Reflections
The Swan Song: Words at the end of life.
In the final moments of life, big things become small and small things become most important.
The things that often dominate our lives: money, careers, status, and the accumulation of possessions, can suddenly seem irrelevant. Meanwhile, things we may have overlooked become invaluable: time, relationships, conversations, honesty, authenticity and love.
End of life offers unique clarity. When death stares back at you in the mirror, priorities shift. Often, as part of the dying process, there are words that need to be spoken, heard and deeply felt. These conversations can promote healing for both the dying and the living.
As a Registered Nurse working in ICU, and adult oncology, I witnessed many bedside conversations.
One case stands out for me.
My patient was an 18-year-old-male, who had been tragically struck by a bus. His parents sat at the bedside, devastated as they struggled to comprehend the words they had just heard; their son was brain dead. They listened to the rhythmic whoosh noise of the ventilator pushing oxygen into his lungs, the steady beeping of the monitors, and the quiet drip of multiple intravenous medications. Activity continued around them in the intensive care unit, yet everything felt silent as they focused solely on their beloved son.
His hands were warm. His chest continued to rise and fall. The monitor displayed his heartbeat, pulse, and oxygen levels. The desperate parents pleaded for a miracle. Multiple tests had been completed, and there was no response or brain activity. Their precious son was deemed brain dead. As these parents wrestled with the reality of what they had been told, the floodgates of grief opened.
With time, compassionate support and many difficult conversations, they made the courageous decision to donate their son’s organs.
End of life conversations often revolve around themes of love, forgiveness, gratitude and transition. Dr. Ira Byock, author of the book Dying Well, identifies four statements that are especially meaningful at the end of life:
“I forgive you.”
“Please forgive me.”
“Thank you.”
“I love you.”
The first two statements can help clear the air of regrets, guilt, resentment and unfinished business. “Thank you” expresses gratitude and acknowledges the value of a life shared. “I love you” may be the most important statement of all.
Declarations such as these can repair relationships, strengthen bonds and positively influence the healing process for those left behind. For this family, there was comfort in knowing their son’s death would help save other lives. Along with words of love and gratitude, they were able to tell him about the precious gift he was giving to others through organ donation.
The realization that time is running out can feel like an existential slap in the face. Suddenly, this is the last chance. The finality of death hits hard and becomes impossible to ignore.
Many people find themselves asking: “Why did I wait so long to say what I needed to say?” “How long will I wait to hear what I need to hear?” These questions arise for both the dying person and those gathered at the bedside. If the dying person is unconscious, you can still use your voice and your touch.
When physical healing is no longer possible, relational healing may still occur. If we are given the gift of being present at the bedside during someone’s final days, it is an opportunity not to be taken for granted.
Hearing is believed to be the last sense to fade. Perhaps they can hear you, even though they cannot respond. Perhaps speaking your truth offers peace, or simply the comfort of knowing that what needed to be said was finally spoken.
In many ways, bedside conversations are not only for the dying, they are also for the living. They provide an opportunity to release guilt, express love, seek forgiveness and say goodbye. Know that you tried even if no response comes.
As time runs out, people often find the courage to say what has remained unspoken for years. We may need to release our grief, our guilt, our anger or our love. We may finally speak truths we have carried for far too long.
Not every relationship can be repaired. Some family histories are complex and deeply painful. Depending on the relationship, sometimes healing may sound like; “I forgive you, and I am done.” That can be enough.
Comforting statements you can offer the dying:
“We will be ok. “
“We will take care of Mom/Dad.”
“You are not going to feel pain.”
“It’s ok to go.”
“You will not be alone.”
“Until we meet again.”
These words can offer peace, comfort and reassurance.
One of the most commonly spoken words from the dying is “Mom.” It relates to that consoling feeling of home, being comforted by the one who first held them. Final words are typically brief and simple due to a lack of energy, low oxygen levels, or a dry mouth. They are often heard in the liminal space, between two worlds.
Some examples of historically famous last words:
Steve Jobs: “Oh wow, Oh wow, Oh wow.”
Emily Dickinson: “I must go in, the fog is rising.”
Thomas Edison: “It is very beautiful over there.”
Frequently, however, there are no words at all. End of life intermittent consciousness may include audible moans, gurgling, irregular breath sounds or silence – a lot of silence. Ritual last words can be comforting, however, your presence is what really matters.
What is it about end of life that compels us to finally speak the words we have held back? Is it forgiveness for the dying person or is it for us? Do we need to release our own guilt for them or for ourselves? Are we looking for closure? Does closure even exist or is it something we endlessly strive toward?
Precious time at the end of life is just that, precious. It may be the final opportunity to express love, gratitude, regret, forgiveness or appreciation. Words carry tremendous power. They shape our relationships and affect us deeply. End of life can offer precious time to make amends, express love and speak from the heart, if we allow ourselves to take that step.
Let’s be gentle with each other now, here, in the present. We don’t need to carry these unheard words for years. Speak them now. Offer the apology. Express gratitude. Share the love. Life is short, and we were never meant to carry the weight of the world alone. Allow others the gift of hearing your truth while they are still here. Allow them a peaceful death when their time comes. Allow yourself the opportunity to begin healing long before the bedside.
Move forward. Live fully. Love deeply.
Let’s talk.
Jayne Dill RN, End of Life Doula, Grief Educator
londondeathdoula.ca