A Time to Die

• Sharing Psalms of Comfort

My husband, son, and I had just enjoyed an afternoon at a beautiful Cape Cod beach, letting the waves wash away our sadness after the recent death of my father-in-law. My mother-in-law had died suddenly a year before, and we were still trying to orient ourselves to their absence.

When I put in a call to my widowed 89-year-old father back home in Michigan to share with him the beauty of our day, his phone rang and rang. So I contacted my sister. "Dad's in the hospital," she said. And so began another good-bye.

Diagnosed with a fast-acting terminal cancer, my father told me, "I'm tired of this country," early in his decline. Further along, he asked, "Why is it taking so long?" His lifelong faith in Jesus as Savior had blossomed into a full-blown longing to join Jesus in heaven. He was ready to go.

I struggled with mixed emotions. While our family accepted Dad's decision to forego treatment, we had to ready ourselves for the ordeal of death.

Feeling dazed, I sought peace through prayer. "Lord, I don't want to let my father go," I lamented. "But I know he's ready, so I release him to you. Show me how to help him through this, even though it pains me."

I pondered the strange mix of pain and hope dying in Christ brings. It reminded me of childbirth. Both involve an ordeal of unknown duration—yet in both, the ordeal is limited because of the joy of new life at the end. There was my key to helping my dad. I could look at dying in a new way—as labor and delivery into eternal life!

I'd read about women called "doulas" who specialize in helping birthing mothers through labor. Their supportive presence makes the pain of childbirth more bearable. They gave me my model: I'd become a doula for my dad. I'd see to his comfort and encourage him through his dying labor. Then, through my tears of grief, I'd celebrate his delivery into eternal life.

A doula knows it's not her body at the center of the action. A doula for the dying quickly learns to accept the same limits. Much as we might want to assume our loved one's pain, we remain on the sidelines. But we can accomplish some tasks specifically related to dying.

1. GIVE ENCOURAGEMENT.

We focus so much on his physical comfort; how often do we bolster a dying person's morale as he wearily presses toward the finish line?

According to the American College of Physicians Complete Home Medical Guide (available at www.acponline.org), "One of the most important things you can do to help the person you're caring for is to have a positive attitude. … [They] need encouragement, and they need help noticing the good things that are happening around them. At the same time, it's important to be realistic about the seriousness of their problems. These patients must not feel that their problems are being ignored or belittled."

Several months after my father's death, my sister-in-law, Joan, lay dying from complications of diabetes. At her hospital bed, while she was still conscious but impaired by the effects of a stroke, I told her how much her sweet attitude and patience through her struggle had touched me. Joan raised her bandaged hand to point toward heaven and declared firmly, "It's him! His grace is sufficient for me!" She hadn't been able to process many lucid thoughts that day, but encouragement in the midst of her suffering released this powerful testimony from her lips.

Giving encouragement may not always have such a dramatic result, but I've seen enough to know giving it really matters.

2. FOCUS ON HIS NEEDS.

We all bring huge needs to the deathbed, but the dying person's needs must be foremost. For example, when my father wanted to rest instead of talk, I saved conversation for a time when it was welcome. But if he wanted to discuss what was coming, I had to be willing to talk about death rather than waste energy in secrecy and denial. Who knew how much time was left?

As appropriate opportunities arise, ask what medical interventions your loved one does and doesn't want, who should make decisions when he no longer can, and his preferences regarding burial and funeral arrangements. If you can discuss these matters before a deathbed experience, do so! My husband, Gary, clarified these matters with his parents before his mother's sudden death, and it eased our way through urgent arrangements. We used the occasion of her death to open the subject with my father, so we knew his wishes clearly.

3. HELP BRING CLOSURE.

Ask what unfinished business he needs to address and how you can help him with it. This might include practical arrangements left unfinished, relationships in need of mending, information to be shared, good-byes to be said. Hospice physician Roscoe Stuber advises, "Ask the person, 'Is there anything you need to do before you're ready to die? How can I help you with that?'"

We were blessed to know with certainty our parents' trust in Christ well before they died. Not all families approach the deathbed with that certainty. Many shy away from the most significant matter to resolve before death: What spiritual steps does this person need to take to be prepared to die? Yet spiritual preparation for death is a central task for the dying, and it can be addressed with both tact and confidence (see sidebar).

4. GIVE PERMISSION TO DIE.

According to materials from the Hospice of North Central Florida, "A dying person will normally try to hold on, even though it brings prolonged discomfort, in order to be sure those who are left behind will be all right. Therefore, your ability to release the dying person from this concern and give him or her assurance that it is all right to let go whenever he or she is ready is one of the greatest gifts you have to give your loved one at this time."

Get help bearing your grief from your family, friends, and pastor so you can lovingly assist the dying person with her tasks. You can tell her how much you'll miss her, and that you understand and accept her readiness to go. You have to bring yourself to the point where you mean this, because it will be tested by the realities of dying.

For instance, many dying persons come to the point where they refuse food. When my father reached this state, I had to weigh whether to cajole him to eat. Being his ally and accepting his goal allowed me to offer food gently and to accept his refusal, saving us both a futile struggle.

