At Dying Beds

At dying beds I’ve experienced a lot of silence – which felt at times good, at times disturbing. Dying people will be almost always be in coma in their last hours (and, mostly, days). What hinders us from speaking with the dying?

  • As family members, we may be in a shock state, frozen or confused.
  • We may be insecure if they hear and understand us.
  • We may be insecure what is relevant and helpful for them.
  • We may feel insecure what the staff thinks of us if we behave unconventional.
But surely, if we find out what hinders us from speaking and acting, this can free us and widen the range of our possibilities, to the benefit of both ourselves and the patient.

Sometimes it’s extremely difficult to notice and interpret any nonverbal reactions of coma patients. In other cases we need to sharpen our senses. With no other body reactions left, often there are still reactions on our words, or on caressing, in the patients’ changing his of breath style and rhythm (unless on a breathing machine).
If we do find tiny nonverbal reactions or changes of the way of breathing, the questions are:

  • Does the patient show this behavior repeatedly (every time) when we bring up a certain topic or do something particular (or when a certain person is arriving or leaving or being mentioned)?
  • Do we rather see the reaction as one of stress or relief?

I would like to summarize a few things that I have learned from the Encounters I had with dying people.
1. Treat dying people as living people.                                                                              2. At a dying bed, get aware of what hinders you from acting and speaking free. Free yourself to get flexible.
3. Observe which tiny reactions (movements, mimics, breath) the dying person shows repeatedly on certain key words, persons, behavior. Are they reacions of stress, relief or interest? Which are the triggers?
4. Dying patients may be in coma, but they’re usually not deaf. Choose your words well. No catastrophic medical descriptions or burial talk.
5. Create rapport. Introduce yourself and tell your aim shortly. Use body contact, use your voice and breath pacing.
6. See a coma patient as someone who is already in trance. Create rapport. Interventions can start right away, without induction
7. The subconscious responds strongly to imagery. Speak in a dream language. Use metaphors, avoid abstract words.
8. Breath pacing and leading can regulate pain or breath problems (and can regulate breath down till it almost stops).
9. Breath, blood pressure and heart rate can also be regulated by metaphors (f. e. of a flying eagle, a pulsating jellyfish or a manta ray).
10. Speak about emotional content rather than about facts.
11. Express in metaphors or more directly that it is possible and good to let go – of live, of psychological problems of body problems.
12. Use metaphoric terms to speak about the good future.
13. Introduce thoughts like “You can love them from the other side”, “things will change, relations go on”.
14. Use negative terms only with a good reason. Except for pacing strong pain, don’t mention “pain” but “body sensations”. Teach this to the relatives.
15. People will rather die when they’re ready to go. What may help: Rituals, a bye-bye from family members, messages of “letting go”.

El cine a través del escaparate

Llovía. No había clase. Como cada sábado por la mañana, ella estaba detrás del mostrador de cristal donde se exponían panecillos, pasteles y otros productos de panadería y de pastelería para la venta. A través del escaparate veía como el viento barría las hojas de los arboles revoloteándolas por la calle.
Delante de la tienda una mujer luchó con su paraguas. Encima, en el escaparate, había una inscripción con letras gruesas que decía: “Panadería Müller”, en escritura invertida, desde luego, para alguien que lo leyese desde adentro. Cuando ella estaba sola y no tenía que atender a clientes, le gustaba imaginarse que este escaparate fuera una pantalla de cine y que lo que veía detrás de él fuera solo una película.
En su fantasía entonces cambiaba la escena. Los coches se volvían en carruajes, las hojas en pájaros y, por ejemplo, esta mujer con el paraguas se convertía en su madre luchando contra un dragón furioso. Especialmente esta imagen le divertía mucho. Su madre, que lo entendía todo mal, que malinterpretaba sus palabras, que sabía convertir lo bueno en malo y lo malo en bueno, probablemente también hubiera podido superar un combate contra un dragón furioso o por lo menos hubiera conseguido un empate. Hasta el próximo combate.
La mujer con el paraguas había desaparecido hace tiempo. Ahora ella se imaginaba, pues, qué le gustaría escribir en el escaparate en lugar de la palabra aburrida: “Panadería Müller”. ¿Qué tal si fuera “eres importante para mí”, “de todas formas te quiero” o “me enojo contigo porque te quiero”? O quizás también: “Te enojo …”. Sonreía un poco pensando en esto. Se figuró el efecto que tuviera esta inscripción en la gran luna del escaparate. Toda la gente que pasara por la panadería podría leerla, también su madre. Ella se figuraba entonces la inscripción: “Eres importante para mí”. ¿Podría su madre finalmente entenderla entonces a ella? Se la imaginó parada delante del escaparate, frunciendo y meneando la cabeza. Entonces se le ocurrió la idea: “Tienes que colocar tus palabras en escritura invertida.”

(Por Stefan Hammel, traducción: Bettina Betz)

Africa

This therapeutic story can be used for supporting learning in general, as well as re-learning abilities after a health problem. For example, it can be applied quite beautifully with stroke patients. Obviously, it is also indicated as a story supporting change and developement with anyone who has got a strong biographical link to Africa. Of course, instead of Africa, other continents or regions of the world can be used, in order to adapt the story to individual needs. The reason why I chose the mapping of Africa as the key focus of this story is, that on maps Africa has the shape of a head or scull and thus points to brain functions.

Maps have existed for millennia but there a big differences between modern maps and those from dating from earlier centuries. For example, three hundred years ago, if a publisher printed a map of Africa, it had big white patches on it. ‚Terra incognita’ was marked on it; unknown territory. The coasts were then largely free of such white spots, but the interior of the continent was still a single, large white patch. However, many researchers undertook trips into the heart of Africa and what they learned there, they reported to the cartographers who diligently recorded everything. Land and water routes were discovered. The turns of each river were researched and drawn. The names of the settlements were recorded and the names of the tribes written down. The white patches on the map became smaller and smaller. The parts of the country that were explored and known steadily grew. Finally, the white spots disappeared completely. The whole of Africa was mapped.

