Giving permission–the final gift

As November is coming to an end, so is Hospice and Palliative Care month along with Caregiver month. I have another topic that I want to touch on. Giving permission. That may seem like something simple, but in reality is something that we don’t do nearly enough.

Many of you have probably heard it said that you need to give your loved ones permission to die. It is absolutely true. I have had numerous patients clinging to life by a thread. Until they were given permission by everybody close to them, they would not pass on. A lot of people also will wait for someone. Sometimes they are waiting on a child to come home, which was the case with my Grandfather. When his last son came home and said goodbye, he passed away the next morning.

One of my ICU patients could have passed at any moment. He was unresponsive and I had told him numerous times throughout my shift that it was okay to go. However his family was all standing at the foot of his bed and hadn’t said a word to him. After telling them the importance of saying goodbye and giving permission, each one of them went to the head of the bed. One at a time they held his hand, gave him a kiss, said their goodbyes and most important GAVE PERMISSION. They said that they would be okay once he was gone. They still would love him with all of their hearts’.

Within sixty seconds, I noticed a change on the monitor. He was starting to have pauses between heartbeats. Short ones at first and then longer. At the two-minute mark…nothing. He had passed away. He had been given the permission that he needed. That was one of the most poignant deaths that I have seen.

Most recently, actually last week, I was able to see a very good friend of mine. She had ovarian cancer and was terminal. I knew it would be my only chance to see her before she passed. Each time we had talked over the last few months, I could tell that she was progressing. She was also a nurse–actually became one because of my Grandmother. When I called her last week, my heart sunk when I heard her voice. I knew she wasn’t going to make it much longer.

As she was sitting in her chair talking to family and friends, she never let go of my hand. When everyone had left, we were able to talk candidly. I asked if she had considered hospice yet, she replied she had thought about it, but nobody had brought it up. My gut was telling me that she had days. We talked about that it was a hard decision to stay and that is was an equally hard decision to go. Quality of life was a priority. We talked about that she would have a wealth of people waiting for her on the other side, including my Mother. I told her to give my Mom a hug and say hi when she got up there and that I would see her again soon enough.

With tears in my eyes when I gave her a final hug and said goodbye, there was a peacefulness that washed over her. It wasn’t there when I showed up. I had given her permission and brought up something that nobody else had. I wasn’t doing it because I’m a nurse, I did it because I was her friend. We spoke on the phone Saturday night and she said that she was trying to figure out if it was worth trying to keep fighting. I told her that I loved her and also said that I thought it was time for her to let go…she died the next night.

The power of permission is beyond measure. It is beyond anything that medicine can do. It is something that we all need to remember and not be afraid of. It is empowering to those we give it to.

To some death seems like a cut and dry process. To anyone that has been involved with patients, parents, family members or friends, we know that this process is so complex and emotional for everyone involved.

There is a stigma that seems to hang around death. It seems that once the funeral is over, then suddenly society expects that grief should also end. That is most definitely not the case. Grief continues for years. It changes form, it lessens, but I don’t know if it ever truly ceases. We learn to incorporate it into our lives. But, it is always brought back to the surface with the holiday season, birthdays, anniversaries and a litany of other dates that bring back treasured memories. That is how we cope. It means that we truly love someone and they will always live in our heart. It’s okay to grieve, just as it is okay to give permission.

You will lose someone you can’t live without, and your heart will be badly broken, and the bad news is that you never completely get over the loss of your beloved. But this is also the good news. They live forever in your broken heart that doesn’t seal back up. And you come through. It’s like having a broken leg that never heals perfectly—that still hurts when the weather gets cold, but you learn to dance with the limp. –Anne Lamott



Caring For Life: The Art & Essentials

November is National Hospice and Palliative Care month, as well as Caregiver month. Caregivers and family are heavily involved in the health of their loved ones. So many times they are the driving force behind getting Hospice and Palliative care involved. So it works out perfect that both of these happen to be in the same month.

A little background first. As a Registered Nurse, I had heard the first and last breaths of life as well as the first and last heartbeats and everything in between. A life is equally precious no matter how young or old. Everyone will ultimately transition from this earth, some sooner than others.

If you are reading this, then here is the first rule for anybody. It doesn’t matter how old or young you are. Make sure that your wishes for a major medical event and/or end of life care are clear. Telling someone is not sufficient, it needs to be done so that it is a legal document. There are several different options and the terminology can get a little confusing. So here are the nitty-gritty details.

A “Durable Power of Attorney for Healthcare” allows you to name a person to oversee your medical care and make healthcare decisions for you in the event you are unable. This person may be referred to by several different terms including healthcare proxy or healthcare agent. When arranging your care, the person that is designated is legally bound to carry out your wishes to the extent that they know about them.

To further make your wishes clear, you can use a second type of directive as well. A “Living Will” will have your written wishes for your agent and health care providers.

Many states have combined a Durable Power of Attorney for Healthcare and Living Will into an “Advance Healthcare Directive.” One of the best documents that I’ve had experience with is Five Wishes. This is a very comprehensive Advance Directive.

Personally, this is the Advance Directive that I had my Mother fill out. I was named her healthcare proxy and it was very detailed with how she wanted to be cared for in a multitude of circumstances. It also guided me through what her final wishes were when I ultimately had to withdraw life support. We had discussed everything very candidly beforehand so there weren’t any surprises.

With my chronic illnesses, I have an Advance Directive on file at all medical facilities that I’m cared for. I also have my Five Wishes filled out and have three different proxies named. This is in the event that your primary or secondary proxies are unavailable. You always have someone available to make decisions for you.

Even if you don’t have medical conditions, it is always essential to think ahead for what circumstances could possibly arise down the road. Encourage family members to have some sort of document drawn up. Just because you have an Advance Directive, doesn’t mean that somebody can automatically dictate your care. This only goes into effect in the event that you are unable to make decisions for yourself. You also have the right to change your wishes at any point in time.

With the Holiday Season coming upon us, it is time to have some conversations with family members. What a better time to discuss one of the times in life when everyone will need the most care. Work on creating everyone’s wishes. That is one of the best gifts that we can give to anybody. Dignity and respect.