Living when death is so certain to someone close to you the trials and tribulations of overcoming death dr geoffrey wango

5/5/2018 1Dr Geoffrey Wango, Psychology Department, University of Nairobi
Dr. Geoffrey Wango
Senior Lecturer
Counselling Psychology
University of Nairobi
Living with Death so Certain for
Someone Close to You: The Trials
and Tribulations of Overcoming
Death

Then the Lord said, "My Spirit will not contend with humans
forever, for they are mortal; their days will be a hundred and
twenty years".
Genesis 6:3
All our days pass away under your wrath; we finish our years with
a moan.
Psalm 90:9
Our days may come to seventy years, or eighty, if our strength
endures; yet the best of them are but trouble and sorrow, for they
quickly pass, and we fly away.
Psalm 90:10
He's forgotten me. He can't be in any hurry to see me. He knows
me all too well."
Jeanne Calment [lived 122 years and 164 days 31].

Our lives can be prolonged by physicians
not one day; we live as long as God has
decided. But there is a great difference
whether we live miserably, like poor
dogs, or well and healthy; a clever doctor
can do a lot in that respect.
Johann Wolfgang von Goethe, in a conversation
with F. von Müller, August 12, 1827.

It's only when we truly know and understand
that we have a limited time on earth -- and
that we have no way of knowing when our
time is up, we will then begin to live each day
to the fullest, as if it was the only one we had.
Dr. Elisabeth Kübler-Ross

Preamble
Aim and Purpose
Identify typical emotions involved in loss
and grief, death, and the grieving process.
Identify various emotions in the mourning
process.
Develop a healthy outlook to deal with loss
particularly death.
Discuss how to assist a client develop a
healthy outlook concerning loss especially
when facing prospects of death.

The Meaning of Life
Life has meaning under all
circumstances, even the
most miserable ones.
Our main motivation for
living is our will to find
meaning in life.
Viktor Frankl
Man's Search for Meaning

Preamble
Although inquiry on the nature of death is familiar to
philosophers and theologians, doctor and nurses,
most people actively avoid the subject of death.
However, even for the least introspective among us,
the ever present fact of mortality constantly threatens
to wake us from the dream of the reality of life. Yet,
when sudden death, serious injury, or terminal illness
strikes our family or circle of friends, the foundation
of our world is shaken. From the moment an
individual is diagnosed with an incurable illness,
death becomes the alarm that will not stop ringing.
Even during remissions or times of relative health, its
distant ring can be heard, loudly or silently.

Preamble
The intrusion of death forces us to look at aspects
that we want to assume or avoid – life and death.
Hitherto philosophical issues that seemed abstract
and avoidable, such as how long a human being
lives, acquire concrete relevance and immediacy.
Existential concepts such as the ‘aloneness’ of each
individual in the universe become all too real when
faced with the approaching and inevitable death –
the loss of everyone and everything we know and
love. The person living with progressive illness
directly experiences the profound implications that
issues of meaning and value of life hold for the way
we live, individually and collectively.

Life and Death
• Life is a gift from God, the supreme supernatural
being. As a result, we will not live forever and will
physically depart this world through death.
• Death is the permanent cessation of all biological
functions that sustain a living organism. It is
experienced by every living organism and hence by
every human being.
• Even if one escapes death by all means, it is still
the final stage of growth. Thus, while young people
may ignore the existence of death majorly because
of their egocentric feelings and the perception that
they are not as vulnerable, older people and the
aged begin to think of their own demise.

Life and Death
• Death is a loss, the greatest of all loss that involves
life. It is such an enduring finality.
• Several phenomena commonly bring about death.
Death may be by natural causes (disaster, aging,
disease) or caused by human fault (war, murder,
suicide, accidents). Causes of death include:
aging, predation, disease (illness), suicide, murder
(homicide), deprivation (malnutrition, starvation,
dehydration) or fatal accidents.
• Some of the factors that cause death may be
lethal, leading to sudden death (instant /
immediate), while in certain instances, it takes
some time (process) before death finally ensues.

