Presence with the dying.

One of my early memories is that of leaning my head on my mother’s upper chest and feeling the vibrations of her voice as my ears heard her singing.  She raised her voice as part of the congregational singing in church even though she, in the words of a classic phrase, “couldn’t carry a tune in a bucket”.  The nuances of music meant little to her.  She knew what she did and did not like to hear, but that was the end of it.  Yet she insisted (in spite of very difficult family finances) on paying Miss Heller to come to our house to teach piano to each of us three children.  It was a required part of our childhood through 8th grade.  And she faithfully took us to every school music program to listen to our participation in school choirs.  I tell you this so you will understand the ending of this post.

I remember the first time I was immediately present for a human death.  As a wet-behind-the-ears EMT I was a crew-member on a unit dispatched to attend a chest pain patient.  He was seated on the park bench in front of the pharmacy, dressed in his Sunday-go-to-meeting cloths, with his worried wife beside him.  A paramedic unit had also been dispatched and was en-route but due to his dire condition we decided to load & go– not waste a minute in waiting.  His wife was very attentive, and very worried.  I still remember the fear in her eyes as she nearly begged to go with us in the ambulance, but due to the limited space with a full crew we told her no, she needed to meet us at the hospital and not ride with us.  We both promised to take good care of her man.

As the driver pulled away from the curb we EMTs in the back were obtaining vital signs and administering oxygen, the only “medicine” an EMT-B had until we could meet up with the medic unit from the city.  As I took the man’s blood pressure the pulse disappeared.  I felt for it in his wrist, my partner felt for it in his neck, and as the man looked in our eyes, first to me, then to her, and back to me, we confirmed with each other that he was in cardiac arrest.  He lost consciousness as my hands went to his chest to begin compressions.  It was the first time I’d felt ribs breaking under the force of compressions; I hope he didn’t feel that as his last sensation on earth…

It was probably an hour later that I met his wife in her grief.  What could I say?  “I am so sad for your loss today…”  came no where close to touching the depth of what had occurred that Sunday afternoon.  “I’m so sorry that I didn’t have you with him when he died.”  Yes-  I did tell her that.  And she said it was OK, that she understood, and I knew that I didn’t feel like it was OK.  My thought was that after all their years together he should have taken his last gaze into eyes of one who knew and loved him, not the eyes of strangers.

Fast-forward ten years:  no longer an EMT, now a nurse in an Emergency Department.  The call comes in, a 40-something male in cardiac arrest on the way in by ambulance.  When they arrived his wife was by his side.  These medics had made a better choice than I had on my first case.  His wife had been present for the monitors, the intubation, the IV start, the breaking of ribs with compressions, the suctioning of vomit, all of it.  As we transferred him from the medics’ cot to the ER bed the doctor ( himself a former paramedic) was telling her to leave, telling us to get her out of there.  And she begged to stay.   This facility had no in-house social worker, no in-house chaplain, and there was no time to consult anyone else.  Based on a rapid assessment of her and the entire situation, I made a quick decision.  I said to her, “You’ve been with him so far, you stay.  You’ll need to stand here at his feet, and no where else.”  And as each person in the resuscitation team continued to engaged our tasks,  I told the doctor,  “She stays.”    He did a great job of simply working the code while being extremely angry with a nurse on the team.  The efforts did not revive the patient.  The widow told me over and over how thankful she was to have been present with her husband through the entire process.  She said, ” I can see you did all that was possible for him.”  That visceral knowledge, and the compassion she sensed from me helped her begin to navigate her grief; but the most essential thing was that she was present with her man in his last conscious moments at home and was with him until he was pronounced dead.  For her it was a big deal.

What does this have to do with my tone-deaf mother singing in church with a young toddler on her lap, feeling the vibrations of her voice?   My mother’s final months stripped her of the last shreds of independence.  Her personal independence was entwined with the core of who she felt herself to be as a human being.  Independence was seemingly inseparable from identity for her.  At the very end, all  that she had was people who gave sacrificially to be the love of God to her. They were present with her, and she came to peace with being totally dependent and weak.

I think she sang in years past because she believed in music even if she didn’t understand it.   I think she believed in Love more than music, but understood it even less.  In the end, having received the love of God through family and those of her faith community, having given us during a long life what she could, and having come to peace with complete and personally devastating loss, in the wee hours of the morning she died.  A young graduate nurse had been taking the night shifts of the round-the-clock hospice care, and she was gently singing hymns to Mother as the last breathing ebbed away.

Present Love, and music, have power to touch the human soul in ways we cannot measure.  May you and I always have the courage to make Presence a top priority,048

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