Analysis Of Letting Go And Dying In Do Not Go Gentle Into That Good Night

Abstract

Letting go is one of the most difficult tasks we face in life, especially when it means we are losing someone we love. Programs, such as hospice, have been designed to offer a level of care that focuses on quality of life and comfort care, for those that are coping with dying. They also offer care for the families of the individuals who are facing death. Through a task-based model and their philosophies, they are able to help. individuals and their families in the process of letting go.

Letting Go

Death is not a term that I am unfamiliar with, in fact most people have experienced it in some shape or form during their life. Throughout our time here we experience the gift of life, and the heartbreak associated with death. It is the Ying and Yang of our existence. Many of us however, have a very difficult time coping with death, and even more so, the process of death. They say that letting go is the hardest. I would have to agree with that statement. There are those however, that seek to make the process easier on those who are dying, and on those who are facing the loss of someone they love. Hospice is “medical care to help someone with a terminal illness live as well as possible for as long as possible, increasing quality of life” (What is Hospice?, 2018). They do so, by covering the four dimensions of care, using an interdisciplinary team approach, and by most importantly…showing care and compassion during a difficult time in our lives.

This semester has been one of the most difficult I have ever faced. In mid-September I received a phone call from a hospital back home, telling me I was needed immediately. The doctor informed me over the phone that my father had suffered a major stroke and may not make it through the night. For the next month, I spent as much time as I possibly could by his side. I stayed by his bed until the ICU nurses ran me out when visiting hours were over, and then I cried until the next morning when I was able to go in again. I watched him fight for his life and win small battles here and there, but ultimately, he was slowly losing the war. I met with palliative and hospice care and I knew in my mind that this was where we were, but my heart disagreed. I knew that once the decision was made to move him to hospice care, that I would lose him. I knew however that he was suffering…that his body was shutting down, and that he just did not have any strength left to fight with. He entered hospice care on a Saturday afternoon and Sunday morning he was gone. Even though I did not get to spend much time with the hospice team, I can honestly say they made an impact on me and I like to think they did my dad too. They showed a level of care and compassion that I did not expect. They treated us like family. They listened. Letting go is by far the hardest part, but during my experience with hospice, it was made a little easier.

There are four dimensions of care that a hospice team focuses on when helping individuals and their families cope with death and letting go during the dying process. These are based on the task-based model for coping and dying by Corr. The first is the physical dimension. This is the focus on controlling physical pain or distress and satisfying the basic bodily needs. Management of these areas, helps bring a level of comfort to the individual. Having help with this area relieves a certain level of stress on the family members, and also brings them a level of comfort. The fear that my dad would be in pain or would be suffering, was very upsetting and stressful for me. Hospice was very helpful in educating me about the measures they would take to ease his pain and suffering, and how it would affect him. Knowing this, did help in easing my worries and helped me with making the decisions that I faced.

The next area of focus is the psychological dimension. This dimension involves empathic listening, for both the individual and their families. When an individual is dying, various feelings may be experienced. They may experience fear, anger, sadness, or anxiety. “These feelings are real, and they must be lived through” (Corr, Corr, & Doka, 2019). It is a time when emotions and feelings can come to the surface and individuals may seek to “let go” of things and may attempt to mend relationships. It is a time of healing for the individual who is dying and for their family/friends. As a caregiver, sometimes they need someone to listen to them and take them seriously. Caregivers can also serve as an assist in contacting family/friends that the individual may be seeking out during this time. Mending relationships or having the chance to make peace with others can be a very important step in the process of letting go and of dying. I believe the hospice team helped me more in this area than any other. Having someone to listen to my fears, my sadness and my anxiety was, relieving. I knew they could not fix certain things, but just having someone hear me, made a difference. Having someone to talk me through the process of what was happening and to offer me counseling services both before and after I lost my dad, gave me a support system that I desperately needed.

Social dimensions are the next area. The focus here is “to sustain and enhance those interpersonal attachments that are significant to the person concerned, and to sustain selected interactions with social groups within society or with society itself” (Kilcrease, 2019). This is an area where caregivers can assist individuals in taking care of both interpersonal attachments and societal interactions. These can include listening to their concerns and advocating for resources to help with those concerns. Having someone to listen and to help with these tasks can take a weight off of the individual and therefore can make letting go seem easier and less stressful.