Death
- Societies, Communities, Religion (Faith), Philosophy
and Psychology, as well as people, interpret life and
death in various ways.
- In the more traditional societies, death is part of the
life cycle (birth, living [marriage, family, old age],
death and life thereafter).
- Various religions will interpret life and death
according to their philosophical underpinnings.
- Modern medicine, Science and technology will
explain life and death in logical ways. For instance,
that the human body, like other aspects of lfe,
expires.
- It must be admitted that even modern medicine,
science and technological advancement may not

Death
Death is a part of living, for just as there is life, there is
death. Various factors influence how we learnt about
life and perceive death, including our ideas, views and
beliefs about life/death. They include the following:
Family
Religion and Religious beliefs
Friends and Peers
Superstitions
Experiences with death
Media
Science and Fiction
Academics, Health, Philosophy and Psychology

Death
• The death of human beings is considered highly
unpleasant. This is because of the affection that
exist in human relations.
• The emotions of parting as a result of death can be
overwhelming for humankind. But still, it is such an
eventuality. Ultimately, we lose our relatives and
friends to death.
• Thus, and unfortunately so, there comes a time
when one comes face-to-face with the death not of
‘others’ but someone so close and intimate to
them, somebody dear and close to us.
• As a result, the inevitability of death imposes
several burdens on us and our loved one.

Imminent Death, Someone Close ...
• The knowledge that one is about to die is one of
the most difficult and exceptional circumstances –
that life will soon be no more, that the future is
uncertain, and that it will be all over soon.
• The pain of knowing that one is facing death is so
intense that no one is that enabled to deal with it.
• The pain and the inherent confusion can be
extremely overwhelming. A person will struggle to
deal with the consequences after the news.
• The effects of the imminent death influence all
facets of our lives, including health, family,
emotions as well as our decision-making
processes.

PhysicalPhysical
Spiritual
Emotional
Social
Psychological
Cognitive
The pain of grief can disrupt physical
life, making it sometimes difficult for you
and the person to go about everyday
activities such as eating, sleeping,
showering and all. The person may
experience a loss of appetite and
difficulty sleeping.
Assist the person set up a daily routine
and focus on the future and not on the
unfortunate predicament.
Imminent Death, Someone Close ..
5/5/2018
Dr Geoffrey Wango, Psychology Department,
University of Nairobi 15

Spiritual
Emotional
Social
Psychological
Cognitive
PhysicalPhysical
There is the obvious feelings of
uneasiness as the future appears
blocked or out rightly blank. The news
of imminent death may make it appear
as if there is no inherent future. Yet
there is life till the end of it all.
The person needs to feel emotionally
encouraged. Also, the family members
and friends need to encourage each
other as well.
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Spiritual
Emotional
Social
Psychological
Cognitive
PhysicalPhysical
The effect of such looming loss is so
strenuous that it affects everyone. This
includes the thought processes, and
ability to think straight (coherently). This
is because the pending demise causes
intense grief to all.
Assist the person to focus on several
activities, especially matters of
immediate concern to him or her, and
the family.
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Spiritual
Emotional
Social
Psychological
Cognitive
PhysicalPhysical
The person experiences all kinds of
different and unexpected emotions,
from shock to anger and
disappointment, to pain and disbelief.
Family members share in this emotional
turmoil. This is extended to guilt and
profound sadness.
Prayer and meditation, as well as family
and friends, can assist to uplift
everyone’s emotions.
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Spiritual
Emotional
Social
Psychological
Cognitive
PhysicalPhysical
There is a lot of confusion and
uncertainty. You or the person may
even be unsure of what to tell God, or
even pray. This is as a result of inability
to comprehend godliness, or what to tell
God. It is also problematic at this time to
comprehend the following: (1) The Will
of God; (2) The Power of God; and, (3)
The Spirit of God. Faith, life and
hereafter may be incomprehensible.
Maintain your Faith in God and
encourage him or her. Pray more often.
Meditate upon the Lord.
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Spiritual
Emotional
Social
Psychological
Cognitive
PhysicalPhysical
Respect their desire and guide them
where necessary.
The person may feel socially isolated
and feelings of loneliness. This is
because of a tendency or inclination
that they are alone on the life journey.
The truth is, death awaits all of us, and
for some, it is immediate while for
others they get some additional time.
The person has the sort of additional
time to prepare. Let him or her use it to
socialize with family and friends,
colleagues and other acquaintances..
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The Ultimate Realization: The Truth
About Death …

What happens when the
news comes in of imminent
death to someone so close
and dear to us ..

