Category: Supporting

Falling silent after a patient’s death

Written by Suraj Shah.

I feel like when my patients die, I definitely do spend a moment reflecting on the patient but mostly thinking of the families and those moments always truly humble me, because it reminds me that in a few days I will likely not think of that moment, but those families will never forget.

In a recent BBC news article, surgeon Pauline Chen suggests that doctors and nurses should be obliged to pause for silent reflection when someone they are treating dies. It would be good for them, she says, and may make them better carers.

In summary, the article highlights:

  • there should be a mandatory 5 minutes silence when a patient dies.
  • all carers would gather round the bedside and reflect in silence on that person’s life and death.
  • most caregivers, particularly doctors in the west avoid confronting the reality because a patient who dies represents a professional failure.
  • having a five minute pause for silence will give closure.
  • the conscious pause will also establish a ritual, which leads to offering great comfort at difficult moments.
  • also the five minute pause will allow caregivers to acknowledge their own feelings.
  • by denying the acknowledgement of feelings, doctors and other caregivers end up being restrained by them.

I asked a bunch of friends who are in the medical profession what they thought about it.

One friend wrote:

“What a heartfelt story. I think that a moment of silence for patients who have passed is actually something that is not only good for that person but for the families and the medical doctors and registered nurses.

I feel like when my patients die, I definitely do spend a moment reflecting on the patient but mostly thinking of the families, and those moments always truly humble me, because it reminds me that in a few days I will likely not think of that moment, but those families will never forget. Thank you for sharing this with me. I think I will be more conscious in those moments to come.”

Another friend wrote:

“Interesting article. I do think that we could do more to respect a patient who has died. We as doctors could also do a lot better to respect the woes of patients who are living.

From the point of view of an ER doctor, I think that 5 minutes is not possible in that environment. Also, it would be nice to have some tradition that reflects and acknowledges the death of a patient, but it would be better if it came from a tradition of spirituality or compassion (universal spirituality is better than any particular religion in our society, mostly) rather than one of hospital policy. The culture in the ER that I see is that some people would like this very much, and others would just scoff at it.

Overall, a tradition of some moments of silence, and then a protocol of supporting family, etc, would be good. I sort of do that in my own way, but it would be nice to have more of a protocol that gets people on the same page, and also has room for exceptions (i.e. it is not appropriate to have a moment of silence if a family member is freaking out … you have to support them first and do what is right for them, silence otherwise).

Perhaps that protocol would also one day become tradition and influence us a bit deeper. There are many medical professionals who are compassionate, and there are many that are not (maybe selectively compassionate depending on mood etc.) We are a pretty diverse and intense bunch of people.

I think that our society has to be more compassionate in general. That is the real issue. Compassionate and intelligent in conjunction with each other. We are way too materialistic and not compassionate enough.”

Are you a carer of some form where you face death more often than most other people? If so, how do you feel about observing silence after a patient’s death?

Allowing for silence

Written by Suraj Shah.

Music is made up of notes and pauses. In fact, in music, the notes are merely a frame for silence.

Without the gaps, all the notes would clump together and all we would hear is noise.

What is silence?

In music, silence is the gap between the notes. In conversations, silence is the space between the words. It’s in that space that wisdom develops.

In Atmasiddhi, the 142 verse masterpiece composed by self-realised poet Shrimad Rajchandra, he writes:

Kar vichaar toh paam // contemplate to realise

Such a powerful statement, yet how often do allow ourselves to get into the gaps of our mind’s constant monologue.

How often do we take time to retreat from the unending noise of the outer world?

How can we create space for contemplation, for introspection, to allow for the emergence of wisdom?

It starts in our day-to-day conversations.

Learning to listen

In our day-to-day interactions, we have so many opportunities to speak with people, to connect with others, to learn more about them, the world, and ourselves.

But in all of our interactions, how often do we really listen?

When a friend speaks, do we listen? Or are we disrespectfully constructing our reply in our heads as they speak?

How often do we take the time to pause after a friend has spoken, to truly absorb what has been said, to contemplate on it, and then to respond appropriately.

What’s the alternative?

  • Automatic robot-like reactions.
  • Thoughtless regurgitation of opinions.
  • Careless advice and ‘recommendations’.
  • Interfering and causing mayhem.

Listening to those who desperately need to be heard

All around us are people desperately waiting to be heard.

They are in our homes, our schools, our workplaces, our churches and temples.

