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The Final Journey

Written by Loretta Dixon

Thursday, 09 October 2008 12:39

My badge five pointed star
Now tarnished and worn like my hands
Sitting by the bed in velvet darkness
Waiting for deaths expected call
Changing of breath
Nurse ears finely tuned
For silence
The herald of journeys end

This is a poem I wrote after I had been sitting with someone through the night as they made their final journey. This was one of the many people I had been with who chose to die at home.

Most people I have worked with have, if given the choice, chosen to be at home for this final event, cared for by their loved ones, with their own things around them and in their own familiar bed. In some ways it gives a measure of control to something they have very little control over.

Does it make people seem more relaxed? Yes, I believe so. Of course there can always be unexpected events just as coming into the world can bring unplanned events, but good palliative care would have things set in place to cover symptoms that may arise.

Palliative care is care that looks at setting things up in advance so that symptoms can be well controlled, and family/carers well prepared for what may occur.

Palliative care also concentrates on preparing families for the sounds and normal symptoms that tell us someone is letting go of this life and preparing to die. Such things as breathing patterns, coolness of body parts and sounds, most of which the patient themselves are unaware of and well prepared families can recognise the stage their loved ones are at. Just as at a birth there are certain signs which tell you how far along the birth is.
This seems to take the ‘fear’ of what may happen away.

I have worked in this way for many years and believe that dying at home is a choice that needs to be presented to people and families.

There is a lot more about the process of letting go of this body. Sometimes symbolic language is used and a person may be telling their family that they are preparing to die. It is part of what I consider good palliative care. That families and carers are alerted to this and understand the process.

Not long ago I had a woman who started to say she was looking for the dress store to buy a new dress for her holiday. To anyone not aware, this may have sounded like she was hallucinating. To me it said she was nearing the end and was preparing herself. I mentioned this to the family, after which they listened more closely and were able to understand more of what she said. They were amazed at the amount she told them in a symbolic way. She died, as expected, about 3 days after.

In the quietness of the night, sitting by the bedside with your loved one, can be a very special time for families and memories can be shared in the comfort of home. Palliative care nurses and carers are aware of the different means of communication that a person who is dying may use and I have, on many occasions, alerted the family to how the person is now communicating. Sometimes it may be just a twitch of an eyebrow, letting you know they are aware.

Sometimes symptoms can change and become more severe as they can whether at home or elsewhere. Good palliative care means that the Nurse and Doctor have been proactive and medication is already set up and can be used if needed.

I have at times, helped someone in late stages return to their own home to die and seen them relax and be able to let go in the familiar surroundings.

I am not suggesting that things are always perfect when at home. That can not be guaranteed wherever you are. But most people with pain or other symptoms can be well controlled, most families can be well prepared and most people if given the choice would want to be at home if they knew expert help was available.

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