by Charlene Thurston, RN, ANP, Program Director, from the Fall 2018 Currents Newsletter

In our spring newsletter, I wrote about how patients and families could make the decision to stop treatment and allow natural death, especially important when serious illness so compromised the patient’s quality of life that life felt no longer worth living, After writing that article, I realized that an additional article needed to be written to help families understand the importance of allowing their loved ones to let go, to give them permission to let go and die when it was their time. This is such a hard thing for families to do because we want to keep our loved ones with us as long as possible; but it is so important.

So often we see very, very ill patients struggling and suffering because they don’t want to let their families down. This can become very difficult as their bodies don’t have the energy to persevere. As hard as it is, as family members, we must come to terms with our own pain of grief and not impose our needs on the patient who is so fragile and vulnerable and needing to be released. Patients try to take care of their loved ones, even during their dying, so if loved ones are clinging and holding on, the dying person keeps trying to hold on for them until they feel they’ll be okay and can give them permission to go.

When we’re working with patients and families through this period, we try to help them prepare to let go by completing their relationships in a meaningful way. Ira Byock, MD, a highly respected physician in the hospice and palliative care field, wrote a book, “The Four Things that Matter Most“, and we try to help our patients and families by following those teachings. They can be summed up as saying “I love you”; “I’m sorry – please forgive me”; “I forgive you”; and “Thank you”. Ultimately, we try to help people say “Good-bye – We love you, we’ll miss you, but, when you’re ready to go, do so, knowing that we’ll be ok.” We’ve found that helping people come together in this way brings much peace of mind to both patients and their families.

When there are loved ones who live far away or, for other reasons, won’t be able to return to see the person who is dying, we encourage families to arrange a way for them to say their good-bye’s by phone, letter, or email, so that their relationships can be completed. This has great value for both patients and their loved ones. Even in the final moments, a phone can be held to the patient’s ear and the words can be said.

Helping children say their good-bye’s in some way is also extremely important. This is very difficult for families. However, preparing children for the fact that the patient is very ill and will die soon, and giving them a way to visit, if they’d like to, or helping them express their love or good-bye in some other way, like through a note, drawing, or phone, etc., allows them to prepare for the loss and to feel included in the family. There are many helpful websites that can provide guidance. The American Cancer Society’s section on helping children when a family member has cancer has excellent suggestions for helping children and is appropriate for any illness, not just cancer. Here is a link to that page.

How we end our relationships when faced with death is one of the most important things we can do. It will greatly impact both how peaceful the patient can feel in the dying process, and how his or her loved ones will carry on for the rest of their lives. Taking the opportunity to let each other know how much we’ve meant to one another, what we’ve given to one another, how much we forgive one another, and how we’ll remember and move on to live our lives is the gift that can be given and received when death comes from terminal illness. It’s the opportunity that is greatly missed when a loved one dies from a sudden fatal illness or accident since in those cases, there was no time to prepare.

A poem that has brought comfort to many families when a loved one has died is included here in the hope that it might bring comfort to our readers.

Funded by the Palliative & Supportive Care of Nantucket Foundation, the Palliative & Supportive Care Program is operated as a department of the Nantucket Cottage Hospital, which is an affiliate of Massachusetts General Hospital, and a member of Partners HealthCare. Palliative & Supportive Care of Nantucket is a specialized health care program dedicated to providing excellent physical, psychological, social, and spiritual care to persons with life-threatening illness and their families.

A Partnership in Caring

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