Assisi Hospice

The dying days are about living well too

published by The Straits Times on March 15, 2016

When a loved one is dying, preparations go beyond practical arrangements and medical decisions.
Joyce Teo reports.

As people live longer due to medical and economic advances, more may die after living for weeks or months with a life-threatening illness. Knowing that death is imminent, the dying person and his family members should start talking about it in order to prepare and plan for the final journey. The dying person may have his own view on the type of funeral service that he wants, where he wants to die, and other last wishes. Then, there are the medical decisions and arrangements to be made, such as appointing a power of attorney or signing a will. But end-of-life preparations go beyond these aspects.

“Sometimes, when we focus so much on death, we tend to forget that the dying person is still living,” said Ms Candice Tan, a senior medical social worker at Tan Tock Seng Hospital. “If we think about it, living and dying share the same trajectory. We start dying the day we start living.” Ms Tan added: “When we are able to see both sides of this coin, we realise that end-of-life conversations are not just about death and dying, but also about living, and living well till the very end.” She and the medical social workers at Assisi Hospice highlight a few things to focus on for a family facing a loved one’s impending death.

Be there for the person. Spend time with him and behave as per normal. Do the things that you would usually do with him. Tell him about the things that are happening in the family or at work, for instance. Keep an open mind because the situation may change. For example, a doctor might give a prognosis of a certain period but some patients may outlive their prognosis or die earlier than expected. Families can spend this time wisely with their loved ones, instead of focusing on the prognosis.

Celebrate special occasions or the festive seasons. “We encourage families to normalise things, to celebrate whatever time they have left, so that it doesn’t have to be overly bleak,” said Ms Tan. Gather friends and family for special occasions. That event could be the last time the person sees certain relatives, she said. “It’s quite depressing at times but it doesn’t have to be so all the time. It’s about finding momentary happiness or pleasure.”

A dying person has needs and wants to be heard. Allow him to talk about his thoughts and feelings on his condition. Lend a listening ear but don’t pressure someone into opening up if he does not wish to. Be patient as he may be riding a roller coaster of thoughts and emotions during this time. “The topic of death is still taboo in our culture, making it very difficult and painful for anyone to initiate or even endure such a conversation with a loved one who is dying,” said Ms Ivee Tee, a senior medical social worker at Assisi Hospice. “But when they open up and share their feelings with one another, both the patient and the family members can benefit and be empowered to cope with dying and death.”

The dying person may have questions or doubts about the dying process or life after death. He may seek solace and meaning in his religious faith, drawing reconciliation from a higher power or some form of transcendence. The family can help him explore religious beliefs, get a religious leader or representative to visit him, and play religious music, for instance. Spirituality need not be found only through religion. The United States-based National Institute on Ageing said that spiritual needs involve finding meaning in one’s life and ending disagreements with others, if possible. Hence, the dying person might find peace by resolving unsettled issues with friends or family, it said. There are also other methods to address one’s spiritual needs, like meditation.

Say “Thank you”, “I’m sorry”, “Forgive me or I forgive you”, “I love you”, and “Goodbye” to a dying relative. At the Assisi Hospice, medical social workers and staff encourage families to talk to their loved ones. But family members sometimes lament they have run out of things to say or do not know how to have a meaningful conversation. These five phrases can be hard to say. They are simple but powerful words and have brought about many touching scenes of reconciliation at the hospice, said medical social workers.

Talk to the dying person about his life. Get him to talk about the things he enjoyed doing, significant life events, people he valued, his attitudes, values and beliefs. It’s important to talk about the things that give us meaning in life, about what it means to live well and how we want to be remembered, said Ms Tan. “When we know that we have lived well, death may become less frightening or daunting.”

Allow him to share any last wishes, such as how he wants his funeral to be. This allows the family to spend the remaining time together without having to worry about how to plan it. Last year, a patient at Assisi Hospice wanted to watch a race and place bets at the Turf Club. The family was initially hesitant but decided to do so, on the encouragement of the staff, who also helped with preparing for the trip. The patient won his bet. He had a beer to celebrate and was happy to have had a family outing, according to the hospice staff. • This is the first of a two-part series on dealing with death and dying. In the next Healthy Spaces column, we will look at coping with grief.

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