boy playing flute
Music Is Hope

The Final Moment Is Not the Important Moment

C. Gourgey Ph.D.

When my father was 82 he had surgery for cancer. The operation was a success. But being as old as he was, he could not sustain the consequences of the surgery, which gradually worsened until eventually he died.

I visited him in the hospital every day, for several weeks. But I was not with him when he died.

I remember that day. I called him that morning at the hospital. He sounded surprisingly better, and spoke very clearly. I was glad to hear that he seemed to have improved. He asked when I was coming to see him. I told him I would be there that afternoon, right after a class I had to teach. Hearing that made him very happy.

But before I left for the hospital, the telephone rang. My aunt called to tell me the news: my father had just died.

I went immediately to the hospital. My mother had been there all day. She told me she was with him all morning, then went out for a lunch break. When she returned, she discovered he had died while she was gone. She felt disappointed, even guilty, for not having been there at the very last moment.

But in the end, it didn’t matter.

Eventually we came to realize that the work was done. My dad got the support from his family that he needed. He knew he was well cared for. When I spoke to him that morning and told him I would soon be on my way, that was all he needed to know. He wanted nothing more from me.

Anyone who works in hospice will have heard stories about patients who died just at the moment when their loved ones were out of the room. It is as if some people choose to die alone, and it happens often enough to be worth noting. Yet I have met so many family members who experience guilt and even anguish if they fail to be with their loved one right at the last moment. That is why I am writing this article.

Our culture has very strange, ambivalent attitudes toward death. We try to deny that it exists. We worship youth, and pretend we can be young indefinitely. Yet we also mystify the moment of death, building it up into something both much more and much less than it really is.

Actually, it all makes sense. Since we tend to avoid the process of dying, we don’t come to terms with it until the final moment when death becomes a reality we can no longer escape. We reduce the whole process to a single moment, and hang everything on that one moment.

There is a group of musicians who call themselves “music thanatologists.” They have promoted the concept of the “death vigil”: they would have families call them in to provide music for the patient just when death appears imminent, and would take shifts to play continuous music to ensure that the patient’s last moment of life is music-filled.

I think this is completely misguided.

First, one cannot assume that all patients want music when they die. Some may, and some may not.

But more importantly: the time our loved one most needs our support is not at the very end. Once the final moment arrives, that person is already in God’s hands. The work is done, and we are no longer needed. We are most needed at the beginning, when the diagnosis is still fresh, when there is still so much fear of the unknown. We are needed in the middle, when our loved one is struggling with the effects of the illness, the disability and the pain and the fear. We are needed towards the end, to help shepherd our loved one towards a final state of peace. We are not needed at the very end.

If we understand this, and accept the process of dying, we can put our minds at rest. Our culture, which does not understand this process, makes a burden of being present at the very last moment. This is wrong. What is needed is to accept the process and be present throughout. If we have maintained a conscious presence with the one we love throughout the course of the illness, we will know we have been there when it really counted. Then if we happen to be there when the final moment comes, it is good, and if we happen not to be there at that moment, it is also good.

We are not in control of the end. Jesus said “for you know neither the day nor the hour” (Matthew 15:13). No one, not even the doctor or the nurse, can know when that moment will come. If we live for the sake of that one moment, we will lose the others. I have seen family members neglect themselves, fail to take breaks, and push themselves past the point of fatigue because they were afraid of being away from the bed for even a second, lest that second be the last. Had they taken better care of themselves, the time before the end would have been better both for them and for their loved one. Since we cannot know the end, there is no guilt if we are not present precisely when it arrives.

Often family members try to be there as much as they can, and that is good as long as they care for themselves too. They may even spend the night in the patient’s room, and that is all right if they can afford to do so and if they feel comfortable with it. The hospice is happy to provide a cot for a family member who wishes to share the patient’s room. But every person is different, and every situation is different. Many people have job and family commitments, and cannot be there as much as they would like. Others may not be in the best of health themselves, or they may be under a lot of stress or simply tired. There is nothing wrong with going home and spending the night in one’s own bed, if that is the best way to conserve one’s energy. Even if the time spent with the loved one is not continuous, the relationship is still unbroken.

This last point is crucial. People often feel guilty if, for whatever reason, they could not visit every single day. They may count the days they were there, agonizing over how many more days it could have been. The number is not important. Any number could be larger or smaller. Even if one’s presence has been interrupted, the relationship is still unbroken.

I always tell family members: If you want to take good care of your loved one, take good care of yourself. When you are well rested in body and in mind, you can be more present with your loved one. Of course this is easier to say than to do. Caregiving is very stressful, especially when it is for someone very close to us. Even trying one’s best, one may not always be able to get the rest one needs. Still, one should not feel any guilt about taking breaks or trying to preserve one’s strength. Everyone needs a little down time, and it is also good for the person for whom we are caring that we allow it to ourselves.

By being fully present with our loved one, we help that person prepare for the end. It is the preparation to which we are called, not the end itself. In truth, we can never really be with the person at the end, because once it occurs, the person is in a different place. We cannot know that place until we get there ourselves. But we might get just a hint of it from the peace we may hope will surround our loved one as the end approaches, a peace we can help our loved one realize if we maintain our presence when it really matters.