The final area is the spiritual dimension. In this area, individuals seek meaningfulness, re-establishing or maintaining connectedness, and transcendence. This area is not separate from the other dimensions, but it runs through them. Hospice caregivers can assist in this dimension by listening empathically to the individual. It is not necessarily important to respond, but more so to hear their story. Another way they can help is by participating, such as by reading scripture to the patient and by just giving their support. Chaplains are a part of the hospice team that can play an important role in this dimension. In my dads’ case, he was unable to communicate for the most part, so he was unable to work through this dimension with the members of the hospice team. They were however, there as a support system for me. Having someone to talk to and pray with me, for me, and most importantly for my dad was very helpful to me. I am a very spiritual person and I spent a great deal of time in prayer when I was with my dad…even when I was not. Being so far from home, I lacked the first-hand support of my church family and my pastor, even though I knew they were only a phone call away, having someone physically there with me was something I needed. Having that spiritual support helped ease me more into the stage where I was more prepared to let go. As much as I wanted to keep him here, and do any and everything I could to help him heal and recover, I knew I could not. In my heart I knew his healing would be delivered on the other side, not here with me. “Come unto me, all ye that labour and are heavy laden, and I will give you rest” (Matthew 11:28-29 King James Version (KJV). I am very thankful for those that prayed with me during those days, and provided the spiritual and emotional support I needed.

“Do not go gentle into that good night. Rage, rage against the dying of the light” (Thomas, 1971). When someone we love is dying, our instinct is to hold on to them with everything we have and fight hard against the sickness. In reality, this can lead to those we love only suffering more than they should. When an individual is terminal, and they sense that death is near, their desire to live decreases and they begin to let go. Loved ones may face this issue as well. Once there is an acceptance that their loved one is dying, then they are able to see that death is a welcomed end to the suffering, and they will be ready to let go as well. The hospice philosophy was designed to guide the program for the care of individuals who are dying and their family. One of these principles is to affirm life, not death. “To care for and about persons who are coping with dying because they are living and struggling with these special pressures” (Corr, Corr, & Doka, 2019). This can be applied to their loved ones as well and the struggles they face as they cope with their family member dying. Another principle is to strive to maximize present quality in living. This principle defines how hospice care is attentive to other forms of caring when a cure is not a reasonable expectation any longer. It also relates to the emphasis on minimizing discomfort for the individual, while working towards personal growth in other areas as the end of life nears. This goes back to the four dimensions of care. Another hospice principle is to offer care to the patient and family unit, whoever that “unit” may consist of. The emphasis here is on the importance of family-centered care in a supportive environment where the patient-family unit can have a sense of security. One final principle consists of offering continuing care and ongoing support to the family members who are coping with death, both before and after the loss of their loved one. This is where members of the hospice team can help counsel family members on when it is time to let go. Three things that should be considered, and that the hospice team can help the family work through, are the medical situation, talking to people they trust, and finally listening to their heart. When it comes to the medical situation, the hospice team can help explain the course of the illness and the clarity of the prognosis, to the family, who may or may not clearly understand the information they have previously been provided by other doctors or specialists. They can also help the family understand what to expect when the patient themselves actually decide that it is time to let go. For example, there may be changes in mood or behaviors, or they may choose to stop eating/drinking. The next step will be explaining to the family to talk to people that they trust regarding what is going on. This can be other family members, or someone who is not related to them, such as a family pastor. This is also a time when they should discuss what the loved ones wishes are, if they have been made known prior to. Finally, the hospice workers can counsel the family members on listening to their heart. To focus on what is the best thing to do for their loved one? In making decisions like this, they can be counseled on the importance of looking past your own fears and wishes for your loved one. In my dads’ case, he did not make his wishes known ahead of time, so it was left to me to make decisions. The doctors and social workers were very compassionate, yet professional when they talked to me about his prognosis. They talked to me about how important it was to think about what he would want, and to put aside the thoughts of what I wanted. Sometimes as loved ones, we tend to be very selfish creatures when it comes to those we love. However, when we sit down and truly listen to our heart, it will guide us to make the right decision.

Dying is a part of life. It is an end to our journey, regardless of how short or long it may have been. For those who face death due to disease, illness, or age, there are programs available to help make coping with dying and the process of dying a little easier for the individuals and their families. Hospice is one of these programs. Their multi-discipline team approach places great emphasis on the quality of life during these times, and on comfort. They care not only for the individual, but also for their loved ones. They are there to help with coping with dying and with the process of letting go by focusing on four dimensions of care and by incorporating the principles of the hospice philosophy. Anyone who has had an experience with hospice, will probably be quick to tell you about the level of care and compassion they experienced and about how much their empathic listening meant during their time of need. I for one, can attest to this. They took my hand and gently walked with me down a road I was terrified of, to help me see what was best for my dad, and helped me find the courage to let go.

References

Corr, C. A., Corr, D. M., & Doka, K. J. (2019). Death & Dying, Life & Living. Boston: Cengage.

Kilcrease, J. W. (2019). Introduction to Dying. Retrieved from Kilcrease.com: https://kilcrease.com/index.php/about-dying

Thomas, D. (1971). Do Not Go Gentle Into That Good Night. The Poems of Dylan Thomas. New Directions.

What is Hospice? (2018). Retrieved from Hospice Foundation of America: https://hospicefoundation.org/Hospice-Care/Hospice-Services