I keep remembering the words of Cicely Saunders spoken to her young patient as he lay dying. “You matter because you are”. This became the mantra of Palliative Care and began a world movement and a new paradigm in caring for the dying. Death is regarded as a sacred rite of passage. To care for a dying patient became a privilege and honor.

In this time of extreme crisis with concerns for our own safety, I wonder, are there ways that we can still let our patients and families experience the sacredness of these transitions? Can we as clinicians create a moment of stillness and presence for our patients under the cloak of masks and gowns? How can families confined in a distant room be guided in ritual and ceremony at the moment of their loved one’s death? How can nurses, physicians, respiratory therapists pause for a moment to recognize and preserve the dignity of every death?

These ideas are simple gestures but may provide meaning and solace to the patient, family and clinicians.

As death approaches or just after the last breath and death has been pronounced, the bedside clinician can whisper or say to the patient, (name) “ you are loved, you are safe, and your family will be cared for.” After saying this three times, lightly touch the point in the middle of the forehead and if appropriate, silently offer a blessing/prayer as the soul departs. In some distant part of consciousness, the patient hears the truth and love of this simple message.

Soon after the last breath, in many cultures and religions caring for the body is seen as caring for the departing soul. Anointing the body through bathing and lightly touching the point between the eyebrows is a ritual in many Judeo-Christian religions. If there are particular rituals that are important to the family and can be offered by the bedside clinician it may help the family find some peace in being isolated from their dying loved one. Although it may be difficult to realize, it is an honor and privilege to witness someone’s last breath on their journey ‘home’.

Spiritual care providers in acute care settings are essential at this time of crisis and uncertainty. Often it is the spiritual caregiver, hospital chaplain, or nurse/ social worker who prepares the family for the impending death or announcing that death has occurred. For the family, on hearing that their loved one has died. time comes to an abrupt halt. In offering this news it may help if the family has pictures or any items of significance to the patient. These items can be placed on a table for all present to view. Possibly inquire about special prayers, rituals ,or music that has significance for the patient. In indigenous cultures around the world, pictures and personal items are thought to hold the spirit of the person. The words, sounds and messages at this moment, whether abrupt or with care and concern, become etched forever in the memories of all that are present.

Lastly, how do you care for yourselves? Often the moral and physical distress takes its toll physically as well as mentally. After an exhausting 12 hours, the only thought is to shed the protective gear and go home. Now more than ever continue with whatever self-care routine you enjoyed before the pandemic, whether. a walk or a short run in the park. In the work place, find a way to remember by saying names of those that died in the past 24 hours or sharing a memory with a colleague.

These are just a few suggestions that can offer some sense of dignity to the dying and their families.

I invite you all to contribute your ideas or thoughts on our Palliative Care Blog. Or write me Nancy.English@cuanschutz.edu

Image by MSPC student, Nezha Hamid