That which I greatly feared..

One of the challenges of companioning the dying is in the palliative management of ‘difficult symptoms’- such as respiratory congestion. I have never been great with lung secretions at the best of times. (My son does not ‘do’ blood very well- whereas for me, mucous and other mucoid-like fluids together with their accompanying gurgles, wheezes and other grossities combine to remove all appetite for food.) Some people have a great fear of ‘the death rattle’. They are convinced that they will die gasping for air..drowning in their own fluids. I recently had a patient who rapidly developed a fulminant congestion in the last few hours of her life. Her family was terrified. They insisted that “she was afraid that this would happen to her”. The patient herself was deeply sedated and unresponsive, and did not appear at all distressed by her respiratory state. However, her children were already fast-forwarding themselves onto their own deathbeds, anticipating an end as gruesome in their minds as the one playing out before them. I too found myself thinking later “please God- don’t let that happen to me”, and wondered if I should write an advance directive requesting atropine. I prayed that I would be able to just quietly ‘bleed out’ at the very end. None of us knows the manner in which we will die – unless one is planning one’s own demise [not an advisable option]. All we can hope for is that His grace will be made available to us- grace to die well and meet the world to come with awe and wonder. We are not given grace to obsess about that day. I find myself praying for the family- for that gentle amnesia of grief that will thaw the fast-frozen images of death in the same way that the joy of birth swallows up the pain of labour and delivery. God, who does not allow one sparrow to fall to the ground alone and isolated, is the Beloved Companion on the final journey. May we say with confidence that- in death as in life, “I will fear no evil for THOU art with me”.

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