Two care workers share their views on what is truly important when it comes to a good goodbye.

Residents arrive in a nursing home and hospice with a prognosis. With this in mind, care staff strive to meet residents where they are, to empathise and provide comfort care.

However, when faced with our residents’ deaths, care staff are also challenged with our own thoughts and feelings about it.

What happens when we are at a different pace or have a different perspective as residents? How does that affect our care and our own lives?

Different pace
Mak Lian had a lively spirit but she was non-verbal. Most days, the nurses heard nothing more than a grunt or an occasional shriek from her. She also had the habit of sporadically reaching out to grab and pull others. Nurses who assisted her at meal times needed to be alert to such behaviour.
One nursing staff, Valerie, was responsible for tending to her during meal times. Each bite took time and Valerie would wait until Mak Lian had swallowed her food. During lull moments, Valerie would come by Mak Lian’s side to smoothen her clothing and gently pat her hands.

Over the years, Mak Lian and Valerie developed a special bond. Mak Lian would eat more when Valerie was with her. Mak Lian would also keep snacks for Valerie.

This special connection was abruptly shaken when Mak Lian’s condition rapidly deteriorated. Mak Lian passed away the weekend that Valerie was not working.

Valerie could not accept that Mak Lian was gone. During one of her daily duties, she was asked, “I know you took care of Mak Lian while
she was around. How are you feeling?” Right there and then, she started sobbing. She steadied herself against the wall and muttered, “So fast. So fast.”

As care workers, we might not expect residents to go quite so quickly. Seeing them day in day out, we might get the unrealistic expectation that they will be here every day. Or in their final moments, we hesitate to leave their bedside. In providing care while protecting self-care, should we pace ourselves against a resident’s prognosis or simply do our best during our work shifts?

Different perspective
Tim’s children would not describe him as a good father. He left his wife and three children when they were at a tender age. Most days, he gambled. After his admission to the home, his outpatient consults became opportunities to purchase a 4D or TOTO ticket.

Rose, our pastoral care staff, befriended him from his first day. They would talk about lucky numbers, his roommates and on occasion, the pain he was feeling. He never spoke about his family. Throughout his time in the home, only his youngest daughter visited him.

One quiet afternoon, Rose asked him, “How do you feel about leaving your family?” Softly but with certainty, he replied, “I let my wife down.” She then shared with him that in the final moments, the “四道: 道謝 、道愛、道歉、道別” (Translated to mean: Thank you, I love you, I am sorry and goodbye) were difficult but important conversations to have. Since his wife never visited him, he decided to write her a letter.

Deftly, Rose pulled a clean napkin from her pocket. She did not have fancy paper or multicoloured pens. With the clean napkin and the nearest ballpoint pen she could find, she wrote down his message: “I am sorry for letting you down. Please forgive me. I love you.”
Tim folded this recycled napkin, with his precious message, and tucked it in his shirt pocket. For the next few weeks, it remained unread, but the care staff could see his relaxed demeanour.

In his final days, the social workers invited his family over. When his wife arrived, he pulled the napkin out and passed it to her. Some quiet moments passed while she read his note. Simple, genuine and beautiful. Eyes swelling, she responded, “I forgive you.”

Rose explained, “The material is not important. You can use fancy paper or a napkin. What’s important is how the resident and the family are feeling.” As care workers, we sometimes stress about giving the best to residents without checking what is best for our residents.
Does the best come from the logistics or from tending the heart of our residents?

Different posture
The window between the first signs of dying and the time of death can range from minutes to weeks. Rose, in her 10 years of experience as a pastoral care worker, has encountered residents without next-of-kin leave peacefully within minutes. She has also witnessed residents, who having seen their children graduate, struggle to accept that they have reached the end.

She describes this time between the first signs of dying and the time of death to be the sacred encounter between self and God. It is unknown to care workers and not intended for us to get stress over and around. When Rose is called to the bedside of dying residents, she would give them a gentle touch and, with a warm voice, assure them that they are not alone. When the day’s work is done, she passes the baton to the next care worker on duty.

Working in a hospice, where death is often at the forefront, it might seem like you need to work around the time of death. But the final moments are uncertain and out of the residents and our control.

If we accept that we’re not masters of death, but students of it, then this new posture might shift the way we perceive and pace ourselves around residents. It can help us navigate our own uncertainties and provide the care that residents really need. As leaders of nursing homes and hospices, timely debriefs or having a professional counselor can also ensure that care staff receive sufficient support.

Names have been changed to protect confidentiality