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”.

The Cloak Room

Noticing that the man I mentioned yesterday died so soon after my visit I got curious about the effectivity of the cloak room metaphor.

I remember I was called to the bed of a dying woman. When I arrived she was breathing about once per minute. I didn’t know that a person could breathe so little and still be alive. Her daughter and her son in law were there. I asked if it were appropriate to speak a prayer, to which they said “Yes”. After telling the dying woman that her daughter and son in law were there, who I was and what I was going to do I put my hand on her arm and spoke a prayer. Then I said to her: “I would like to tell you something, Mrs. S. I imagine there’s a door. When it will be the right time for you, you can go through that door. Next to the door there’s a cloak room. There’s someone who can have an eye on your things so they’re safe. It’s a special wardrobe. You can had in anything that’s a burden to you.
If you’re afraid – take it off. You don’t need any fear over there.
If you’re sad – hand it in. For what? You don’t have any use for that now.
If you bear a grudge or haven’t forgiven someone – hang it on the big wardrobe.
If you feel obliged to anything – take it off.
If you think you need to stay – there’s nothing you need to! If you want, give it to the one who’s standing there for guarding it.
If you think there’s still something left to do or that there’s anything missing – hand it in to the one who will guard it for you.
If there’s anything unpleasant in your body – give it to him as well.
If there’s any problem with breathing – give it to him as well.
If there’s anything else you would like to give to him – hand in anything that you don’t need any more.
Give him anything that has become a burden for you. Take it off. You don’t need it any more. And when you notice that it’s time for you, go through the door.” I finished with a blessing.
During the prayer the breath frequency of the woman had gon up to about six breaths per minutes, and thus it stayed for a while. Her daughter and son-in-law were observing her breath silently. The silence felt somewhat heavy for me and I had the imagination it could be the same for the dying woman. So I asked: “Can you tell me what happened so your mother got in this state?” The daughter said a few sentences. Her mother’s breath got very slow again. After five breaths there was a very tiny one. Then everything was still. (Stefan Hammel, Loslassen und leben. Impress, Mainz 2016)
I’ve used this metaphor a number of times now. Often the effect seemed to be very strong. The structure is thus: There’s door and a cloak room and an attendant next to it. You say: Whatever burdens you concerning the past: Hand it in. This can be specified as a bad conscience or anger against someone else or sadness about something that happened. Whatever burdens you concerning the future: Hand it in. This could be specified as worries about the relatives or about what comes after death. Whatever burdens you concerning the present, hand it in. This could for example be specified as a discomfort of the body (pain) or breathing problems.

You Can Love Me from the Other Side

Having learnt that dying people may well notice when their relatives decide to let go of them and, if you will, allow them to go, I more and more integrated the theme of „letting go“ in my work with dying people.

I remember being at the dying bed of a man. His wife was next to him. They knew each other only since two years and had been very happy with each other. He had been inspired by her Christian faith and had adapted more and more of it for himself. I had met him in a clear state some days ago. Now he was in coma. I told him about about a coat rack for his troubles… that he could imagine the cloak room of God where he could lay down anything that would burden him. He could take off any fear or grieve and it would be taken care of. After that his wife said that he could let go and that she could let go and that he could express his love to her also when he is on the other side and that he could care for her from over there. A quarter of an hour later he died without struggle.
I kept her intervention in mind which is summarized: “You can love me and care for me from the other side”. Sometimes I say to people: “What is going to come is just the invisible second part of your live together.” The difference which this makes both for the ones who leave and for those who stay is remarkable.

Letting Go of Life

From my experience as a chaplain I see a lot of evidence that the ears of the dying are open till the last seconds. They may not be conscious. Maybe they’re like dreaming. But certainly they hear us and it makes a lot of difference what we say to them.
I remember being at the dying bed of a man. All the members of his family were assembled: His wife, his children and children in law, his brothers and sisters and grandchildren. Some of them were crying strongly. The man was breathing in short, quick, strong inhalations with long pauses between each breath and the next. I was wondering what he could understand of what was going on. He looked as if he were sleeping. Probably he was under a high dose of Morphine. I couldn’t detect any reaction in his face. When I prayed for him at the side of the dying bed I included a prayer that God may give both him and his family the ability of letting go while being aware of all the good that would rest with them. After the prayer there was a little silence. Then his daughter said: “Letting go is so hard. But I have heard that only when you let go of what you love it will really belong to you.” Then she looked over to her father and said: “He’s not breathing any more.” (Stefan Hammel, Loslassen und leben. Impress, Mainz 2016)