The Eye in the Needle …News
- News of someone close to you facing imminent
death comes as a result of several factors:
- The person may be ageing gracefully and
hence death is imminent.
- Terminal illness and hence a diagnosis.
- A fatal accident and the unfortunate
misfortune that she or he will not recover.
- Both doctors and nurses will consult and
counsel him or her as they divulge medical
details. The news may be at most shocking.
- It is essential that they be accompanied by a
family or close friend to receive the news.

The Eye in the Needle …News
Regular Life and Effective Transformation in Management
towards Coping with Imminent Death
Stage 1
Regular
Life
Stage 2
Change /
Revolutio
n
Stage 3
Prognosis
Stage 4
News
Stage 5
Treatment
/
Manageme
nt
Standard
Living into
Feeling
unwell /
Travelling /
Ageing
Hospital
visit /
Accident /
Aged
gracefully
Actual
Diagnosis /
Results –
Outcome /
Ageing-
weakened
body organs
Transformation
/ Disclosure
Coping and
Adjustments
/
Modifications
and
Amendments

- After the news and the person has calmed down, it is
imperative that you grasp the situation. If possible,
you can find out the following:
- Nature of illness / Extent of injury.
- Detailed medical analysis.
- How much time is at hand.
- Note that the doctors and nurses will be cautious
depending on the circumstances. Also, in certain
instances, it may be difficult to conduct a thorough
diagnosis and thus quantify the extent of illness as
well as the time left. Many persons in developing
countries have to contend with limited medical
analysis and care, and hence altogether may miss out
on important medical details.
Eye in the Needle …Find out …

Death and Dying
Admittedly, life and
death are a part of us.
We are aware that
death and dying are
imminent. The
question is when and
how.

Death and Dying
A major life challenge is
to be made aware that
someone close to you
(child, parent, spouse,
relative, friend or
colleague) is going to
die, or facing imminent
death.

Death and Dying
The most important
thing to do is to
assist the person to
‘Live well’, and ‘Die
well.’

Death and Dying
- The relationship between the person or patient
and care givers (family, nurse, doctor, relatives,
clergy, friends, colleagues and other
acquaintances) is key to helping the patient
deal with the upcoming finality with courage
and determination.
- Do not interrogate the person or moralize them;
instead, allow them to express themselves in
order to obtain finer details. In addition, allow
the person express their emotions. This
enables him or her ease pain including through
crying.

Meeting the needs of the Dying Person
Meet the needs
of the dying
person:
-Physical
-Psychosocial
-Spiritual

Create a nursing
and therapeutic
care. This enables
to plan for death
and assists the
dying person /
patient.

The Medics
(Doctors and
Nurses) have a
role in loss,
grief, death and
dying.

What to Expect …
There will be changes and deep transformations in the
life of the person. These include:
Change in attitude towards life
Change in health (at worst deteriorating health)
Financial implications (including bills)
Other changes such as memory loss
Some people will try to assure you and the person that
‘everything will be alright,’ but the truth of the matter
is that certain aspects of your lives will change. For
example, you will be losing your parent, child, relative,
friend, colleague or acquaintance.
It is important that you adjust and accommodate
these changes, alterations and/or modifications.

