Can we understand what the dying are trying to tell us? What we perceive as confusion often is unique and symbolic communication, according to Maggie Callanan, RN, co-author of “Final Gifts: Understanding the Special Awareness, Needs and Communication of the Dying.”
Callanan spoke to 60 nurses on May 17 at a dinner hosted by Regional Hospice and Home Care of Western CT in celebration of National Nurses Day. Since becoming a hospice nurse in 1981, Callanan has studied, taught and written about end of life, including the unique and symbolic communication of her dying patients.
“What matters to dying people?” she asked. “They want to focus on more than the physical. If you want to give good holistic nursing care, ask them, ‘What’s going on?’ It may be a pain in the hip, or it may be a dream.”
Dying people want to talk about what it’s like to die, according to Callanan. “They feel isolated and unique,” she said. “Often they talk in terms of preparing for travel or change. They feel the presence of others who are not alive. Sometimes they know when they are going to die or seem to choose when it will happen.”
Occurences in dreams and near-death events directly relate to their life experiences, Callanan said. Old teachings may come back, such as childhood beliefs or religious training, or they may use symbolic language of travel experiences. One man who was an avid sailor asked Callanan what time high tide was one day. Callanan realized he might be going to “set sail.” She called his wife who had gone home to rest, so his family was able to be with him when he died that night.
“A typical dream patients have early in hospice care is being at a crossroads and not knowing which way to go,” Callanan said. “They feel lost. They don’t know what the journey is yet.” As they get closer to death the path becomes clearer. “Validate what you see and hear,” she said to the nurses. “Listen to the patient.”
Joan Thorburn, RN, CHPN, a nurse case manager at Regional Hospice and Home Care of Western CT, shared her wisdom related to dying patients after the talk. “People think that dying alone is terrible,” she said. “I always tell them, some people, especially introverted people, want to be alone. A mother may want to spare her children, one last time. People die as they have lived.”