Suggestions for preparing for dying

Dear Dying Person,

This letter isn’t from your pastor or a relative, so you’ll notice right away I don’t say how sorry I am or extend my sympathies. It isn’t hardness of heart. We just don’t know each other. But as a nurse, I’ve seen lots of people die, and each death was sad; some were better than others. Expectant couples take classes to prepare for the birth of a child. I think someone should talk to you about preparing for death. You know about those things your family and friends are trying to avoid. So, here goes.

Preparing for death just as expectant couples take classes to prepare for the birth of a child’

- Get a confessor. Early on, find someone with whom you can ‘talk dirty’. A friend, physician, nurse or family member who will allow you to say words like ‘dead, kick the bucket, croak, tumour, cancer’. All those things that you and your loved ones are thinking but are too polite to say out loud. Say them. It won’t hurt and you’ll feel better later.

- You have as many rights as you did a year ago or ten years ago. You need not spend the days or weeks or months ahead of you in pain or depression or anxiety. Don’t let someone convince you that you will become addicted to narcotics or that your depression would lift if only you had a better spiritual life. You may not have quantity left but you can demand the best quality. Insist on good pain control. And with the chemical changes of your disease at work, maybe you could benefit from medicines for depression or anxiety.

‘The children make their beds and put the toys back on the shelf. One child made his own bed until the day before he died.’

- You’re not dead yet. So don’t act it any more than you have to. My friend’s son was hospitalised with leukaemia at St Jude’s Hospital for Children. There, as long as they can, the children make their beds and put the toys back on the shelf. One child made his own bed until the day before he died. It helps you and those who love you when you do what you can.

- Have you decided what to wear at the funeral? Honouring your wishes will comfort your family after your death. You may even take some satisfaction in knowing that your desire for cremation or burial or whatever will be fulfilled.

- Have you ever read about or talked with anyone who has had a Near-Death Experience? Possibly your nurses have heard stories from their patients. Ask them. Scientific proof and religious backgrounds aside, please think about this with an open mind. Not enough nice things are said about death – it gets a bad press. The patients I have talked to really enjoyed it. Maybe you will like it.

- Everybody dies. There’s nothing to be ashamed of. Joggers die. Health food advocates die, and so do people who have spent their entire life in a lazy chair eating corn chips. Don’t muddy it all up feeling guilty. If you’ve been told you’re going to die soon, the only word that should bother you is ‘soon’.

- Do you have some deep dark worry that’s hard to confess? I don’t mean the real story about Aunt Marion’s diamond ring or that little $1,000 dent in the Ford. I mean the nitty-gritty, the mechanics of death. Maybe your confessor or your nurses can help you with this. Stuff like: What happens when you stop breathing or your heart stops? Will you feel it? Are you worried that you’ll look or smell terrible? I worry that my handsome prince will lean over my bed to kiss the lips of Sleeping Beauty and I’ll have dog-breath. I probably will, but even saying this to someone seems to help.

- Do you want music at your last moments? A special reading, or candles burning? Who should be there? I’d like to have my husband. My sons too, although as teenagers they would probably get bored if I didn’t die quickly enough. The ones I really want are my dog and cat, though the cat will only come if it’s convenient for her.

- Consider a ‘living’ wake. This might help with some unfinished business, to say some goodbyes or express regrets or thanks, but, more important, it would celebrate your life. Everyone invited would be asked to bring a story of days they had fun with you, or that they shared in your life. It would be a time to celebrate, refreshments could be served, some old movies shown, pictures, mementoes. Of course, it would be a fun time for others as well. You may also want to contribute in some way.

I certainly don’t know all the answers. These are just suggestions. But among the many patients I have cared for, one question recurs: “Can we talk?” Talk about death is as difficult as talking about sex. But when I have talked ‘dirty’ with my patients, when they have whispered their deepest fears and concerns, they seemed to gain a measure of peace. Always, I learned more than I taught. I felt honoured to be their listening friend.

Don’t hold back – get some help. Then give it your best shot. You probably will only get one chance to die. In the end you’ll have to do it alone. Make the byes good.
by Kathleen MacInnes. This item first appeared in “The American Journal of Nursing” (March ’92).

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