The Ultimate Realization: The Truth
About Death …
The ultimate realization occurs when we recognize
that life and death are interconnected, for just as there
is life, there is death. And truly, death is a reality not a
finality.
Dr. Geoffrey Wango

What to Expect: Care and Care Giving
Duties
Caregivers look after the persons’ (patients’) needs
such as health and hygiene, physical and
psychological wellbeing including food, clothing,
beddings, medication and spiritual nourishment.
Looking after a seriously sick person can be
burdensome. This is because the caregiver attends
to the person all day long. Circumstances may
sometimes require the caregivers (doctors, nurses,
family, relatives) to have a regular rota of caring.
Finally, the demands of round-the-clock care and
mental stress can become overwhelming.

What to Expect: Care and Care Giving
Duties
Some people or patients have to be looked after
24/7. There are the hospital visits, washing and
dressing, feeding, taking medicine and if possible
taking the person out for relaxation purposes.
In several instances, the house or home may be
specially adjusted to adopt to the needs of the
person / patient.
If caring eventually becomes too hard to handle,
the person (or patient) can be moved into
permanent (or health) care centre.

Principles of Palliative and Hospice Care
Adhere to the principles of palliative and
hospice care. These are:
Respects the goals, likes and choices of the
dying person.
Looks after the medical, emotional, social,
and spiritual needs of the dying person.
Supports the needs of the family members.
Helps the person gain access to needed
healthcare providers and appropriate settings.
Builds ways to provide excellent end-of-life
care.

What to expect when
someone close to you
is facing imminent
death …..

Ensure the person is safe and
comfortable. This includes food,
clothing, shelter, safety and security,
and a clean environment such as
house, utensils and beddings.
Physical needsPhysical needs
Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Medical Needs
Psychological /
Emotional Needs
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The person requires proper medication
(regular and stipulated hospital
attendance), including taking drugs and
attending clinics as appropriate. A
proper diet and good nutrition are part
of good health.
Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Psychological /
Emotional Needs
Medical needsMedical needs
Physical needs
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Provide psychological and emotional
support particularly aligned to the needs
of the person, such as making the
person feel comfortable. In addition, the
presence of family members (parent/s,
spouse, child/ren), friends and
colleagues, prayers and general comfort
reassures the person that they are
valuable.
Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Psychological /
Emotional Needs
Physical needs
Medical Needs
You can also allow the person to
disclose anything to the family such as
nature of illness and other issues (such
as property hitherto unknown, will,
trust). Let them choose what to say.
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There are several issues that may
require legal consultation, such as
preparing a will, trust, unpaid or
uncleared debts and other pending legal
issues. Ensure that they are sorted out.
Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Physical needs
Medical Needs
Psychological /
Emotional Needs
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Finances can be burdensome especially
after a prolonged illness. These include
bank loans and mortgages, insurance,
extra incurred expenditure as well as
other commitments to dependant
persons. There is need to clear burdens
of loans and debts to provide a more
relaxing environment for the person /
patient.
Additional Support
Services
Spiritual needs
Financial needs
Physical needs
Medical Needs
Psychological /
Emotional Needs
Legal aspects
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Religion and spiritualism, as well as
faith and prayers are very important to
many people. Allow the person
experience their spiritualism through
prayer and meditation as well as
(unlimited) access to their spiritual
leader or a member of the clergy. Do
not force them into religion or faith at
this time as a result of their imminent
condition.Additional Support
Services
Spiritual needs
Physical needs
Medical Needs
Psychological /
Emotional Needs
Legal aspects
Financial needs
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Counselling and Therapy are significant.
Additionally, friends and family provide
a lot of support. This includes sharing
fond memories with the person.
Additional Support
Services
Physical needs
Medical Needs
Psychological /
Emotional Needs
Legal aspects
Financial needs
Spiritual needs
Person may be withdrawn and refrain
from social activities. They will tend to
spend time alone. A person may also
experience increased anxiety,
discomfort, confusion, agitation and/or
nervousness.
5/5/2018

The truth is, just as we go about life courteously, we
cannot simply walk away from death. Hence, we
must adopt strategies that enable us to walk
gracefully through life even when we know that
there is death, for we must have greater hope beyond
the visible horizons.
Dr. Geoffrey Wango

