Reflections on “Final Gifts”: Permission to Die, Birth and Death, and the Value of Reconciliation

I found Final Gifts by Maggie Callanan and Patricia Kelley to be a powerful insight into the lives of three different groups of people: nurses for the dying, the family and friends of the dying and the dying themselves. It looks at “Nearing Death Awareness,” or the increasing awareness one has when one is dying over a long period of time, the actual experience of it and what they need in order to die peacefully. Three concepts I felt really stood out to me and that I feel I can apply immediately in the future were the idea that the dying often need permission to die, the relationship between birth and death and the value of reconciliation and the role we can play in it.

It was helpful for me to acknowledge the truth that dying people often need permission to die; receiving it can provide a great amount of relief and the withholding of it can make the process of death longer and more challenging. This is likely due to what they are trying to communicate and why: “The dying often use the metaphor of travel to alert those around them that it is time for them to die. They also have a deep concern about the welfare of those they love, asking themselves, ‘Do they understand? Are they going to be alright?’[1] In the example of Ellen, her family struggled at first to understand that she was trying to communicate that she was dying to them. This increased the level of stress and anxiety for both Ellen and her family.  Once they realized that she was likely referring to heaven, they went in and comforted and affirmed her. “Ellen’s family provided what she needed by letting her know they understood the messages she was so desperately trying to give them-‘I am dying, it is time for my journey from this life, I need to know you understand and are ready; I need your permission to go.’”[2] While I have never witnessed this, I have heard stories from people about someone they love “constantly agitated towards the end.” I’ve also encountered people in homes who didn’t seem to make any sense and they were generally dismissed. This idea encourages me to approach people not only with a heart of compassion but with a belief that there is, perhaps, an understanding that can be reached.

Another idea I found helpful was the analogy between birth and death. As one nurse described, “I also feel strongly that, like birthing, dying can be an opportunity for the whole family to share positive experiences, rather than only sadness, pain and loss. That is the challenge of the work…”[3] In fact, both birth and death used to happen in the home until industrialization and the twentieth century hit; then birth became a procedure and death a failure at successful treatment.  Recently there has been some headway made in both these areas, and both birth and death are now often possible in the comfort of one’s home rather than in the often isolating and unfamiliar hospital. Consider the difference that this has made for births: “Family members present at delivery share a special bond with mother and child-a closeness born of sharing that powerful moment. The deeper their involvement and understanding, the likelier they are to come away with a sense of learning and growth.”[4] This same thing could be said for those who experience death alongside loved ones. Their deeper involvement leaves them with a sense that there were fully participatory in the end and the person dying is less lonely and fearful because they are surrounded by those who care for them. When I consider the growth and community that comes from birth I have to believe that the same is true for death and I see the value of community in times where people are facing a terminal illness.

I also learned that many times the most important thing for a person as they are nearing death is reconciliation.  “As death nears, people often realize some things feel unfinished or incomplete-perhaps issues that once seemed insignificant or that happened long ago. Now the dying person realizes their importance and wants to settle them.”[5] If this is request is understood people will often do what they can to assist the person but there are also times when the request is unclear, leaving the person upset or appearing in pain when they aren’t physically pained; rather they are suffering psychologically or emotionally. They desire peace, and to die peacefully they need either healing or reconciliation to occur in the relationship (often in the form of an apology or expression of gratitude). “Most dying people begin by listing their accomplishments, but they also will consider their disappointments-tasks not completed, opportunities missed, relationships broken or left to wither. As caregivers or friends, if we can help dying people conduct such reviews and heal damaged relationships, we can help them find peace.”[6] I saw this with my Father’s mother as she was nearing her own end. It was clear she wanted reconciliation with my mother and I tried to provide the best reassurances I could. That seemed to be a great comfort to her in those moments, as she was very fearful of death.

[1]Callanan, Maggie & Kelley, Patricia. (2012) Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. United States of America: Simon & Schuster Paperbacks. Pg. 74

[2] Callanan & Kelley. Pg. 75

[3] Callanan & Kelley. Pg. 130

[4] Callanan & Kelley, Pg. 30

[5] Callanan & Kelley, Pg. 137

[6] Callanan & Kelley, Pg. 153

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