In my ten years working in hospice, I have had the privilege of helping numerous patients work toward finding peace as they near the end of their life. Patients often struggle with the dying process (What does this look like for them? Will it be painful? What are they really facing?) as well as struggling with leaving this world and all they have in this world. This leaving is often fraught with emotional and spiritual pain as patients seek to find some peace and acceptance with this reality. Often times, patients hold onto hope that a miracle will happen, while at the same time, preparing for their eventual passing. Having a foot in both camps can be difficult to manage.
As a Social Worker, addressing this issue of leaving is one of the greatest gifts we can give to a patient. This is addressed in many different ways, but I have found much success in encouraging patients to say what needs to be said through writing letters. I recently had the experience of helping a patient write letters to her family that could be read after she passed. When the patient and I first talked about this, she was hesitant … unsure that she would be able to formulate a thought, afraid of what those thoughts would be, afraid that she would not be able to say what she needed to say. In helping her, I offered to type her thoughts as she spoke them. She agreed to this and started to tell me about her family members. She shared her thoughts about the type of people they are becoming, the light that she sees in their eyes, and the joy that they bring to her, as well as her joy in being a part of them. She did not hesitate to talk about the specialness of each family member. At this first session, this patient did not want to write about her hopes for her family members after she was gone. She did not want to believe that she was going to be gone.
At the next visit, she had experienced some decline and seemed to be coming to a closer acceptance to the reality of her passing, and it was as if she turned a corner—she started to talk about the things she wanted her family members to remember once she was gone. She talked about the connection she will always feel with them, gave advice for the future, and encouraged them to move forward with life.
These moments, when you get to see someone reach this level of acceptance, are profound for me. It takes such courage and vulnerability to share your deepest longings for the people you love. My patients and their families are courageous. They travel this road, which no one really wants to go down, but we all have to. We, as hospice workers, get to navigate the difficult waters with our patients, whether it is the Nurse, Hospice CNA, Spiritual Care Provider, Volunteer, Physician, or the Social Worker, we, too, need to be courageous in our efforts—courage to tackle the big things and the wisdom to know when to do it.
Sharla P., LSW
Medical Social Services
Heart ‘n Home Hospice & Palliative Care, LLC