The person (or patient) needs to be happy. Finding happiness
is the sort of care that brings about hope by illuminating life.
It goes beyond ordinary life activities (routine) to reach the
heart and express special warmth. This includes special
outings other than the regular hospital (medical visits). You
or the carer giver can also take the person (or patient) for a
walk, drive or enable them take time to look out, admiring the
sunshine, trees and flowers. The person can also watch
television or listen to music. If possible, assist them take a
walk to the garden, go out to listen to outdoor concerts, visit
designated places of worship (Church, Cathedral, Mosque),
drive through the farm or garden, or visit a favourite spot
(such as building, home, place of worship.
Finding Happiness through Tender Loving
Care

- Care giving requires effectiveness, safety,
person / patient centeredness and coordination.
Care must be of quality, efficient and accessible.
- Care giving requires thoughtfulness in order to
provide necessary and efficient quality services
from doctors, nurses, social workers (including
counselors, clergy) and other non-medial staff
(family, relatives, friends and other
acquaintances).
Finding Happiness through Tender Loving
Care

Tender Loving Care is the one and only
way to find happiness amidst the cloud of
grief and imminent loss.

Disclosure - Giving it Out, Not Grieving it on
- Disclosure is the act or action of making new or
unknown or secret information known.
- Disclosure is a highly volatile and touching issue
especially when it touches on illness, and worst to
impending death.
- The information about the intensity of the situation
can be overwhelming to all, particularly the children,
spouse, relatives, friends and colleagues at work or in
the neighbourhood. It is difficult, if not appalling for
someone to tell their spouse, child or friend that it is
all over and not out of lost love!
- Indeed, many people tend to prefer the veil of
secrecy about anticipated death. This is especially
critical when the news will affect lots of people.

Disclosure – Preparation and Rationale
- Disclosure of personal information is a pertinent issue though
obviously a precarious and emotional one. Therefore, allow
and assist the person to prepare adequately as follows:
(1) Time and timing. This is highly critical. The person must be
ready, just as the family members, relatives, friends and
others must be prepared. Also, as much information as is
necessary should be availed to avoid creating confusion.
(2) Spouse, child/ren, family, friends, colleagues. Let the person
identify the person/s to reveal the information.
(3) Information to disclose. The person should choose what to tell
and what not to. This implies a rational precariousness or
action of making unknown or secret information known.
(4) Professional expertise. Ensure that there are several
professionals, including doctors and nurses, a counsellor and
a member of the clergy to assist with various needs.
- Disclosure can be done at home or in hospital.

Disclosure – The Process, What Happens
- If at all possible, the person can tell the members present
the purpose of meeting. It is healthy for him or her to do the
disclosure, unless they are unable owing to circumstance.
- There is likely to be commotion as some members cry,
others scream and some even faint. The initial outburst of
tears and moment of sadness is healthy as everyone,
including the person/ patient comes to terms with the reality.
- There will be pertinent questions that will be asked. It is
essential that these be answered or explained, and the
family should be present as issues are resolved.
- Steps should be taken to ensure that professionals and
family members are duly invited. The question-answer
session will include: What? Who? Where? How? Why?
(medical diagnosis, progress, options, estimated time).

Disclosure – The Anger, Why it Happens
- There is a lot of anger and resentment. Depending on the
circumstances, people including yourself will be angry with
anyone and anything they can lay some blame on: the
person who caused the accident; relatives who had
neglected your close family member or friend; doctors and
nurses for failure to conduct a proper (earlier) diagnosis;
doctors and nurses for neglecting the person / patient, and
all the other reasons that can take the blame.
- People react differently to anger – some people are able to
control the intensity of anger and resentment, while others
will pour it all in a rage.
- This is also the time to deal with your own anger; to forgive,
love and care for the person more. That way you regain
inner energy. Also, if anyone is angry with your close family
member or friend, or you are aware of past mistakes done
to others, seek their forgiveness on his or her behalf.

Interpretation of Life and Death is
found in living a fulfilling life.

Why so afraid of Death …
Why not so afraid of Death
Some people are so scared of death, while others
are not as frightened. This depends on several
factors such as gender, age, life goals, personality
and circumstance.

