Near end of life

We do everything we possibly can that is evidence based, but we face challenges every day that exceed the evidence based tools we have.


As we talk openly about the challenges we face, and more importantly that our patients, and their loved ones face, we seek to understand what has happened in circumstances outside our ordinary experiences.



More and more physicians and nurses come to me and offer stories of their own experiences, things they are not quite sure that they believe, stories that they yet are fearful of sharing.



Sarah is a nurse caring for patients near the end of life. Last week one of her patients made transition. The next day she was walking in the hospital and thought that she saw the patient, and worse yet, that the patient was not wearing his oxygen.



How could this be? And as she hurried over to the patient, to do something, to replace the oxygen, she realized, first, that this was a different person, and second that the patient she was caring for had passed away the day before.



What had happened? She had been truly touched by this patient. For her, the spirit of the patient was still present. She returned to her unit, and found out that the patient was still in the morgue, no one had notified his family, the phone number on the medical record was incorrect. And yet another nurse remembered a niece having provided a different phone number. Sarah called the niece. The family was able to pick up the patient's remains, and, perhaps more importantly, Sarah and another nurse recalled a conversation with the patient, about wishes and instructions. And the family was moved by this, and everyone felt a sense of peace and closure.


"What happened," Sarah asked? Was this Reiki energy? And more importantly, how do we account for this? And perhaps more importantly, is it OK to talk about such experiences, or do we need to hold them in, and deny them. How often do such things happen? And does it reduce stress and burn out on nurses and doctors to talk about their own feelings about what happens near death?

A month ago, a nurse reported caring for a patient who arrived in tremendous pain. He had no family. He had suffered through a long hospitalization, and surgery that, however well intentioned had left him in a grotesque shape, and in a great deal of pain. The care team used medication, but as well, the staff sat with the patient, sometimes held his hand, sometimes just in presence, sometimes, with the music therapist, in song, sometimes with the pastor in prayer.

The grimaces left his face, his breathing became even and unlabored, and he lived peacefully for several days, and finally made transition. He did not die in pain and he did not die alone.



The day after he had died one of the nurses was walking down the hall. She heard a voice, "psst." But no one was there. "Psst, i'm over here." She walked back to the room where this patient had been living, and felt his presence, "its OK, you took away my pain, its OK now." She felt his presence, and then he was gone.

What has happened?

Is this OK to talk about?

Are these nurses "crazy" as they sometimes fear?


Is this Reiki?

When we provide Reiki near transition for treatment, does it rise to the level of attunement?

Does it hurt and cause stress to hold things in? Are we better off for talking about what we experience? Are we better off for sharing?

What do you think?

For those doctors and nurses caring for patients living the last days of their lives, thank you. Thank you for giving compassion, for caring when you cannot cure. For those who have shared experiences, talked about the perceptions and stresses, thank you. I find these days that more doctors and nurses find it "OK" to talk about their experiences.

I hope that sharing makes each day a little easier, reduces the stress, and allows you to continue this important work. Practicing health care with the best evidence based practices available to us, and at the same time, being open to human spirituality, seems a path worth pursuing.