Lessons learned while watching someone die

Melanie Cole tries not to total up the number of people she's watched die.

"When I stop to think about how many deaths I've attended, it can be overwhelming," said the staffer from the Rensselaer branch of The Community Hospice.

Because Mrs. Cole does "on-call" work, going to the bedsides of patients in their last days, she could easily see someone die every day she goes to work.

Last moments

On-call Hospice nurses are on intimate terms with death. Sandy Zarecki, now supervisor of Hospice's Amsterdam office, previously did on-call work for many years. Before that, she worked at Amsterdam Memorial Hospital.

At the hospital, she said, "we tried every single thing we could to avoid death. When you transition to [working for] Hospice, you learn to help people on that journey to a very peaceful death."

That goal doesn't necessarily console someone who finds out he or she is dying.

"Most people aren't okay with dying," Mrs. Cole stated, looking back on 12 years with Hospice and previous work with cancer patients. "They know everybody has to die, but we're all over" the spectrum of acceptance.

Denial

Mrs. Zarecki said that many patients don't want to admit their fears or even the fact that they're in pain -- especially male patients.

She has also seen patients experience more fear when they're estranged from their faith and has witnessed chaplains helping people reconcile with God.

"Spirituality plays a big role in how people cope with illness and death, but it's a mixture. I'm not sure everybody fits into a box," Mrs. Cole pointed out, adding that a person does not need to be connected to an organized religion to have a peaceful death.

What often helps to ease a patient's fears, in her experience, is when the person knows he or she has led a meaningful life and will be missed, but that family members will find the strength to carry on.

Moving on

Both nurses described dying as an "experience" -- not simply the body's shutting down, but a person's moving away from life as they know it and toward something else.

There is a pattern that lets Hospice workers know when the physical dying process is progressing: changes in a patient's breathing pattern, skin coloration and heart rate; periods of apnea; and so on.

Mrs. Zarecki said that families often hold out hope for recovery even in the face of those signs, so she has to review the progression of the patient's condition to gently convince the family that death is imminent.

Last smiles

More inexplicable signs often occur, as well. Even after a dozen years of Hospice work, Mrs. Cole is still surprised when a dying patient "seems to discover what they're moving toward. Patients will often smile," seeming to see something that others around them don't.

Mrs. Zarecki said that many patients report seeing "people who have gone before," and that patients "often will look like they're reaching out" to another person. She tells families that the patient is "taking the hand of an angel."

The moment of death comes differently to each person. Mrs. Cole remarked that "everybody's wish is that they will go to sleep and not wake up. For most, it's not like that. Most of the time, you can see it coming."

Loved ones

Mrs. Cole tries to help families remain calm and present to the dying person, encouraging them to reassure their loved one. "There's this moment, and it's that person's moment. It's not about us," she stated.

If a patient becomes unresponsive, Mrs. Zarecki urges family members to talk to and touch their loved one anyway, to let the person know he or she is not alone.

Both nurses have seen patients linger until a particular family member arrives or die at the one moment the family leaves the room. "Do they have any control over it?" Mrs. Cole mused. "I don't know."

Mrs. Zarecki said that the final moment of death is usually peaceful; all the person's pain and suffering are eased. She called that moment "going home."

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Wishes and tears mark nurse's days

"When I shed no more tears, it's time to stop doing this work," Melanie Cole told The Evangelist. "I respect what an important moment this is for patients and their families."

Although the nurse often weeps, she recognizes that it's the family's loss, not hers. She is simply a witness.

After the person passes away, Sandy Zarecki confirms the death, consoles the family and says a prayer. Since many patients die at home, she notifies the doctor and funeral director, and waits for them to arrive, prepares the body and gathers the family in another room so they don't witness the body being taken away.

Wishes

Going through the dying process, often daily, has made the Hospice workers wish for some changes: that families would make some choices long before they have to say goodbye to a loved one, for example, and that the family members would be gentle with themselves afterward.

"I wish people would let go of anger more often. I wish they'd realize that sadness is not our enemy, and I wish they would have patience with themselves through that," said Mrs. Cole. "It's a new world when you've lost [a loved one]; we're way too rough on ourselves."

Own demise

Working with others who are dying has kept the reality of the Hospice workers' own deaths from seeming far away.

"It certainly limits your ability to deny that it's going to happen!" Mrs. Cole said wryly. "It also teaches that you can't anticipate or plan it; just live your life in the best way you can and know that whatever comes is going to come, no matter what you do. You can't teach somebody how not to be afraid of death; however they do it will be right for them."

After she retires, Mrs. Zarecki plans to write a book called "Dancing with Death." Every time Hospice workers go on-call, she explained, they are beginning the dance and wondering if they or death will take the lead that day. (KB)

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