 Goals have been fulfilled (career, family, home). Also, people who
are secure with certain plans for their future are more contented.
 Older people, as they have experienced all aspects of life.
 People who have tended to live longer than expected.
 Males tend to be more afraid of death than females.
 Child/ren and teenagers growing up are terrified of death.
 People who are generally happy and contented in life tend to
dread death.
 Religious / Spiritual people are more hopeful of life hereafter.
 Persons who have come to terms with finitude.
 Dealing with the deaths of several relatives, friends and
acquaintances tend to reduce the anxiety of death.
 Certain professionals such as persons working in armed forces
(military and police officers) and medicine (doctors and nurses)
and others (social workers, counselors and clergy) have
experience of death which reduces their panic of death.
Why not so afraid of Death …

Why so afraid of Death …
 Poor planning, lack of clear goals and an unfulfilled life (career,
family, home) makes the person miserable and disillusioned.
 Young people are not sure if it is time yet and dread death.
 Parents, especially young mothers, are fearful of death of their
child/ren.
 The unexpected news of death can be traumatic as people may
have tended to think they would live a longer life.
 Males tend to be more afraid of death than females.
 Child/ren and teens are terrified of death because of side effects.
 People who are disappointed in life and others who are depressed
are actually scared of death as it marks their failure.
 People who are not religious / spiritual dread the future afterlife.
 A person who has experienced the deaths of several relatives,
friends and acquaintances can also fear death.
 Professionals who don’t deal directly with death may panic at the
mention of death.

Tops
Tips

When life is meaningful to us, we value it much
more – you value your spouse, children,
family, friends and colleagues more. You value
the time that you have together more, and you
are careful to make more special moments,
treasure these moments, and remember those
moments much more when the person is alive
and when they are long gone. That way, your
spirit is lifted up.
Dr. Geoffrey Wango, Counselling Psychologist, University of Nairobi

Physical Support
(Hospital,
Medicine, Clinic,
Drugs)
Physical Support
(Hospital,
Medicine, Clinic,
Drugs)
Social
Psychological
Support Services
Social
Psychological
Support Services
Spiritual Nourishment
(Religion and Faith, belief in
the Supernatural – God)
Spiritual Nourishment
(Religion and Faith, belief in
the Supernatural – God)
60
Care
Self Care and
Personal
Upliftment
Regular
exercise
Regular
exercise
Healthy
diet and
Nutrition
Healthy
diet and
Nutrition
5/5/2018
University of Nairobi

Find out anything
the person would
like done and assist
them. They can tell
you or write it down.

It is important that the persons
adhere to the following:
Attend hospital and clinics as
scheduled.
Take drugs as prescribed.
Eat a healthy diet full of nutritious
food.
Regularize their life as much as
possible.
Take a lot of water.
If possible, adopt regular walks
and exercises.

It is important that your loved one
comprehend what having this period of time
means to them, to you and others. It is
therefore helpful that they characterize life
as a gift. This in turn allows them time to
prepare self, family and significant others for
their physically absence. It is also a glad
opportunity to tie up loose ends. Let him or
her take this as an opportunity of
reconnecting with those close to him or her.
These are people who have shared, and
continue to share, their lives with him or her,
who touch their lives and are close to each
other. Let them connect with each other.
-

Encourage the person each moment
and everyday.

Assist the person sort out thoughts from
worries and anxieties. This enables the
person to:
(1)Lift a lot of weight off their shoulders.
(2)Identify various action points and
prioritize them.
(3)Work out on several loose ends
(preparing a will, clearance of financial
obligations such as loans and mortgages).
(4)Avoid being desperate and a miserable
sod. Instead, encourage him or her to
meditate and sort out various issues.

Let the person find happiness in their
heart rather than in the circumstances.

- Encourage the person to make
noble and valiant sentiments after
the prognosis. In addition,
encourage him or her to make
amends with persons who may be
unhappy with him or her. Apologize
if necessary and seek their
forgiveness as well. This lifts a lot
of unnecessary weight off their
shoulders to enables the person
find inner peace.