5. BECOME A PATIENT ADVOCATE.

One day, I observed Dad wasn't receiving adequate pain medication. His physician's order specified Dad could ask for more as needed, but I knew my father wouldn't ask. Dad was in an excellent skilled nursing facility with a caring staff and doctor, so when we communicated his need for more regular, scheduled doses of pain medication, they were responsive. Without our presence and advocacy, however, who knows how long Dad would have suffered before someone realized there were gaps in his treatment.

You can do a service for your loved one by being there, being aware, and respectfully communicating for him when he's too ill to ask for what he needs. My siblings kept a log book at Dad's bed so we could share observations and updates with each other. One nurse I spoke to advises families to choose one person to speak with the medical staff, if possible, to be most effective and avoid confusion.

6. SPEAK CAREFULLY.

Hearing is one of the last senses to go. Only say things in your loved one's presence you're willing for her to hear, and make sure she hears some happy memories. My pastor-husband, Gary, quietly preparing for Dad's funeral, asked us siblings to share memories of Dad at his bedside. Dad's eyes were closed and he couldn't speak, but I saw him smile as we shared good memories, including funny ones.

7. USE SCRIPTURE TO COMFORT.

Scripture has the power to bring comfort to the very point of death. I'll never forget entering Dad's hospital room upon our return from Cape Cod and seeing his struggle to bear the physical pain and to have patience with the ordeal of dying until he could leave "this country." As I tried to get a grip on my torrent of emotions, Gary asked Dad if he could share some Scripture with him. Dad nodded with a glint of longing in his eyes. Gary opened his Bible to 2 Corinthians 4:16-18 and read, "Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal."

I saw the power of God's truth visibly touch, calm, and strengthen my father for what he was going through—and for what lay ahead.

8. PROVIDE A PRAYERFUL PRESENCE.

There comes a time when words are mostly past. Hold the dying person's hand so she knows you're there. The website www.hospice.net describes physical changes and stages that often precede death, so caregivers may know what to expect.

"Being there at the time of death is as much a gift to the family as it is to the patient," says hospice physician Roscoe Stuber. "The actual moment of death most often comes very quietly. The breathing slows until they take their last breath, and then the breathing just stops."

At this moment, the labor of dying is finished. New life—free, whole, and eternal—has begun. Shed your tears, give thanks, delight in the One who's received your loved one into his loving hands, and turn to nurture the living.

Esther Bruland, PhD, is an educator, author, and freelance writer who lives with her family in Pennsylvania.

What if She's not a Christian?

What do you do if you're not sure of the dying person's faith, or if you know she hasn't yet accepted Christ?

If you've shared your faith with her before and she put off accepting Christ, don't assume that decision still stands. Staring death in the face can prompt some radical soul-searching. You can gently share Christ with a dying person, taking your cues from her concerns. Bathe the situation in prayer, and remember Jesus is the best gift you have to offer.

If you've never shared your faith with the person before and aren't sure how to find the right opening, Pastor Rick Warren suggests approaching her with an apology. In "Discovering My Life Mission," he gives this example: "[Name of person], I just need to stop and apologize to you. We've known each other a long time, and I consider you to be a good friend. But friends don't keep secrets, and I've never told you about the best thing that ever happened to me. I guess I was afraid of what you'd think. …" Then share your faith story in a brief way.

You may want to add something like this: "We've all sinned; none of us is worthy of the gift of heaven, but it's a gift God wants us to receive. All he asks is that we admit our sin, believe Jesus died to pay the penalty for our sin, believe he arose and is alive, and confess him as Savior. Is that something you would like to do?" (If the person can no longer speak, ask her to nod or squeeze your hand as her "yes.")

If you receive an affirmative, pray the sinner's prayer (repenting of sins and acknowledging that Jesus is the risen Lord and Savior) with her. Then read John 6:47 as assurance of God's promise. Jesus said, "I tell you the truth, he who believes has everlasting life."

If she responds with "not now," say, "Please think about this. You can still do this on your own." Continue to pray for her. Only God knows what ultimately transacts between his convicting Spirit and her, but you can share, watch, and pray.
—E.B.

Care for the Caregiver

Being at a deathbed can be a weird juggling act of emotions, pain, medical interventions, family concerns, daily demands, and not knowing what to say or do, or how to pace yourself for the unknown. The nonprofit website www.hospicenet.org describes several emotions caregivers experience. Feeling overwhelmed tops the list, along with anger, fear, loss, sorrow, and guilt at being well while the person you care deeply about is sick. Hospital social worker Barb McClurg advises reeling families, "Take one thing at a time. You can't look at the whole picture at once. You need to stay focused and make decisions day by day—even minute by minute. Deal with what's happening right now."

She also urges family members to take care of themselves: "You can't deal with what's going on with your loved one if you're not eating and sleeping." When families must deal with the big picture, McClurg advises drawing upon the assistance of hospital social workers, hospice professionals, and your pastor. "When you're not thinking straight, they make sure all the pieces are there and put together," says McClurg. Hospice physician Roscoe Stuber similarly urges working with the professionals as a cohesive team, stressing the need for honesty among patient, family, doctor, and others.
—E.B.

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