Luís

Yo todavía era niño. Pero también si hubiera sido mayor, no habría podido decir como el carpa se hubiera explicado a si mismo su curioso viaje. Es que algunos amigos míos se habían permitido una jugarreta con él. De noche, clandestinamente lo habían sacado de su estanque con una red. Lo habían llevado en un cubo a través de bosques y campos por muchos kilómetros. La piscina en el jardín de mis padres debería ser su nuevo hogar. Tengo que admitir: No fue poco nuestro asombro cuando lo vimos nadando sus rondas en el agua. Me parece que fue en septiembre. Ya no se echaba cloro al agua, la temporada de nadar casi se había acabado. Entonces pez y ser humano ya no se hacían tanta competencia el uno al otro, y así Luís, como lo llamamos, podía quedarse allí por el momento. Vino el invierno y con él una espesa capa de hielo.
En la primavera, el agua fue cambiada. Como se puso en manifiesto , Luís había superado bien el invierno. El consejo familiar acordó devolverlo a su hogar. Otra vez Luís fue despachado en un cubo. Lo más grande que pudimos encontrar era un cubo ya inservible de pintura. Siguiendo caminos de bosque y de campo, nos fuimos para devolverlo a sus amigos y familiares. En el cubo, Luís dio sus vueltas, en círculos bastante pequeños, porque había crecido durante el invierno, y un viejo cubo de pintura no es una casa señorial para un carpa. Encima de eso, la mitad del agua se nos derramó a lo largo del camino. Pero finalmente llegamos. Con un empuje Luís acabó en su estanque para reencontrar sus viejos conocidos. Lo que hizo después fue muy sorprendente: Luís dio sus vueltas allí, pero lo hizo como que si no se encontrara en un estanque sino en un pequeño cubo, como antes. Trazó seis o siete círculos de un diámetro inferior a medio metro. Después los círculos se convirtieron en una espiral, estrecha al inicio y ampliándose más y más. Finalmente Luís comprendió donde se encontraba. En una larga línea se disparó fuera de su órbita de cubo.

(Por Stefan Hammel, traducción: Bettina Betz)

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)

Snail and Vole

A story by Katharina Lamprecht

A vole watched a snail, which dipsy-doodled along a path and asked her: “Why do you crawl so arduously back and forth? Doing that it takes you much longer to get forward”. The snail sighed. “That’s true, but I always look on both sides of the path for something to eat. When I´m on the left side I keep thinking, that there might be better food on the right. When I´m on the right side I think the same and therefore go back to the left. I´m always afraid that I will overlook some yummy greens”. The vole understood perfectly. “I´ll help you. I´m a big taller than you are and walk in the middle of the path, that´s a good lookout. You can stay on the right side and in case I see something worth coming over to the left, I´ll let you know”. And in this way they went on. The vole saw many lush and juicy herbs on the left side, but it didn’t say a word. Because now, giving all her attention to just one side of the path, the snail found enough treats. After a while, as the snail discovered that she found enough to eat, she thanked the vole for the help and went on by herself. Just following her path.

El vuelo del águila

No sé si ya alguna vez hayas visto un águila. Claro, en el parque zoológico, pero en eso no estaba pensando. Si uno ve un águila en el zoológico, esa parece sin ganas, cansada y medio dormida. ¿Pues qué debería hacer? Un águila fue creada para volar, y eso no lo puede hacer en una jaula, en todo caso no verdaderamente. Lo que a mí me impresiona de las águilas es su fuerza y como la manejan. Se podría pensar que un ave tan grande también aleteara fuertemente cuando vuela. Pero eso no le hace falta a un águila. Traza círculos en el cielo, y aunque solo pocas veces mueve sus alas, puede subir hasta que la perdemos de la vista. ¿Cómo es que el águila sabe que es capaz de volar? Si un semejante animal pudiera hablar – creo que no empezaría a cuestionar la existencia del aire antes de ponerse a volar. Las águilas no necesitan pruebas. A ellas les basta de ser sostenidas. El resultado les sirve de prueba.

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.

Margarita y Lucía

En la rendija de un muro vivían dos lagartijas, Margarita y Lucía. Lucía estaba todo el día echada en el muro tomando sol. Margarita pasaba la mayoría del tiempo buscando insectos para sí misma y para sus hijos. Cuando veía a Lucía echada en el muro, se enfadaba.
“¡Tú cómo gastas el tiempo! Si fueras lagartija decente, por fin te preocuparías del bienestar de tus hijos. ¿Qué es lo que haces todo el día allí arriba?” Lucía pestañó y dijo: “Recupero energía. De esta manera sí que hago algo para mis hijos.”
“Lo veo diferente”, gruñó Margarita. “Y un día te llevará el águila ratonera o el halcón.”
“Esperemos a ver qué pasa”, opinó Lucía y se desperezó en el sol. Margarita prefiría buscar presa en la sombra de los arbustos bajos. Pasaba mucho tiempo cazando hormigas. A menudo parecía cansada. Su vida estaba cada día más amenazada: Ya no tenía nada que contraponer a la rapidez de los gatos y a la de las comadrejas.
Los hijos de Lucía se volvieron fuertes y despabilados, todo como ella misma. Pronto empezaron cogiendo las arañas más gordas, los cárabos más rápidos y aun grandes libélulas. Pero lo que les gustaba lo más era echarse en el muro al lado de su madre y estirarse a la luz del sol.