Midwife For Souls

Spiritual Care for the Dying

A pastoral guide for hospice care, workers and all who live with the terminally ill ~ By Kathy Kalina, RN ~ Book Review

Being present with someone who is in the process of dying — especially the active stages — can be frightening and puzzling without experienced guidance.

Author Kathy Kalina gently and generously shares her 25 years of experience as a hospice nurse in helping the dying bedside to prepare for what she calls “a joyous homecoming”.

Few of us (except nurses and doctors) have much end of life experience, but with 10,000 Baby Boomers reaching age 65 a day and 7,200 of the Greatest/Silent generation dying each day in the U.S., the need for end-of-life preparation has never been more vital.

Sadly, too many people are ignoring or even shunning the very thought of death, let alone seeking wise steps which can be taken ahead of time to insure we will be there for one another during this solemn time of physical, emotional and spiritual need.

Thankfully, Midwife For Souls explains the simple truth about the sacred work of being with the dying. Although the book is primarily aimed at nurses and hospice workers/volunteers, family members will also find this journey into the mostly private world of hospice care very enlightening.

As the saying goes: We all fall into one of three categories: we either already are a caregiver, will soon be a caregiver, or we will receive help from a caregiver.

Perhaps a few readers may even feel called to become a hospice volunteer, Midwife or “Doula,” which is defined as: “A trained professional who provides expert guidance and who supports another person through a significant health-related experience, such as childbirth as well as the dying experience.”

According to Sally Gabriel, PhD at Epiloguecare.com, a Sarasota-based Certified End of Life Doula, “Far too many people are unprepared for the experience of dying. In our largely death-phobic culture, having someone around you who is helpful, calm and present in the face of death is a huge relief. My role is to provide a peaceful presence at the bedside, spend the time to support the deep relationships patients and families need, and to calmly address the complex situations that can occur at the end of life.”

A noble and sacred calling indeed.

Midwife For Souls begins with a frank discussion of the differences between medical treatment and hospice treatment. Doctors are trained to think of death as a personal enemy and largely as a medical event, which is best attended to by professionals. Within most hospitals patient comfort and emotional well-being are rarely on their life-saving radar screens.

In contrast, hospice nurses and workers view their role as providing patients with the best pain relief which will offer the most comfort. The goal is not so much prolonging life as it is maintaining the dignity of the dying by offering compassionate lovingkindness — which is what terminal patients and family members need most.

The author correctly identifies that our fragmented society has made end of life care more challenging with families typically spread all over the country. She points out that in-home care giving is the best option — in the same way that natural in-home childbirth is often preferred vs. a hospital.

She argues there are striking similarities with having a natural childbirth and natural death in the home, such as; 1) the initial shock of diagnosis, 2) initially seeking professionals for a good outcome, and 3) in the final stages, both involves a life review, serious adjustments and surrender.

Midwife For Souls offers many great suggestions for both family members and hospice workers. She views the family as the basic first unit of care giving and hospice workers should carefully listen to the families and patient’s wishes about symptom control.

“The role of Midwife is as a privileged guest on the patient’s sacred journey and not someone that is in charge” says Ms. Kalina. “The truth is God, the family and the patient are really in charge. However, if the patient and family are at odds, the Midwife serves as an advocate for the patient first.”

The work of hospice care is to first control the pain, then to establish a relationship with the patient. “Often hospice workers can help clear the air of chronic sadness,” and at times even help initiate upbeat conversations along with providing a healing touch.

“As patients approach the end of life, there is an urgent need for expression of heartfelt love and hugs to reassure the patient that they’re still lovable.”

Being a Midwife For Souls means being spiritually attentive to some of the most difficult questions imaginable like: “Am I going to die?” The author suggests asking the patient questions such as: “Are you afraid to die?” Or “Do you believe in God?”

Kathy shares the story of one patient saying, “I would to ask for forgiveness, but I just don’t know how.” Her response: “Allow me to help… I’ll go first.” Then she proceeded to lead them in prayer.

She recounts a number of stories of hospice patients seeing angels or deceased family members and witnessing a radiant joy in patient’s faces at moment of death. A Midwife may also initiate discussion of the patient’s life experiences and a life review to help them find meaning, forgiveness and reconciliation.

The book explains the signs of “active dying,” such as: increased weakness, the need to be turned over every 2–3 hours, difficulty swallowing, changes in appearance, the skin having a waxy appearance and changes in breathing. When these signs appear she suggests the family be notified and prepared.

Kathy explains, “Dying is a spiritual process which involves final detachments from family members and even pets that often results in restlessness, a struggle between their will and their spirit. This may last 12-24 hours or longer.”

Some patients report seeing angels appear near the ceiling during the end stages. There’s a few practical things that can be done to soothe the patient who is actively dying such as giving them eye drops and artificial saliva. At a certain point she advises, “Speak only when words will improve on silence.”

