Wednesday, January 28, 2009

Last Words

The grief support groups I facilitate are open to all members of the community, and in the years I've been doing them, I've talked to people with a wide variety of experiences. The way a loved one died can influence how we go through the grief process. Sometimes in grief support groups we talk about last words. At times, the conversation is about the last words said to us by the people who died. More often, it's about our last words to them.

Because I work for a hospice, what I hear most often is “I did everything I could, and said everything I needed to say. I have no regrets.” This does not take away the grief, but it does make it a bit simpler. I've been told that some of the sweetest, deepest moments have been spent in the knowledge that time is limited. Often, the hardest thing we have to do is give the dying person reassurance that we will be okay, and to give that person permission to die. When we are as prepared as we can be for death, and able to say what needs to be said, there is a certain peace about the relationship.

When someone dies unexpectedly, and is already gone by the time we get the news, the comment usually is “I didn't get to say goodbye.” The sense of shock and disbelief can be overwhelming. There is no warning. If there was unresolved conflict, that can certainly complicate the grief process. Even if the relationship was a strong, supportive one, there is usually a lot of unfinished business. Many people have not told their families or friends about all the things they will need to know to notify others, plan a funeral, find a will, access bank accounts, and take care of insurance and other business. The surviving family members have to figure out how to do the tasks usually done by the one who died, and there are always questions they would like to ask.

If the person committed suicide, there are a host of other issues. Last words to a loved one before a suicide are often magnified, as if we could have prevented the act by having said or done something different. Survivors often struggle with confusion, guilt, or anger, and many questions remain unanswered. Deaths by violence have an especially intense grief process. There are often specialized support groups in a community that help people deal with the unique grief issues in losses by suicide and homicide. I've added some links to North Texas groups.

I often recommend books for particular grief issues. I Wasn't Ready to Say Goodbye: Surviving, Coping, and Healing after the Sudden Death of a Loved One, by Brook Noel and Pamela D. Blair, is a good book for understanding the challenges of a sudden loss. No Time to Say Goodbye: Surviving the Suicide of a Loved One by Carla Fine can be helpful for someone whose loved one died by suicide. A mother in one of my support groups groups whose daughter was murdered found A Grief Like No Other: Surviving the Violent Death of Someone You Love by Kathleen O'Hara to be especially helpful.

When someone has gone to the hospital or is home on hospice, still alive, but unconscious when family members arrive, the question after death is often, “Were they able to hear what I said?” Last words were said to the person, but there is little reassurance that they were heard or understood. It is often said that the hearing is the last thing to go. I usually reassure people that somehow, the dying person heard them. Part of this comes from stories of hospice staff, who have told about those who wait until someone comes home before they die. Even in a state of unresponsiveness, a person often waits until everyone has arrived. In some cases, where one family member cannot come home, we've had hospice staff put a phone up to a dying patient's ear, and hearing the voice of the person who could not be present is enough to help the dying person let go.

I experienced something similar. My stepmother was hospitalized a number of times with pneumonia her last few years. She was a fighter, and always had recovered. In 2002, I was told that she was in the hospital again, just as I was starting a new job. I was hesitant to leave for Ohio in the middle of my training, but a week later, I got a call saying Esther would not survive. The pneumonia was not getting better, and she was going into septic shock. I was the last person to arrive in Ohio. All the members of my family went to Esther's bedside. She lay in intensive care, with tubes coming out and going in to many places, perfectly still except for her breathing. We all took some time to talk to her. I told her I was sorry that she wasn't going to go home, that I'd thought she'd get better. I also told her I'd bought a bell for her so she could call for help without having to use much energy while she was recovering. This may have not been the most eloquent thing to say, but it was enough. When we had all spoken to Esther, we went back to my dad's house. A few hours later, the nurse called to say she was gone, that as soon as we left, her blood pressure dropped, and she began to die. It comforted me that this deathly ill family member waited to die until all of us had come to see her. Somehow, she knew.

Stories from those who have died and then been resuscitated also confirm that a person can be aware of what is going on even when they seem totally unresponsive. Those people sometimes recognize hospital staff that were in the room while they were dying that they did not see any other time. I read about near-death experiences a long time ago, when a member of our church was talking about his. The stories can be pretty amazing.

Sometimes our last words to our loved ones were said in anger. It may take a lot of work on self-forgiveness to get past the words we said that we wish we could have taken back. I experienced years of guilt after my mother died because of the last things I said to her. Long ago, I forgave that 9 year old child I used to be. The day my mother's aneurysm burst, my sister and I were supposed to go back to church for a Sunday afternoon mass, a Holy Hour for girl scouts. My mother was the leader of our troop. I don't know if I was resisting the idea of going to church twice in one day, or if I was reacting to her being sharp because of the pressure building up inside her head. I do remember being very angry, and thinking “I hate you, I wish you were dead!” I didn't say that, but I did say “You hate me! You wish I was dead!” She left angry at me, and my sister and I went to the service with another adult soon after. During that Holy Hour for girl scouts, my mother, who was sitting with the leaders, collapsed. At that time, children my age were not allowed to visit relatives in the hospital. I didn't get to see her before she died, two days later. After my dad told us my mother had died, we didn't really talk about it much. I was afraid to tell him I thought her death was my fault. Over the next few years, I grew more depressed, feeling guilty, sad, and ashamed. I was the target of bullies on the playground, and often cried at school. A staff member called home, insisting I get some help. I started coming out of depression when I went into counseling and found a safe place to talk. Much later I learned that children of 9 or 10 often experience “magical thinking”, attributing great power to words or actions. Children whose parents divorce or who have a family member die may blame themselves.

Many years later, I was trying to put a cranky child to bed. He looked up at me with anger in his eyes, and spat out “I hate you! I wish you were dead!” And truthfully, I had to keep myself from laughing out loud. I realized that this did not have the power to destroy me, that as his mother I could look at the day and figure out why he was so tired and upset. I knew he really loved me, and a moment of anger didn't change the love between us. It was an oddly liberating moment.

There are some ways to deal with endings that were not as peaceful as we would like. Some people write letters to loved ones, or journal. Some work with a therapist doing an “empty chair” exercise, where they have a conversation with their loved ones. Many people talk to the person who is gone, or talk to God about the person who is gone. If a child is having trouble, I recommend a grief support group especially for children. I've added some links to family grief centers in my area to the right of this posting.

Grief counselors talk about the work of grief. If there are last words unsaid or last words regretted, I encourage you to start journaling, find a support group, find a counselor, or read a good book about your kind of loss. It feels good to let go of the burden of painful last words. I feel so much freer than I used to. Mom loved me. I loved her. Words I said in anger before she died can't change that reality.

1 comment:

  1. Hello Sue, thank you for your prompt answer.I will visit your blog again. It´s a real special blog.
    You can found a google Translation gadget scrooling on Aiko´s blog. It´s about life - music - gardening - the thoughts of the dog - and so on.
    Best regards