The Changing Face of Goodbyes

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Death is not a new part of the human experience. People have been dying for thousands of years and we have developed traditions and rituals to help us find peace in our final moments and give those left behind a formal opportunity to grieve.

For many generations, in most parts of the world the norm was for family, friends and members of the community to gather together for a service conducted by a religious leader in a place of worship. This was followed by an opportunity to witness the body being laid to rest in a plot set aside for that purpose and a time for conversation and practical support in the form of tuna casseroles, a potlatch or sticky buns, depending on one’s geographical and cultural context.

Today such funerals are less and less common in the Greater Vancouver Area. At the time of death, families are often uncertain what to do next, and friends and members of the community are unsure how and where to express their grief and offer support. As I have increasingly observed this change, I cannot help but wonder if it helps or hinders our grieving process.

Often, a traditional funeral is simply not practical, given the realities of immigration. Relatives from Hong Kong, Austria, Chile and other such far-off places may not be able to fly here for a funeral because of finances, visa requirements, or other factors. Other times, children and grandchildren born and raised in Canada simply do not know what their historic cultural and religious traditions are.

I remember one woman close to death who told her daughters she wanted to die as a Muslim. They had never been to a mosque in their lives and never read the Quran, so they turned to me for advice. Together we found ways that they felt honoured their mother’s dying wishes and beliefs. In this case the mother initiated the conversation about what she wanted, and her daughters left the hospital with few regrets. For them, this had been a “good death” and their experience left them better equipped to continue their journey of grief.

While it is wonderful when such experiences arise spontaneously within families, it is often painful for all involved when these opportunities for discussion and closure do not or cannot occur. One young man tried to act as his grandmother’s translator while I visited her. Even though he’d taken her to countless medical appointments and handled most of her routine daily conversations, he had no idea how to translate my questions about his grandmother’s beliefs, about what gave her life meaning, or about where she found hope and encouragement. As the grandson and I spoke afterwards, he told me he had never thought about such things before and he tearfully thanked me for introducing an element of his grandmother’s care he had not realized was missing until we spoke.

As the “outsider”, every staff member who interacts with a family caring for their loved one has a special opportunity and obligation to be part of this conversation that so many are afraid to start, don’t know how to start, or may not know needs to happen. To assist in initiating and recording this conversation, Providence Health Care Pastoral Care Services has recently developed a Spiritual Assessment form for use in Acute Care. This form helps identify the patient’s coping strategies and examines attitudes like trust, faith, value, isolation, peace, shame, honour, regret and forgiveness so spiritual needs can be addressed in a plan of care. The assessment is then filed in the patient’s records where it can be accessed by anyone who provides care to this person.

Allied health providers, nurses, physicians and other staff can learn more about their role as catalysts for end-of-life conversations and spiritual concerns by attending Providence Health Care’s third bi-annual spirituality conference titled: “Spirituality: The Invisible Ingredient in Health and Healing” on May 6 and 7, 2010. Speakers will explore the integral relationship between spirituality, health and healing. Early bird registration closes on the 5th of April 2010. For more information visit the PHC website here: http:www.providencehealthcare.com/events.html.