Traumatic Deaths
Check in the back for the blue towels . . .
Hospice agency web pages and pamphlets don’t highlight traumatic or difficult deaths.
While these unfortunate deaths do occur, they are infrequent. (But they won’t feel infrequent if it’s your loved one who experiences it.)
After the death, how do grievers start healing from those memories? The images of the final days (or more) include triggers for all the senses. Often, it’s not only a “mental picture” a griever recalls. There are smells, tastes, feels, and sounds that abruptly surface. And with certain deaths, it is not being there that fuels the disruptive recollections. Absence can be as tormenting as presence.
My mother died in 2013.
Like many others, I was reviewing pictures of Mom to post comments about her birthday on social media. Maybe an old black-and-white snapshot? Maybe one with just Mom and me? Maybe a collage of photos depicting various decades? While searching, I double-clicked on a tiny image in my computer’s photo file. Mom’s final hospital bed filled my screen.
It wasn’t a terrible picture.
Still, there it was.
Mom. Nearing death.
She was also with one of my sisters. They are holding hands. It’s blurry. I snapped the photo too quickly. Any light in the room came from the cheap fluorescent tubes on the ceiling.
After selecting a nice shot for the social media post, the hospital image lingered. It swept me back to a specific place with particular, peculiar memories. On one late evening, at Mom’s bedside, a machine a little bigger than a shopping cart coasted by the open door. A man was perched on a seat in the rear. Like a pint-sized Zamboni, it was cleaning the wide institutional hallways. How odd. Why do I remember that? I also thought of my sister, her hand intertwined in Mom’s. She is now eleven years older; Mom is not.
Soon, I returned to different thoughts and tasks. The picture, and its impact, faded.
However, for some, the pictures—whether color photos our eyes observe or troubling images that loop through our souls—don’t quickly fade. On many days, in so many ways, we relive the . . .
Lingering death
Sudden death
Suicide
Bloody, messy death
Death of a baby/child/teen
Covid-19-related death
Death when we weren’t there
Non-stop moans and screams
Strange silences between breaths
We all want a peaceful death, for the one dying, for the family and friends. We want what we frequently see in television or movies. Clergy arrive at the right moment with the right blessing. The dying loved one has a good hair day even at the end. The family and friends have had a chance to say farewell. Words of forgiveness or encouragement are shared. Tender kisses are exchanged. Eyes close. Breath ends. Outside, birds sing, butterflies swoop by, or rainbows gild the sky.
Really, the death doesn’t have to perfect. But, please, close enough to perfection!
What if it isn’t?
In the time of a pandemic
I recall those across the world, when the Covid-19 restrictions meant they often could not be with their loved one. Or, if visits were allowed, it included precautions and being hustled into a room and told you have five minutes. Some visits occurred with a window between you and your loved one. How can a thin sheet of glass seem like it’s ten feet thick? How many deaths were “witnessed” on a tablet’s screen?
Funerals were delayed.
Graveside services felt like driving through a fast food joint to grab a bite.
Families planned gatherings that were postponed. Again. And then again.
A memorial service unfolded on Zoom. At some point, the “leave the meeting” button was pressed and the faces in the digital boxes disappeared as if never there. Sure, you’re glad you did something. But was it enough?
The era of a virus enddc. But will our fractured, detached, incomplete memories end?
Sometimes, death is cruel
When starting out as a hospice chaplain, I was asked to shadow several colleagues. I visited patients with another chaplain and observed as she gave support. I had time with social workers and home health aides. One experience included a morning with a veteran hospice nurse.
We drove to the first patient’s house.
With the nurse steering the car and both of us chatting away, she suddenly said, “Check in the back for the blue towels.”
I glanced over my shoulder. Yes indeed, blue towels were stacked neatly on the seat.
“Why blue?” I asked.
“In case of a bleed out.”
She continued explaining. The patient we were to visit had an illness that might, near or at the time of death, cause excessive bleeding. The nurse wanted to make sure the family had supplies to handle it. She added: “The blue color of the towels makes the blood less dramatic for the family.”
This family might experience a “good” death. They might not. The blue towels were a small gesture, and could reduce some of the visual unsettledness of a “bleed out.”
Traumatic deaths come in as many ways as there are patients. Dementia causes a gentle, kind grandfather to curse and bellow at the people that love him most. A patient, with pain exploding like a wildfire, constantly berates the caregivers. Agitated patients toss and turn and “rest” seems like a four-letter bad joke. A patient on hospice care for months seems well-managed. But in the final days, everything becomes chaotic. The hospice nurse you came to trust, and still trust, can’t seem to stop the anguish. Isn’t the nurse supposed to be the expert?
What our five senses experience in the final traumatic moments (or days or more) may or may not be overwhelming as they happen, but they have the potential to leave invisible, lasting scars. Those in the military rightly worry about Post Traumatic Stress Disorder (PTSD). Caregivers for dying loved ones are not immune to PTSD.
Or if, because a pandemic’s restrictions limit contact with a loved one, that may also have a long-term negative impact.
I saw that picture of my mother and it jarred me. Momentarily. Soon, I was focused on different things. However, “soon” is not the case for everyone, whether the trigger is a specific picture or recurring images that disturb heart, mind, and soul.
My simple—but too easily ignored—suggestion is to talk with someone. Your physician. A counselor. A trusted clergy. Understanding and addressing the emotional, spiritual, and physical anguish after a traumatic death cannot be done alone. (Should I repeat the prior sentence?)
Though not a therapist, I have had the pleasure of working with experienced, caring professionals in the grief support field. A few years ago, several of my then colleagues were trained to use Eye Movement Desensitization and Reprocessing (EMDR). They spoke highly of this therapeutic tool for those grieving difficult deaths. I mention this not because EMDR is the guaranteed “solution,” but because it represents a possible path to explore for a griever. There are other resources, none of which will be found if you decide you can deal with grief on your own or pretend the painful memories will politely vanish by, say, tomorrow or the next day.
They. Won’t. Vanish.
I wish all deaths in hospice care were peaceful. I wish everyone longing to cradle their loved one’s hand during the final breaths had that opportunity.
If only our wishes would come true.
Sometimes, they don’t.
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My book, A Companion for the Hospice Journey is available at Amazon.
As much as I was told about "the death rattle" I assumed it was like the dysphagia symptoms he had had for years...so I wasn't prepared for it. What I wasn't told about was the "guppy gasping for air" that went along with the rattle. He had an oxygen tube on his nose but it kept slipping out because of all the mucous, nothing would stop it. I wont go into any details but it lasted about 3 hours and was very upsetting. I was alone with him, the hospice nurse had left, as did the family members I sent away since it was so late at night. I discussed this with the nurse on the phone but decided not to give him the morphine. He has had horrible hallucinations with Dilaudid (sp) in the past and subsequently has been on strong medication for the advanced Parkinson's related hallucinations for the past 10 years. I had given him that med which usually makes him go to sleep, I didn't want to risk him having bad hallucinations at the point of death. He died that night, 4 months ago today. Ive talked to several chaplains and nurses about it.. but I'm still reliving it and questioning the decisions I made that night. So thank you for this post , sincerely K.