As an ICU and palliative care physician, I am a frequent witness to death. And I am often struck by the broad range of experiences for dying patients. I recently visited the Zen Hospice Project in San Francisco, a beautifully painted Victorian House on a tree-lined street where many patients go to die. As I entered the house, I encountered the gentle aroma of banana bread, and followed my nose into the kitchen.
The chef welcomed me with a big smile. She was assembling food for one of the residents and she described what she was preparing with the enthusiasm of a chef preparing a gastronomic sensation for a crowd of foodies. Each of the three miniature portions of pureed food on the small plate was a unique and vibrant color, and they complemented one another in a gorgeous palette.
A nurse entered the kitchen carrying a different patient’s tray. I noticed that the plate’s three portions were completely uneaten except for tiny indentations from the tip of a fork. I asked the chef how it felt to cook food for people who could barely eat it. She smiled. It had been tasted, she said, that’s what mattered. Smelling the food, tasting a little, and feeling loved were all she hoped for from the patients.
Just as meals offer an opportunity to soothe, the room of a dying person is sacred ground. We must always consider the final perceptions of this person — the sounds, the smells, the touch — and do our best to make these things right for them.
Ideally, we would know what the person would most value. Whether she would want her loved ones by her side. Whether she would like to be touched, her arm stroked, her hand held. Whether she would be comforted by a particular smell, a hint of lavender. She might most want to be kept fresh and clean, her mouth moistened and teeth gently brushed. Or she may be calmed by the slow stroke of a comb through her hair.
A dying person has very little agency. He is usually weak and tired, maybe confused. He may be strapped to a bed, with tubes entering his throat to reach his stomach and lungs. Certain elements are not in our control, so we must work with what we have. Nourishing, even sparking the senses, when everything else is losing its luster is one small thing we can do.
Ideally, every person would die in the environment of her choosing — usually at home surrounded by loved ones. But too many will die like my patient, alone in the ICU, his preferences unknown to those caring for him.
My hope is that every one of us pauses to consider our preferences around this inevitable stage of life, and communicates those to our loved ones before we can no longer make requests. But if this hasn’t happened, it may require a little imagination on your part.
What might your loved one want to see? Perhaps a fresh vase of flowers, or photos of loved ones. Maybe a piece of art from home. The aroma of a baking banana bread. Would her glasses be helpful, and do they need polishing? Would she like the window shades open or closed?
Aromatherapy can serve to transport a patient from the sterility of an ICU room into another space entirely. Essential oils, lotions or a spray of rosewater can lend a sense of personal aesthetic. And food, for every one of us, carries tremendous emotional power. The tiniest taste of a favorite flavor, in a patient who can tolerate it, might inspire memories of happier times.
The experience of touch might bring someone solace and peace. For some, a hand held can bring tremendous comfort and dissipate loneliness.
People respond to sound in different ways. Where for one, silence brings a sense of calm; for another, classical music will lend comfort. The effect of reassuring words from loved ones cannot be underestimated. And hearing aids, so frequently forgotten in critical illness, can bring the world back into a person’s life.
Of course, each person will have his or her own preferences. Given how vulnerable people are at this late stage of life, we must do our best to notice the patient’s response, which may be subtle, and act accordingly. For example, a foot massage might calm one person’s anxiety, while, for another, it might be ticklish or even irritating. Ideally, we elicit these details from our loved ones before they can no longer speak.
But I would venture that for most of us, the sounds of a nameless game show would not be the last things we’d want to hear.