Healthcare

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

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2 thoughts on “Giving permission–the final gift”

  1. I have uttered the words; “it’s okay to let go now” to pets and held them as they passed. I have told people in my life that I’d respect their decisions and when it’s their time I’ll be there for them. You’re right, it’s okay to give permission- it’s hard- it’s sad- it’s a very loving thing to do. Beautiful article, sorry you had to say goodbye to your friend, glad you were able to.

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