When I was an oncology nurse, a 44-year-old patient named Madeline forever changed my perception of death.
She had gallbladder cancer and one day broke her hip. This sent her to the hospital, accompanied by her sister. Within a couple of days, a blood clot from Madeline’s hip traveled to her lung, decreasing the blood circulation throughout her body.
When she thanked her doctor for all that had been done for her, it was clear Madeline knew something the doctors didn’t even know yet: she wasn’t going to pull through this.
One evening after waking up from a nap, she said: ‘Get my sister! I’m transitioning!’
She said it with such excitement, as though she were arriving in a foreign country for the first time, ready for a new and thrilling adventure.
Hers was truly what I’ve come to call a ‘good death.’ She was not only unafraid but even enthusiastic about experiencing it.
Can you imagine? She could see and feel something that most of us can’t and watching her go through it transformed how I thought about death.
Certainly not everyone has an experience like Madeline’s at the end, and I was miserable in mainstream hospital nursing, where we weren’t given nearly enough time with patients.
So, even though it made little practical sense, I listened to my heart and went into hospice nursing. Once I did, I saw clear patterns among countless patients that eased my mind about dying and even changed the way I have come to live my life.
Regardless of someone’s cultural background or religious beliefs, there are four common things that dying people say toward the end:
There is no death. I’m going home.
Whether or not they speak to loved ones who are already dead or have believed in this during the course of their life, they seem to have the knowledge that they’re returning somewhere familiar that no longer requires a body.
Everything happens for a reason.
I have listened to so many dying patients tell me they suddenly understand why they had some of their most painful experiences.
They have an epiphany about the lessons they learned and why those experiences were necessary and valuable to help them grow and change.
It’s a kind of ‘life review’ and a sudden flood of wisdom that might have eluded them throughout most of their life. It brings them tremendous comfort, as they no longer feel that they were punished or that their pain was random.
There is no judgment.
They frequently realize that their mistakes in life were the result of their humanity, and they feel newfound forgiveness – for themselves and for others.
They say that there’s no reckoning or punishment after death. Instead, everything they did was in the name of learning, and all that remains is love.
We are all connected to one unconditionally loving energy.
Even those who had been bigoted or harbored grudges often suddenly conclude that we’re all in this together – people of all stripes, religions, and countries. They feel a deep connection with not just all human beings, but all types of beings from animals to trees to molecules.
It’s a profound spiritual experience that sometimes comes as a surprise to their loved ones, and it eases the transition immensely from life into death.
In addition to these four things people say at the end of life, there are other phenomena that are incredibly common among the dying.
They get a burst of energy.
We often call this an ‘end of life rally.’ Even if someone has been asleep for weeks, unable to speak or move, they often awaken for a brief period with unusual vigor, both physically and mentally, to say goodbye and express their love, only to die soon after.
They control the date and time they die.
I have seen more people than I can remember wait for something specific before they let go. They might wait for a particular date, such as their own birthday, an anniversary, or the arrival of a grandchild.
I know a woman, for example, who was on her death bed for ten days until she finally died just four hours after midnight on her 100th birthday.
The dying often wait until someone special can visit them so they can say goodbye, or they wait for permission to go because they’re worried about leaving their loved ones behind.
In this case, it can be helpful for them to hear a gentle ‘I love you and will miss you, but it’s OK for you to go. I don’t want you to suffer anymore.’
Sometimes, they wait until a loved one leaves the room.
This can be painful for those left behind, but hospice nurses know this phenomenon so well that we prepare family and friends for the possibility. It could be that as their final act of love, the dying want to spare us the pain of witnessing their last breath.
This happens even when the dying person is in a sleeping coma. Somehow, they still know when we leave the room.
They talk about visits from the dead – even while they’re awake, not just when they’re asleep.
Research has found that as many as 72 percent of the dying talk about seeing and speaking to their loved ones who have already died.
Some people dismiss these experiences as hallucinatory, but maybe it’s just as easy to think they’re actually connecting with the dead. Many family members and friends find this comforting and take it as confirmation that we only change form when we die.
Whether or not you choose to believe the dying are communicating with the ‘other side,’ the best thing to do is to validate their experience.
I knew a dying woman named Helen who said her late husband was coming that weekend to take her to a dance, and she needed something to wear.
Her niece found a beautiful dress in the closet, along with red patent leather shoes, that she placed in the bedroom where Helen could see them every day. Helen died that weekend in a state of profound peace.
After watching and listening to so many dying patients, I began to live my own life as though each day is a life in and of itself. It might be the last day I get, so I strive to be fully present and make the most of it, appreciating all the small, beautiful moments that come my way.
I look for how I can be of highest service to others, even if it’s as simple as smiling at a stranger or holding a door open for someone.
I listen to my inner guidance, just as I did when I switched from medical floor nursing to hospice nursing and found my true calling … and just as I did when I left hospice nursing to start the Doulagivers Institute, which allows me to train both professionals and family caregivers to better understand and handle the end of life.
I strive not to judge myself or others and, just like the dying, to see life as a series of lessons that help us become better versions of ourselves. I see the connection between all of life’s beings and look for the sacred everywhere.
I also focus on gratitude every day, but perhaps what I’m most grateful for are the many patients who showed me that there’s actually beauty in dying. They showed me that our life and death are a seamless, sacred trajectory that we all share.
The Good Death: A Guide for Supporting Your Loved One through the End of Life by Suzanne B. O’Brien is published by Little, Brown Spark, March 18