 | Tom Welk
DMin is Director of Pastoral Care & Professional Education at Harry Hynes Memorial Hospice. He also teaches at the University of Kansas School of Medicine-Wichita. He has certification with the American Association of Pastoral Counselors in Clinical Pastoral Education. His memberships include Park Ridge Center for Study of Health, Faith, and Ethics, and St. Louis University Center for Health Care Ethics, Charter Board Member Kansas Health Ethics, Inc., and Ethics Committee Member for National Hospice Organization. He has received the President's Award of Excellence for Public and Community Awareness, for the "Dying Well" project from The National Hospice Organization. Tom's group presentations include: Association of Kansas Hospices, Midwest Congress on Aging, and Kansas Health Ethics Conference. Tom Welk can be contacted by fax at (316) 265-6066, by e-mail at: twelk@hynesmemorial.org, or at his office at (316)219-1791. |
Hospice
2004-12-01 09:07:00
Are the unconscious aware?
: A reader writes, "I'm not sure my dad knows I'm there when I visit and visiting is very difficult for me emotionally. Is it doing him any good?"
ANSWER: It is stating the obvious to say that dying means the body is shutting down, with death the total separation of life from the physical body. Generally, this is a gradual process with fluctuations in the physical energy level, and variations in levels of awareness.It has been my experience that individuals who are dying pick and choose as to how they will use their declining energy. They want to take care of issues to put closure on their journey of life in this world. These frequently center on taking care of unresolved conflicts; forgiving and being forgiven; on saying "I love you" to important people in the circle of their lives; on acknowledging how much they will miss loved ones.All of these "tasks" center on relationships and making connections with loved ones. They want to be present to people who are important in their lives. Presence is most often accomplished through physical means: a word, a touch, a gesture of some kind.But there comes a point when the dying person no longer has the physical energy to communicate in these ways. At the same time, it is my firm conviction that there still is an ability to be aware of the presence of others. Hearing is the last sense to be lost. People who have experienced "near death" incidents can recall vividly every word that was spoken in their presence.The reader wonders, "I'm not sure my dad knows when I'm there." My observations lead me to believe he knows. He can hear what is being said around him. He is very much aware of the presence others. But his physical energy is too low for him to be able to respond. His body is shutting down."Is my visiting doing my dad any good?" is another question the reader wonders about. This question can be answered by asking another one, "Do you think it did any good to visit your dad when he was still able to physically respond?" If the answer to that question is yes, then it is safe to say that visiting when a conversation is no longer possible undoubtedly is doing him good. As I stated above, being present to one another is what is important. How that sense of presence is conveyed from one to another is not the most important issue. Just being there can never be underestimated.A third element of the reader's question is contained in the acknowledgment that "visiting is very difficult for me emotionally." This is easily understandable. No one says goodbye to a loved one without tears and pain; these are indications that this person was important; s/he will be missed. Acknowledging this to a dying loved one is not out of place. It will be seen as a tribute.However, if the difficulty is due to the inability to have a "conversation," then I would ask you to consider the observations I made above. Try to understand that this is due to the lack of physical energy, and not the lack of will on the part of the loved one.Some practical advice in this regard: don't ask your loved ones questions, as we would in the course of a normal conversation. My guess is that this could lead to some internal frustration for the dying person. Making simple statements and presuming s/he is able to hear what is being said is a better way to proceed.And finally, I cannot emphasize enough the point of simply "being there." We often use the cliché "Don't just stand there. Do something!" When it comes to attending to a dying loved one we need to turn around this cliché to state, "Don't just do something. Be there!"The reader should not underestimate the importance of "just being there" with her/his dying father. It is doing him a tremendous amount of good. This presence will speak eloquently of the love shared.
