loved one is experiencing, learn from it, and help them pass with dignity and peace. The passing will often leave us with clues, some related to their lives, professions, hobbies; and these are ways of them telling loved ones that they are dying, an attempt to make final communications. It is important for the family to listen for such clues and interpret them, to communicate with their loved one and reassure them that they will be fine; the arrangements have been made. Visions of an afterlife and visitations by deceased loved ones are common with many patients before death. This seems to offer comfort to most who experience this, and they are often unable to describe in words they joy and beauty that they witness. The authors recognize these as supernatural and spiritual events. They serve to ready the patient for the afterlife, and join loved ones who have passed on. The scientific community disputes such assertions; viewing such occurrences as simple functions of the brain as it is failing and dying. Such “visions” would then be common to patients, as a shared physiological process we all experience from dying and near death experiences. The authors do not attempt to explain or dispute the reality of these supernatural events. They share what a loved one might experience as they near death to educate. The experiences they have witnessed and the joy and comfort brought about in an extremely difficult time by these spiritual events.
The patient and their family will go through five stages in dealing with impending death: denial, anger, bargaining, depression, and acceptance. Denial is a result of shock; it keeps those involved from accepting the reality of the situation. (Callanan & Kelley, p.44) Denial should never be encouraged, as it can give false hope, and make the diagnosis even more difficult to accept. Anger can be the toughest to deal with, and can be driven by fear and resentment. Empathy and support should be offered as one works through the anger. Understanding and communication are important to try and overcome anger. Bargaining is best understood as an almost child-like behavior, “one more hug, one more story, one more drink of water (before bedtime)” (Callanan & Kelley, p.53) The dying try to postpone what is inevitable; and usually this bargaining is with a higher power, God. They make promises of change or good deeds while trying to “buy” more time or better health. Those around the patient may not be aware of the bargaining process, as the patient pleads with “god” in private.
Depression stems from grief of losing relationships, health, future opportunities and experiences. (Callanan & Kelley, p.54) The patient seeks to be understood and empathized with; attempts to dismiss or make light of the depression only worsen the situation. Acceptance finally comes as death approaches. Acceptance of death can be peaceful, yet painful for the family as they realize their loved one is ready to move on. (Callanan & Kelley, p.55) Acceptance of death can be misinterpreted that one is giving up, does not care, or is detached from loved ones. “To some degree, most people die—and react to someone else’s death—in ways reflecting their usual style of handling of crisis”. (Callanan & Kelley, p.59) Our everyday natural personas and emotions tend to be amplified by death, and can bring out some of our worst and best behavior. “…Like birthing, dying can be an opportunity for the whole family to share positive experiences, rather than only sadness, pain, and loss. That is the challenge of this work, and that’s the joy for me”. (Callanan & Kelley, p.130)
As a radiation therapist I will be working with many patients that are battling cancer, a life threatening diagnosis. For some, the treatment is palliative; there may be little hope of a cure. It is important to recognize and understand what the patient is experiencing, their emotions, which stage/s of the dying process they are in. Empathy and truly listening to the patient will be vital in building trust and open communication. Stages of death such as anger may be evident, and it is vital to realize the anger is not directed at medical staff, but a reflection of inner struggles the patient is going through. I have very limited experience in discussing and confronting death in my personal life. Final Gifts has given me a better understanding of what dying entails. The experiences Callanan and Kelley share will prove useful in discussing death with future patients. With the goal of providing the best care possible, I will be able to educate the patient better after reading Final Gifts. I will be able to explain what is typical when facing death. Help to alleviate concerns of the unknown, fear of pain and what is happening to them. The stories shared by Callanan and Kelley will make me more receptive to what the patient may be communicating to loved ones. I may be able to pass on such information to the family who are best suited to interpret such final requests. I now believe that death does offer lessons for us to learn from, to help us celebrate our own lives and those of loved ones. We can prepare to eventually leave this world without regrets. We could avoid hostile or broken relationship now, and have a new found appreciation for the time we have.
The authors make many valid and insightful observations on the dying process. Hospice nurses by profession, they were able to observe and document the dying process of their patients, allowing us to learn from experiences of others. The end of life is certainly filled with emotions of all involved, physical changes, spiritual experiences, and highlighted by relationships with friends and family as death draws near. The patient often knows they are dying; their final mission is to make amends, find closure, and wrap up any “loose ends” in their life. It is important for the dying to know their family will be taken care of, that they accept their departure. Family should celebrate the life of the dying; their accomplishments, relationships and triumphs. The spiritual experiences, communicating with others in the afterlife and seeing beautiful places to come is a very fascinating topic. I have yet to personally experience any near death experiences, and find myself somewhat skeptical about the role a higher power and afterlife. I do not dismiss or deny any such experiences. I am able to draw personal comfort knowing there appears to be a peace that comes with such events as ones nears death. These near death experiences play an important role in giving joy and comfort to those passing from this life. I do not need a scientific or religious explanation of the source, and there are infinite theories on the subject. Simply knowing that such events are a cause of peace for the dying is very comforting.
The authors seek to change death from taboo and feared to a part of life more understood and accepted. It is portrayed badly in media, as a sad and painful event. They seek to change the stereotypes of death, to educate the reader, help them face their own death or that of a loved one. Hospice care looks to alleviate the physical pain of the terminally ill, however emotional distress should not be overlooked. Unresolved conflicts with loved ones need to be addressed, sometimes with one’s faith or “God” as well. Once healing of relationships is attempted or obtained, the dying rest knowing nothing was left unsettled in their lives. Families witness their loved one able to pass in peace and tranquility, making the loss that much easier to cope with. Callanan summarizes the process as such, “By listening and understanding these messages, we are given unique opportunities to prepare ourselves for their loss, to deal with our fears of dying, to use well the time that is left, and to participate more significantly in this life event”. (Callanan & Kelley, p. 124)
Callanan, M., Kelley, P. (1992). Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. New York, NY: Simon & Shuster Paperbacks.