- Ensure that the person spend the
little but precious final time left in
familiar grounds with family and
friends including spouse, child/ren,
parent/s, relatives, caregivers,
neighbours, colleagues, clergy and
other acquaintances.
- Illuminate radiance so that you can
provide emotional support, love and
assistance to the person and those
close to him or her, and thus offer
them hope amidst the difficult
circumstances.

 Keep thanking the family members
and friends for the love and care at
every moment. These include:
spouse, child/ren, parent/s, relatives,
caregivers, neighbours, colleagues,
doctors and nurses, clergy and other
acquaintances.
 Show appreciation and at the same
time encourage them.
 Those dearest and closest to the
person may demand to be with him or
her all the way to the final end. Allow
them and explain the circumstances.

- It is significant that you maintain
and uplift their religious / spiritual
life. Their faith may face the
hardest test as they try to reconcile
with fate. If they are not spiritual,
you can consider asking them to
establish such a relationship with
the supernatural being, but don’t
forced it.
- Then, allow God to take their spirit
and commit it to God.

Ensure that, as much as possible,
the person makes the necessary
arrangements for those left
behind. This includes: will, trust,
insurance, financial issues, any
wishes and other statements.
Meeting the
needs of those
left behind,
the bereaved:
-Physical
-Psychosocial
-Spiritual

Someday you will read or hear that Billy
Graham is dead. Don’t you believe a word
of it. I shall be more alive than I am now. I
will just have changed my address. I will
have gone into the presence of God.
Evangelical Pastor Billy Graham
1918 - 2018

The Final Moments - What to Expect
The following are notable developments and how to
deal with them:
The person may keep talking about death, and state
that he or she is going to die soon > Reassure them by
offering them hope.
Less interest in eating or drinking: the person may
have poor appetite and insist they do not feel like
eating > Let them eat and drink frequently: vary the
diet.
Person may have difficulty eating food and
swallowing > Encourage them, be patient.
Person may be increasingly unresponsive or refuse to
speak > Be patient and try interesting topics.
You may notice a marked change in personality >

The Final Moments - What to Expect
The person may not move for longs periods of time >
Encourage them to take a walk and do various
exercises.
Assist to make the person comfortable at home and/or
in hospital. This includes bathing, changing clothes and
in feeding him or her. You can also assist with back
rubs, holding hands, reading for them and background
music. Visit by family, friends, support staff (doctors
and nurses, spiritual leader) and colleagues is highly
reassuring and significant. Listen to the person talk
about their feelings without interruption. Also, do not
disregard those sentiments or dismiss the person.
These activities and talking to the person can be very
comforting. The person feels reassured and also helps

The Final Moments ….
• There will be a few, and additional losses as time goes
by, like limited or prohibited movement, loss of speech,
as well as the senses including smell, sight or inability
to eat. Take courage.
• One of the major aspects as circumstances deteriorate
is that you and the person or patient might find
yourselves preoccupied with death. Yet the end will
come in its own time. The preoccupation with death
can be overcome with the support of the family and
friends, and keeping the person busy with what they
can do like listening to music, watching television or
reading a book if they can. You can also read for him or
her if they ask you to do so.

• It is heartbreaking watching people do everything for you,
particularly your spouse, child/ren, friends, relatives,
doctors and nurses, caregivers and others. There is the
feeling of helplessness and self pity. This can also affect the
person, including eroding not only their self esteem but
their health and psychological well being as well. Cheer him
or her up and encourage them with a smile. You can also
express it to them so that you understand and are
contented with it and glad that you were of help.
• There are also the feelings when they want to hug and kiss
their loved ones, greet friends, wave goodbye, make a visit
colleagues but it is just not possible. Offer a lot of
encouragement.

