Advent Reflections from the Bedside

Tuesday, Dec 17th, 2013

The Christian Season of Advent has taken on new meaning this year—or renewed meaning, since it was five years ago during Advent that the Rosell family waited with Mom Rosell in her dying. So too this family is waiting now with another mother. Each Sunday in Advent has seemed likely her last. On this Third Sunday, Mom Lofgren, or her body, has added empirical validity to data showing that even hospice physicians are notoriously errant prognosticators of death. Family members surely are no better at it.

Given this fact, maintaining “vigil” while waiting is a bit of a challenge. How do we know when to stay and when to go home, or to work or wherever? Ruth and I have developed our own criteria.

We begin with awareness that keeping vigil is not just for the time of death but for the dying process itself, entailing possibly months of waiting rather than merely moments of passing. If we end up having started vigil early, all the better. Can there be a “too early” start to this sacred activity? Maybe not.

We also begin with the assumption that Mom Lofgren would prefer not to die alone. This is not based on nothing. I recall at least one voice message left in the middle of the night back when we still had a landline. Four years ago? It was a message letting Ruth know that, “I’m going to meet Jesus, and I love you.” Then Dorothy went to sleep and woke up in the morning. Still with us. But not always alone, not if we can help it.

“No One Dies Alone” (NODA) is the name of a program recently launched at the University of Kansas Hospital. It began elsewhere back in 2001 as the initiative of a nurse in Oregon, and has spread widely. I’ve read survey data indicating that a “good death” for most of us includes “not dying alone.” When asked what we fear the most, “dying alone” is high on the list. When I got caught in a Costa Rica riptide on March 16, 2003, I feared dying in those waters far from home and too far from shore, all alone. (Dying stupidly, ignorant of how to swim across the current, didn’t appeal to me either, I recall now.)  

There is conjecture in hospice culture that some people wait to die until they are alone, and that it is volitional. Perhaps so. It is a hypothesis impossible to verify unless we concoct a way to interview the dead. Anecdotes might merely record a few bad luck coincidences of family members stepping away from the bedside just before the unanticipated last breath. Who knows? What we do know is that many others of the dying seem unable to “go Home” despite being ready and waiting for Advent. What we know is what most of us state as our own preference. 

We assume then that Mom Lofgren is with the majority of us on this matter, and that she prefers presence to aloneness in these dying days. So we are trying to honor that, and have developed criteria for “the Vigil.” We do our best to be at the bedside when there is/are any one or two of the following:

a) signs of “active dying”;

b) indicators of anxiety, discomfort, or pain that persists/repeats despite morphine;

c) affirmative response to being asked whether she wants one of us to stay;

d) availability to do so;

e) extended periods of alert wakefulness—providing opportunity both to offer loving presence and to enjoy with Mom L. whatever time remains for singing, reading, viewing photos, praying, being together.

We have kept vigil for many weeks now. Ruth has used up all her 2013 vacation days so as to stay by her mother’s bedside, and then she has worked online and by telephone. I have slept, or partly so, many nights in the recliner chair next to my mother-in-law’s bedside, where I sit now writing these reflections. Grandchildren have come and taken a turn to be here with Grandma. Other members of the extended family have come to sit for a spell, as able and available.

But for the past three nights and briefly during some daylight hours, Ruth and I decided to suspend the 24/7 vigil on grounds that criteria for staying were not met, inexplicably so. That gets reassessed repeatedly, of course. And we know that we too are errant, that we might make the wrong call, ultimately missing a holy moment that will never be repeated. Hopefully then, we would be comforted by knowing that we all had done our best, that Mom Lofgren had received excellent care, and was loved to the end.

Until then, we await together one sort of Advent, and remain vigilant as possible.

Tarris Rosell, Ph.D., D.Min.
Professor of Pastoral Theology--Ethics & Ministry Praxis