➣ Unique Needs at the End of Life
by Deborah Grassman
Many people do not realize that military service influences soldiers in ways that can sometimes complicate peaceful dying, even though their death may not occur until many years after they leave military service. Deborah was the first person to identify the influence that the military sometimes exerts on dying Veterans. Peace at Last: Stories of Hope and Healing for Veterans and Their Families was subsequently published and is now a recognized authority on how the military impacts veterans and their families as they experience the dying process.
These influences include:
- The value of stoicism so earnestly and necessarily indoctrinated in young soldiers might interfere with peaceful deaths for all veterans, depending on the degree to which stoicism permeated their later lives;
- Veterans who served in dangerous duty assignments might have their deaths complicated by traumatic memories or paralyzing guilt, depending on the extent to which they were able to integrate and heal traumatic or guilt-inducing memories;
- There is a high incidence of alcohol abuse or other “flight”-type behaviors used either to avoid confronting locked-up feelings or to numb traumatic memories. These factors might contribute to “unfinished business” as veterans face the end of their lives;
- Veterans often acquire wisdom because they have reckoned with trauma, stoicism, and addictions. Understanding these three elements helps access their wisdom and has been referred to as “post-traumatic growth.”
- Veterans and their families have unique bereavement needs to consider when providing care.
When people learn that I work with dying veterans, they will often say, “I can’t imagine working in hospice.” To help you imagine my everyday world, let me tell you the stories of the nine patients on the Hospice and Palliative Care unit at the time of this writing. Then, you can understand the context from which my lessons are derived. You will also understand the privilege that it is to care for veterans. Military experiences changed them in fundamental ways that shape, mold, destroy, and redeem the rest of their lives. Many are able to confront their sufferings successfully. In one aspect of their lives or another, they have been able to redeem portions of their suffering so that it can be used for healing as they face the end of their lives. You will notice that in many ways, they die the same way civilians do. You will also notice that they experience some unique distinctions.
Mark is dying of liver failure from alcohol abuse, his skin yellow as a low-glowing lamp. He came to the Hospice and Palliative Care unit semi-comatose; we won’t get to know him except through his brother’s eyes. I comment on his brother’s devotion. The brother responds, “I look at Mark and know why I’m in Alcoholic’s Anonymous.” I behold one brother willingly serving the suffering of the other.
Donnie is 50 years old and has lung cancer. He’s been a quadriplegic since he was 27 when an automobile accident derailed his career as a professional football player. “I spent three years in despair. Then I found God and salvation,” he tells me. He says he is thankful for his suffering: “I never would have found Jesus if the accident hadn’t happened.” Twenty-three years of redeemed suffering is a story worth beholding.
In the next room, an embittered, lonely man sits sullenly. Alcohol has estranged Zachary from his family. At 82, he’s angry at his body for failing him. He’s been afraid of death since he was 10 years old when a neighbor died falling through a skylight. Bitterly, he tells me, “My only solace is in knowing that someday all the rest of you are going to be in this bed too.” A gathering of team members provided a turning point as Zachary experiences the concern of the four staff members who were willing to love him. “Why aren’t we talking about my breathing, and the 16 pills I’m taking?” he asks us. “Because you are more than just your breathing, and we are more than just pill-givers,” I reply, leaning in and daring to touch him tenderly. A tear forms; his features soften for the first time. “I can’t argue with that,” he says quietly. I can’t tell you the ending of his story, but once the crack starts hope emerges.
In the room next to Zachary is Marvin. He was a photographer to a general in World War II. He has been a physician, sailboat racer, and builder of piers, driveways, and roofs “made with my own hands.” Marvin’s wife and four children sit at his bedside supporting his journey into the next world and supporting one other. Near death, he says little except the Lord’s Prayer. There’s no need for us to intervene. We just get out of the way and behold a life well lived.
In the adjoining bed is Jim, a Vietnam War veteran who has lived a colorful life. He’s intermittently confused; sometimes he’s argumentative. He has no family; a few close friends are his source of comfort. His first days on the unit were filled with agitation. He was convinced the Vietcong had put a bomb in the stereo. Nurse Suzanne responded creatively. She called the security officer and said, “I want you to inspect the stereo and declare it bomb-proof. Tell the patient you’re pulling guard so you’ve got his back and the perimeter is safe. Let him know that another guard will be on patrol when you leave duty.” The police officer responded convincingly, and Jim’s agitation subsided.
Then there’s Bruce, a 67-year-old man who came for pain control. He hadn’t wanted to come to our Hospice unit because, he said, “I’m afraid I’ll never get out.” His early days of anxiety and impatience were manifested with frequent summons on the call light. Probably because he realizes he’s in a safe, loving environment his spirit is now emerging bright and full. He simply needed a little time and a little love to know that he need not fear. He has grown closer to his family as he approaches death and tells us, “I wouldn’t trade these last few weeks in my life for anything.”
Bruce’s roommate, Richard, suffers respiratory distress from a tumor encroaching on his breathing tube. He awaits his daughter’s arrival from Indiana tomorrow. He says his suffering will be redeemed when he can rejoin his wife who died two years ago. “That will be a happy day,” Richard says with tears. We share his anticipated joy.
Ben has a history of drug use and actively continues with alcohol abuse. He identifies himself as a loner who has witnessed much violence. “My family doesn’t care about me,” he told me. We’ve had some difficult sessions confronting his suffering. He’s going to be discharged next week. I don’t know what’s going to happen with him. What I can tell you is that his brow unfurls after prayer, he plans to go to Alcoholic Anonymous meetings, and he wants to reach out to a faith community. Seeds planted and good intentions, however, are still not enough to withstand the ravages of alcohol. Ben’s redemption awaits a courageous decision that only he can make every day for the rest of his life.
The last patient, Edwin, has severe chronic respiratory disease and is ready to die but he worries about his wife of 54 years. His needs are increasing rapidly but he doesn’t acknowledge them because he doesn’t want to worry her. “I can’t hold on much longer though,” Edwin says while making plans to hold on for his wife’s sake. We talk about the advantage of letting go so he can prepare himself and his wife for his death; we talk about the damage his denial is causing them both. Edwin cries as his grieving begins. Stories of sacrifice in the name of love are always worth beholding.