(Susan Lawrence is a volunteer with a not-for-profit hospice as a companion and vigil volunteer. She trained with International End of Life Doula Association and earned her Proficiency Badge with the National End-of-Life Doula Alliance. Susan is a founding member of the Minnesota Death Collaborative. This article, used with permission, appeared online at https://adestellc.com/blog/.)
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As an end-of-life doula and hospice volunteer, I am honored to “sit vigil” with someone as they are actively dying. Healthcare providers may call this “transitioning.” This is the tender time as death draws near, and your loved one continues their journey away from their earthly body. What should you do? What can you expect?
Remember, death is typically not a medical event. Death will come to all of us; it is part of our life from the day we are born. Take your time to sit with your loved one. Say the things you want and need to say – most likely they are still hearing even if they don’t appear to be awake. Maybe you are ready to say you are sorry and you love them. Are you able to forgive them? Now is your opportunity.
Occasionally our loved one wants permission to leave. Reassure them that you will miss them, you will be okay, and they can leave when they are ready. Hold their hand, cradle them in your arms, stroke their hair. They won’t break, but be watchful of signals if they are uncomfortable such as wincing, flinching, or trying to move away. They will let you know.
Tears are okay; you can let your tough side go for a bit. Your loved one might want to die alone. You could sit for hours and hours, and the moment you take a break (and you should ), they could take their last breath. You didn’t fail them by taking care of yourself and leaving their bedside. They wanted you to step away.
If possible, honor the wishes they outlined in a vigil plan. It might be music, readings, photos, candles or essential oils, touch, visitors, and rituals or celebrations. Soften the lighting in the room. Cover them gently with a fresh sheet or blanket. Do they have a favorite quilt? Open a window if they want to hear birdsong. A little fresh air will go a long way for them and for you.
Gently put a little balm on their lips so they won’t dry out as they breathe through their mouth. Find a closet to stash the medical supplies; you won’t be needing them – why look at them? The less “medical” the room looks, the more peaceful it will seem.
On a practical side, educate yourself to the signs and symptoms of imminent death (a future post). Hydrate. Take breaks. Walk down the hall; better yet, walk outside in the fresh air. Meditate.
Children are curious and may want to be in the room; if so, help them manage expectations. This is a gift you can give to children and grandchildren – understanding death is part of life. They can say goodbye in their own way. Encourage them to draw a picture, write a story, or sing a song. Leave their favorite candy alongside. If they ask to gently touch a hand or cheek, let them.
Once your loved one has died, take the time you need to sit with them. There is nothing urgent right now. The funeral home does not have to come immediately. Call the hospice team if they were receiving hospice services. If in a nursing home or hospital, alert the nurse. If they died at home and didn’t have hospice services, call the police. Make sure to tell the dispatcher it is not an emergency.
This is the time to lean on friends and family to assist. Have a list of people who should be notified and ask someone to make a few calls for you. There is no need to rush.
Many of us feel the need to do something. Now is not the time. And remember, be gentle with yourself – you have witnessed a very sacred time in your loved ones’ time on this Earth. Reach out to a grief-support group, the hospice team, or a counselor if your feelings are overwhelming you. And take all the time you need.
Grief is as unique as each of us, and we all have our own way of walking through it and with it.
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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.
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Lovely and so helpful!
While I realize that many of the readers here aren’t religious, one missing here for the religious is the presence of a clergywoman/clergyman near the time of death. The clergy member can be a priest, minister, rabbi, imam, or whoever aligns with the dying person’s faith. Anglicans and Catholics generally have a priest visit the dying person to give her/him Last Rites. This usually includes an opportunity for private confession and absolution (if able), Anointing of the Sick, and and reception of the Eucharist. If the dying person can no longer eat or drink, the priest can put a drop of wine (Blood of Christ) on the host (Body of Christ) and put it on the dying person’s tongue. It will melt and there’s no need for the recipient to swallow it. That’s what the hospice chaplain (also a priest at our church) did for my late husband. I also played the Hallelujah Chorus from Handel’s Messiah on my phone for him as well. He didn’t die immediately after that. But the Last Rites made him able to enter eternity in a state of grace.
Thank you for these thoughts, Sue M. 🙂
A lot of articles published in this blog could use some editing. This is one of them. It contains so much practical and compassionate advice and so much baloney.
1. “death is typically not a medical event” – YES. We have medicalized it to such a great degree, especially the struggle to postpone it that we tend to forget this simple fact and treat it as a medical failure.
2. >>let children who want to be there be there.<< – absolutely. (IMO. even invite them, gently.) This fits well with the previous point – death comes to us all. Best to let children know death from the beginning. Much easier and less distressing than having to change one’s world view later in life.
3. “Your loved one continues their journey away from their earthly body.” Or, more likely IMO, your loved one doesn’t continue at all. The author, writing as an expert (certified Doula) is imposing her personal belief on the reader.
4. “Grief is as unique as each of us, and we all have our own way of walking through it and with it.” Indeed. I could tell many stories of people who grieved in ways I considered “denial” and it worked out well for them.
5. “Many of us feel the need to do something. Now is not the time” – What happened to everyone grieving in their own way?
6. “They wanted you to step away.” And you know this because . . . The fact is you couldn’t stay there every minute. It’s too much to ask of any bladder, colon, or psyche. You picked this particular moment to step away. Bad luck. You have nothing to feel guilty about.
It would be good if points like these could be discussed with authors before we publish their articles because we could mitigate giving out questionable advice (at best) along with some very good advice.
Editor’s response: Thank you, Ron, for your frank comment. We appreciate your thoughts and will keep them in mind. Please know that while The Good Death Society Blog includes articles written exclusively for FEN, frequently our posts are reprints of things already published. The authors’ views are their own – which is why they carry a byline. We gently edit for style and grammar, but are not permitted to rework points of articles that have already been read by thousands in respectable print and online outlets. In our overall purpose for the blog, we may disagree on specifics, but in the end, death is hard, and a good death is worth pursuing. On that, hopefully we can all agree.
Being one without the guidance or structure of a religious doctrine, the post and Sue’s comment are good reminders for me to spend some quiet time contemplating and visualizing my final minutes of life and those first few minutes, days, weeks after I die for those I am leaving behind. More conversations to be had…
A well-written post. I’m a non-practicing doula at this time. I took my certification through the International End of Life Doula Association back in 2021. Plus, I have my certification in MAID.