When the person is strong enough, let him or her provide
as much information and details as possible to enable
those left behind sort out numerous issues. These include:
will, property, account details, money, and any final wishes
like where they would like to be buried (or options such as
cremation). The reason why people, especially males in the
more traditional societies, are in such pain and fear of
death is because they have too many secrets.
Subsequently, they are so scared of death even when it is
so imminent. In the end, such a demise leaves the family,
relatives and friends in utter confusion as they don’t know
what to do, including where to start. Eventually, the family
is in turmoil and a lot of time and property is lost in endless

• Encourage the person to gain greater confidence in
the person they love, even in this difficult
circumstances. Additionally, let the person or patient
appoint someone they trust to sort out their issues
(bank account, property, will, trusts, family and other
obligations). This implies that even as she or he grows
weak and weary, they can resolve certain issue/s.
• It is possible that if they have lived a happy and
contented, fulfilling life, they will breathe with ease as
they pass into the world of external silence.

References
American Psychiatric Association (2013). Diagnostic and Statistical Manual
of Mental Disorders DSM - 5. Washington, D C: American Psychiatric
Association.
Bone, R. C. (1997). Benediction: A farewell to my medical
colleagues. Consultant, 37 (9), 2505 - 2507.
Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we
underestimated the human capacity to thrive after extremely aversive
events? American Psychologist, 59, 20 - 28. doi: 10.1037/0003-
066X.59.1.20.
Byock, I. (2002). The Meaning and Value of Death. Journal of Palliative
Medicine, 5 (2), 279 - 288.
Calhoun, L. G., & Tedeschi, R. G. (2013). Posttraumatic growth in clinical
practice. New York, NY: Routledge.
Calhoun, L. G., Tedeschi, R. G., Cann, A., & Hanks, E. A. (2010). Positive
outcomes following bereavement: Paths to posttraumatic growth.
Psychologica Belgica, 50, 125 - 143. doi: 10.5334/pb-50-1-2-125.
Cook, J., Gold, S., & Dalenberg, C. (Eds.), (2016). APA handbook of
trauma psychology. Washington, DC: American Psychological
Association.

References
Firestone, R. E., & Catlett, J. (2016). Beyond death anxiety: Achieving life-
affirming death awareness. New York: Springer Publishing Company.
Kramer, K. (2005). ‘You cannot die alone: Dr. Elisabeth Kübler-Ross’ (July
8, 1926–August 24, 2004). OMEGA-Journal of Death and Dying, 50 (2),
83 - 101.
Kübler-Ross, E. (2009). On death and dying: What the dying have to teach
doctors, nurses, clergy and their own families. Taylor & Francis.
Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the
meaning of grief through the five stages of loss. New York, N.Y.:
Scribner.
Neimeyer, R. A. (Ed.). (2012). Techniques of Grief Therapy. New York, NY:
Routledge.
Neimeyer, R. A., Klass, D., & Dennis, M. R. (2014). A social constructionist
account of grief: Loss and the narration of meaning. Death Studies, 38,
485 - 498.
Perlman, L. A., Wortman, C. B., Feuer, C. A., Farber, C. H., & Rando, T.
(2014). Treating traumatic bereavement: A practitioner’s guide. New
York, NY: Guilford.

References
Plaut & Roark (2004). ‘Grief Process, Death and Dying.’ [PowerPoint
Presentation].
https://www.slideserve.com/miles/grief-process-death-and-dying, Uploade
.
Tedeschi, R., & Calhoun, L. (2008). Beyond the concept of recovery:
Growth and the experience of loss. Death Studies, 32, 27 - 39. doi:
10.1080/07481180701741251.
Thompson, B. E., & Neimeyer, R. A. (2014). Grief and the expressive arts:
Practices for creating meaning. New York: Routledge.
Trisel, B. A. (2015). Does Death Give Meaning to Life? Journal of
Philosophy of Life, 5 (2), 62 - 81.
van der Kloot Meijburg, H. H. (2005). The significance of dying well. Illness,
Crisis & Loss, 13 (1), 49 - 62.
Wango, G. M. (2018). ‘Loss, Grief and Bereavement: Coping with Loss and
Grief.’ [PowerPoint Presentation]. Nairobi: University of Nairobi.
WanYalom, I. D., & Lieberman, M. A. (1991). Bereavement and heightened
existential awareness. Psychiatry, 54, 334-345.21.

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