(Karen Wyatt, MD, is a family physician who has spent much of her 25-year medical career working with patients in challenging settings, such as hospice, nursing homes, and indigent clinics. She is interested in a spiritual approach to medicine, illness, death and dying, and is the author of two books and host of End-of-Life University podcast. This article, used with permission, appeared online at https://eolupodcast.com/2024/10/31/when-you-cant-be-present-for-a-last-goodbye/.)
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When my niece died in hospice in another city a few years ago, I was unable to travel there to say goodbye before her death. I was crushed that I didn’t have one last opportunity to hold her hand and tell her I loved her, but as it worked out, that visit was just not possible.
In an ideal world, many of us would like to be with our dearest loved ones at the end of their lives, to say goodbye and “I love you” one last time. But in this day and age, we live very busy lives that often take place many miles away from our families, so there are times when we cannot travel to be present for those special and fleeting moments.
Some of us may even go to great lengths to get to another city only to find that we missed the final breath by a few hours. This distressing reality can lead to unresolved guilt and grief as we blame ourselves for not being there. But here are some things I’d like you to know about the dying process based on my many years of hospice experience:
Dying has a unique time frame.
Even with the best of medical knowledge, we cannot accurately predict when a terminal patient will die. I have seen patients live far longer than seemed medically possible, and also some who died much sooner than expected for no obvious reason. Don’t blame yourself if you cannot be there at the “right” time, since you have no way of knowing when that time will be.
Dying is an internal process.
In the last few days before death, patients tend to turn inward and focus on the personal work they need to do to let go of life. They enter into a semi-comatose state where they seem to be having experiences that we cannot understand. They may express a desire to see a particular family member, but often they are preoccupied with their own process and don’t need much interaction with others. Most likely, your loved one is not focusing on whether or not you are physically present in the room.
Each person’s preferences are different.
Some people want to be surrounded by loved ones as they prepare to die, but others need to be left alone in order to complete the work they are doing. We usually cannot predict who will want to be alone in advance and even patients themselves, when asked about it ahead of time, don’t realize that they may need solitude during those last moments. Some people who have always been very social find that they no longer want to interact with others when they are ready to die.
While you may want to be there to say goodbye it’s possible that your loved one is content to have fewer visitors at that time. In fact one woman I know spent every moment at her mother’s side so that she would not die alone. But the mother took her last breath during a brief period when her daughter went outside for a few minutes. Apparently she needed to be alone to finally let go and her daughter simply had to accept her choice.
Sometimes dying patients seem to delay death.
Again, without any medical explanation, some dying patients seem to be able to postpone the time of death in order to “wait” for a loved one who is expected to visit. I have seen many occasions when the patient had an intense need to see someone one last time and, against medical odds, survived an amazing number of extra days, until that person arrived. If your loved one did not wait for you to come, please view it as a sign that there was no unfinished business between you, and don’t blame yourself for not getting there on time.
The dying perceive things we cannot explain.
In my work with dying patients, I have witnessed their ability to “see” and “feel” the love that others are sending to them, even from a far distance. Many of them have explained that they feel connected to distant family members and “know” that they are loved, even if those people cannot be physically present. Trust that all your concern and loving thoughts have been received by your dear one and forgive yourself for not being able to be in the room at the time of death.
If you know you cannot be there and you have a need to say goodbye, try calling on the telephone to express your love. The day before my mother died, she received phone calls from two dear friends who lived far away. Even though she was semi-comatose, she listened as I held the receiver to her ear and smiled at the sound of their voices. She was unable to respond verbally, but I could see that she heard the message, so I reassured her friends that their farewells got through.
Remember that you have no control over the timing of your loved one’s death. Follow your heart and travel if you need to and can, but don’t stress if it doesn’t work out. Your effort and your loving intention will still be perceived by your loved one in some way or another.
Trust that your loved one would not want you to carry a burden of guilt, and create your own “goodbye” ritual if you cannot be there in person. On the day my niece died, I gathered some wildflowers and dropped them into a flowing stream while I spoke all the messages I would have shared with her at bedside. My heart became much lighter as I imagined her standing next to me, watching the blossoms drift slowly downstream.
May you, too, find a way to be at peace with every farewell you must speak from a distance.
(Please scroll down to comment.)
Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
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The article seems filled with empirically baseless assumptions and suggestions, probably designed to relieve guilt.
I wasn’t able to be at my mother’s bedside as she died when she suddenly took a turn for the worse. Fortunately, I was there the week before and we were able to say our goodbyes and last messages. Nevertheless, being absent caused some regrets. I welcome Dr. Wyatt’s suggestions.