Keys

I’m using this story to support people who have suffered a stroke to recover their memories. Of course it can be used with any kind of amnesia or neurological loss of abilities, like with a person waking up after bein in coma for a long time. The story can also be used with students who are afraid of exams or with self inconfidence problems.

Was it a dream? Was it reality? I walked through the building. To my right and to my left were many doors. I turned the handles but not a door opened. The rooms were closed to me. I sat down and wept. “Why are you crying?” asked someone. I pointed to the locked doors. “Do you not know… ” he said and pointed to the pockets of my coat. “You have the keys!” I reached into my pockets and indeed pulled out two massive bunches of keys, two key rings with hundreds and hundreds of different shaped keys, large and small. How was I to know which key fit the lock of many rooms? “You have to try it,” said my encourager. “In your own time. You have all the time in the world. Try all the doors and try all the keys. Gradually you will open more and more doors. Never give up. Your freedom will grow with every open room and one day you will know the door to every key and the key to every door.”

Après la tempête

Pour cette histoire (l’une d’avant-hier) j’ai aussi la traduction Française…

La tempête a fait son œuvre. Dans la forêt il y a des arbres dans tous les sens. Ses troncs encombrent les chemins et les routes. Aucun voyageur ne peut y avancer. Mais une fois que la tempête est passée, le temps pour les ouvriers forestiers est arrivé. Ils dégagent les chemins avec leurs scies, enlèvent les barrières et libèrent toutes les routes, du bord extrême de la forêt jusqu’à son intime intérieur.

After the storm

I’m using this story with stroke patients, with those who suffer from Multiple Sclerosis and with traumatised persons, including certain situations of separation and berievement. Most of all, it can be useful to support persons who want to recover their memory and access to their abilities.

The storm has done its work. The trees lay criss-cross in the forest. Their trunks block paths and streets. No traveller can make progress here. But when the storm is over, then comes the time of the lumberjacks. With their saws they cut free the paths, lift away the barriers and clear all the streets, starting with the outermost edge of the forest all the way to its innermost core.

Picture book for war traumatised children by Susanne Stein

There’s a picture book for refugee children who suffered war trauma, written by my colleague Susanne Stein. It is available in German, English, Farsi (below right) and Arabic (above right). Next to a story which parents can read to their children in order to explain the experience and effects of trauma in a childlike way the book contains many helpful little tools how parents and helpers who are not themselves theapists can help the children who have witnessed and suffered violence. I find this book very, very useful, Therefore, I would like to share it with you. You will find the downloads below. Please don’t miss to visit the Website of Susanne Stein!

Pantomime

After a while of pausing I would like to continue with some stories…
However, I would like to change the format a little bit and take turns between different languages. So, in addition to therapeutic stories in English there will be some in French and Spanish, as well. But, first of all, let’s continue in English . Here’s one which I have personwitnessed in our local hospital.

“Good morning. My name is … ” he began his speech. “She can’t speak,” explained the nurse. “Stroke… ” The helpless gestures of the young lady patient let him know that she did not understand his words, except for a few, for which he managed to coax from her a nod or a shake of the head. How can you still communicate with such a person? With gestures he painted in the air a steep staircase for her with high steps. But alas he sighed “Too steep!” He shook his head in disappointment. Then he drew with his hands a staircase with long low steps. With his fingers, he went along the whole staircase.
The woman looked attentively and nodded. With his hands he painted a high mountain in the air. A man of two fingers wanted to climb it. But he fell again. Then he found a path with a gradual slope, a zigzag, with many turns. He went this way. The woman’s eyes began to shine. And so the pantomime took its course. “Keep your eye on the goal” and “passion” followed as the next images. The movements of a marathon runner and an upwardly clenched fist; they inspired to perseverance and a fighting spirit.
The turning hands of a clock showed that it would take time. He continued the charade with his hands together on the side of his inclined head. “Sleep” and “wake”, “sleep” and “wake”, and many many times they would have to “sleep ” and “wake” until they would be at the peak, which he kept looking upwards at with his eyes and pointing to with his outstretched forefinger. With hands and feet, with his whole body, he portrayed the picture of how her children would hook into her left elbow, and her parents the right and how they would all go together with her, all the way.
Once again he stretched out his fist to the sky. She would have to fight for all she was worth. Three days later, he again visited the woman. “You know,” said the lady in the bed next to her, “she has been here for four weeks and nothing really happened but in the last three days she has made amazing progress”. He spoke with the patient again and this time she understood every sentence. Then he took his leave. “Goodbye” she said. It was her first recovered word.

Everything Else

In a land in our time there lived a man, who read a book and found lots of wonderful stories therein. There were true and invented stories, experienced and pensive, enjoyable and painful stories. There were stories which contained stories, and such which were actually not stories. For every story he read, there occurred to him nearly five which he had either experienced or thought up himself. So the thought came to him, that a lot in the world was a story which could be healing for himself and others; he only needed to absorb the healing stories well and to forget the terrible ones immediately. Then he would learn which story he had used when and for what. So he organised his own stories which he knew, and which had become a help to himself and others, or could become so. Sometimes he noted it down when a new story came to his ears and sometimes when a helpful story occurred to him, he memorised it.

Then he saw before him in a picture the storystories of this life arranged in long shelves, as in a large pharmacy. And behind the counter there sat a man who had learnt to listen to himself and others. He was a master of his subjectspecialty. His talent was that he understood how to tell the right thing at the right time to himself and to those who visited him.