On rare occasions, there may be complications in the dying experience, which can be discerned by looking into the eyes of the patient. If fear is observed, speak words of love and comfort.

Sometimes the dying await permission from the family and won’t let go until it’s given. Kathy advises patients not to worry about their family’s well being, but to go ahead, it is OK. She recommends family members speak to their beloved and give them permission to let go.

Ms. Kalina is outspoken in her convictions about not promoting suicide or euthanasia. She believes that patient or family member suicide requests due to pain can often be controlled with medication and it is best to allow the natural dying process to take its course rather than inducing death.

“There’s a time to live and a time to die,” says the book of Ecclesiastes.

Other patients are very strong-willed and want to prolong the process. The author reminds them God is in no hurry and patiently waits for them to voluntarily surrender.

During the final farewells, pastoral care can also be very important. She may recite The Lord’s Prayer with them, but always asks first if it’s OK.

The work of walking someone back to their eternal home can be very emotionally and physically exhausting, it is important hospice workers and family members keep themselves strong in the process.

The book offer some important spiritual exercises for would-be hospice workers, Midwifes and Doulas. She says to be sure to nourish your own soul daily with regular prayer/meditation times, community prayers, reading of scripture and prayers for humility and of thankfulness.

Midwife For Souls also addresses the problem of physical, emotional and spiritual suffering, which she admits will never fully be understood. “The pain of dying becomes the birth pangs of eternal life.” She advises bowing your head to the mystery of suffering. “Practice unconditional love, learn to see the child of God inside even the roughest exterior.”

Kathy likens the hospice worker’s experience of feeling the pain of another’s suffering to the story of The Velveteen Rabbit — feeling like that tattered and torn stuffed animal who “becomes a little more real” every time she accompanies another patient across the life-death threshold.

It is also important for hospice workers and family members to take some time to reflect upon what has been learned from the passing of this soul. She encourages writing down your memories to help seal your thoughts and feelings for future reference.

Readers are given numerous personal stories of bedside experiences in which family members use this sacred time prior to death to recount stories of their beloved that they will cherish for a lifetime. She encourages them to recount special memories with the patient as a group and to practice listening well.

Many people, including the author, at times fear saying the wrong thing at the wrong time. Kathy says it is important to be sensitive, but to speak up and later to beg for forgiveness if needed.

Sometimes the family may assign the hospice worker a periphery position. In that case, she says to be willing to step into the background and offer whatever help is possible, such as a hand or foot massage. “There’s a time for action and time for just being patient.”

On occasion she finds patients who have lost all hope during their final days. “My job is to have hope for them and even at times be a little bossy when it’s appropriate to help patients who may be facing depression,” saying: “Please stop prematurely dying and start living each remaining day to the fullest!”

Kathy advises both family and hospice workers, “Our job is to bear witness and honor each patient’s individual journey.” She closes with a number of recommended prayer for patients, family, Midwives and Doulas.

Regardless of one’s spiritual belief, this book offers a loving guide that will inspire and equip the reader when facing the death of a friend or loved one.

I also strongly recommend The Grace in Dying by Kathleen Dowling Singh for a more detailed understanding of the nearing-death experience.

For readers who may feel called to serve the dying as a hospice volunteer, contact your local hospice organization to find our what training may be needed to get involved. These organizations offer many types of opportunities ranging from patient home visitation, to pet therapy, to so-called “11th hour” bedside comforting and support.

Over the years that I have served as a hospice volunteer it has been a transformational experience. Often the dying simply want a loving presence or companionship. You can provide a much-needed break for the patient’s primary caregiver. I feel privileged, honored and humbled when I serve the terminally ill. Likely you would too.

Are you living with an expiration date? Have you been diagnosed with a terminal illness? If so, here are 7 humble suggestions for how to prepare.

P.S. Some suggested Bible references Kathy Kalina offers that may be comforting to both patients and the family on the topics of… Suffering: Psalm 2: 16–18, II Corinthians 4:16–18, I Peter 4:12–13, Romans 8:14–18, I Corinthians 1: 3–5, I Peter 5:10, Romans, 8: 22–25 … Hope: Psalm 23, Psalm 91: 1–4, 14–16, John 11:25, Romans 8: 31–39, II Timothy 2: 1–6, Philippians 3:13–14, Hebrews 4:14–15, I John 4: 15–16 … Fear: Isaiah 35: 3–6, Psalm 34: 5–10, I John 4:16–18, Psalms 121, I Corinthians 15: 54–55 … Forgiveness: Isaiah 1:18–19, Psalms 32:1–5, Psalms 103:2–4, Psalms 25: 8–11 I Peter 18:9, Psalms 25 1–7, Psalms 103: 8–14, Luke 15: 4–7, Psalm 51 … Heaven: John 14: 1–3, Philippians 3: 21–22, I Peter 1:3–5, Revelation 21:1–7, Revelation 3: 20–21.