They are in the local park, in the pub, in the line at the grocery store, or sitting at the next table in the cafe.

Everywhere you look, you will find people craving the need to be heard, to be understood, to be loved.

Just open your eyes, and open your heart, and you will find someone who desperately seeks to be listened to.

How to listen

Listening is easy.

Simply shut your mouth, focus on the person you are with, and calm your own mental chatter.

Easy, right?

Not so much.

But here are some tips that may help.

You’re truly listening when…

  • You let me be me.
  • You grasp my point, even when it contradicts your own perspective.
  • You remain calm and pay attention to what I say and don’t say.
  • You hold back your well intended desire to give me good advice.
  • You give me enough space to discover by myself what is going on and what to do.
  • You grant me the dignity to make my own decisions, even if you think they may be wrong.
  • You allow me to deal with the problem in my own way, rather than trying to take it away from me.
  • You are genuine and sincere.

The next person you meet deserves to be listened to. When paths cross, make the meeting fruitful.

(Photo courtesy of Minette Layne)

Community and mutual support

Editor’s note: In this guest post, Dr. Tushar Mehta writes about how spirituality and connection to a community makes a huge difference, and how people can evolve even at a late age.

“Parasparopagraho Jivanam” All life is bound together by mutual support and interdependence

My grandfather passed away 2 days ago, and we just had the funeral today. He was 87 years old, and had deteriorated significantly since he was stuck by a car as he was crossing a road a few years back. This weakened an otherwise vigorous man, and eventually his age caught up to him. There is sadness involved when a family member dies, but there is also an uplifting story in this, and a light.

My grandfather had a hard life from childhood, and the family (my grand mother, mom, uncles and aunts), did go through many hard times. He was a very honest person, but sometimes difficult person often quite stern in demeanor. As family we all gave him due respect and love, but we were not as close to him in a personal and affectionate sort of way.

However, over the last year I saw him change so much. Despite his progressive weakness, he became someone who laughed and smiled so easily and often, which was rare in the past. He became very spiritual in a natural and wholesome way. He spoke of his mortality with ease and confidence, saying that he knew he would not live long this year, and all that mattered was for his soul to grow more mature.

My brother and I spent lots of time with him over the past couple of years, knowing that the inevitable was coming closer. During that time we developed a better friendship as he evolved into someone who became warm and glowing. I would often massage his arthritic neck and back and he much enjoyed this.

Over the last couple of weeks my grandfather did suffer many pains and discomforts of his dying body, but he maintained a spiritual focus, and would listen to and recite mantras so much. In typical Jain fashion he decided that he would die on his own terms and made a decision to stop all medications, food, and eventually even water. This was five days before his death, and is a decision and an act that Jains call Santharo. The purpose is to the leave the body on one’s own terms, a spiritual flight to a new beginning, an austerity where a conscious person decides not to hinder the smallest leaf or insect in that process of consuming a morsel of food; total ahimsa.

However, it does not look that pretty when you are wearing a diaper. My bro and I did all the medical things we could to keep him comfortable. But most importantly my uncle and aunt were with him constantly, caring for his every need and pain as best they could. My aunt was up with him every night and slept by his side (slept very little actually). She was heroic. My grandmother was always there chanting the mantras which he requested and loved. There were also many other friends and family members who came frequently and stayed over many nights to keep him company. He seemed to suffer more at night and had trouble sleeping. When he died, there he was surrounded by many friends and family who were quietly singing mantras and keeping vigil, rubbing his shoulders, head, and feet. He looked very peaceful. This all happened at my uncle and aunt’s home where my grandfather lived.

Today we had a funeral and cremation. It was a bit somber, but afterwards we had a lots of good memories to share. There was a lot of laughter as well, and i think that we were quite at peace and thankful that he achieved such upliftment over the last year or two.

A good friend of mine sent me a wonderful quote from Rabindranath Tagore :

Death is not extinguishing the light; it is only putting out the lamp because the dawn has come.

I think that reflects the way that our family sees things. There is a mystery in life that we theorize about, but there is also a knowledge about a greater journey of the self in the universe, a desire to grow towards the ultimate, about compassion and an inner freedom. Also, there was such generosity and love from a golden web family and friends. I know we will all experience this, and I hope for us to have it sooner rather than later.

Dr. Tushar Mehta is a physician from Toronto, Canada. He is of Jain heritage and feels that this philosophy and spirituality has a great influence on his experience of life.