Living with death coping with life when starring death in the face and the anticipation of death and dying dr geoffrey wango

7/7/2018 1Dr Geoffrey Wango, Psychology Department, University of Nairobi
Dr. Geoffrey Wango
Senior Lecturer
Counselling Psychology
University of Nairobi
Living with Death: Coping with Life
when Starring Death in the Face
and the Anticipation of Death and
Dying

I don’t mind dying, I just don’tI don’t mind dying, I just don’t
want to be there when itwant to be there when it
happens.happens.
Woody Allen

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
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]

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

The Meaning of Life

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 assume or avoid – life and death.
Hitherto philosophical issues that seemed abstract
and avoidable such as how long a human being can
live 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 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 losses 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, is takes some time
(process) before death finally ensues.
Life and Death

• The death of human beings is considered highly
unpleasant. This is because of our attachment to each
other and the affection that exist in human relations.
• The emotions of parting as a result of death can be
overwhelming for humankind. But still, death is such
an eventuality.
• Ultimately, we lose relatives, friends and colleagues to
the hand of death.
• But, and unfortunately so, there comes a time when
one stops talking about the death of others and
focuses on the death that perhaps is most significant
of all, the demise of self.
• As a result, the inevitability of death imposes several
burdens on us and our loved one.
Death

Imminent Death
• The knowledge that one is about to die is one of
the most difficult and exceptional circumstances –
that life will soon be no more, the uncertainty of the
future, and that it will soon be all over.
• 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 facets
of our lives, including health, family, emotions as
well as our decision-making processes.

The pain of grief can disrupt physical
life, making it sometimes difficult to go
about everyday activities such as
eating, sleeping, showering and all. You
may therefore experience a loss of
appetite and difficulty sleeping.
PhysicalPhysical
Spiritual
Emotional
Social
Psychological
Imminent Death
Cognitive
Set up a daily routine and focus on your
future and not on the unfortunate
predicament.
7/7/2018
Dr Geoffrey Wango, Psychology Department,
University of Nairobi 15

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.
Spiritual
Emotional
Social
Psychological
Imminent Death
Cognitive
PhysicalPhysical
You need to feel emotionally
encouraged.
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Sometimes the effect of such looming
loss is so strenuous that it affects your
thinking and reasoning, or ability to think
straight (coherently). This is because
the pending demise causes intense
grief.
Spiritual
Emotional
Social
Psychological
Imminent Death
Cognitive
PhysicalPhysical
Focus on several activities, especially
matters of immediate concern to you
and /or your family.
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You experience all kinds of different and
unexpected emotions, from shock and
anger, to pain and disbelief that extends
to guilt and profound sadness.
Spiritual
Emotional
Social
Psychological
Imminent Death
Cognitive
PhysicalPhysical
Prayer and meditation, family and
friends assist to uplift your emotions.
7/7/2018

Spiritual
Emotional
Social
Psychological
Imminent Death
Cognitive
PhysicalPhysical
At first, one may 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 can
somehow get incomprehensible.
Maintain your Faith in God. Pray more
often. Meditate upon the Lord.
7/7/2018

You may feel socially isolated and suffer
feelings of loneliness. This is because
of a tendency or inclination to feel that
you are alone on the life journey. The
truth, however, is that death awaits all of
us. For some, it is immediate while
others some additional time. You are
one of those with additional time so use
it to socialize with family and friends,
colleagues and other acquaintances.
Spiritual
Emotional
Social
Psychological
Imminent Death
Cognitive
PhysicalPhysical
7/7/2018

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

Meaning: The Interpretation of Life
and Death is found in living a
fulfilling life

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

No one lives
forever.
This is the
simple truth.

What happens when the
news comes in of imminent
death ..

The Eye in the Needle …News
- The news that you are facing imminent death
comes as a result of several factors:
- You may be aging gracefully and hence death
is imminent.
- Terminal illness and hence a diagnosis.
- A fatal accident and the unfortunate
misfortune that you will not recover.
- Both the doctors and the nurses will see you
together to counsel you and divulge medical
details. The news may be at most shocking.
- It is essential that you be accompanied by a
family or close friend as you 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 /
Revolution
Stage 3
Prognosis
Stage 4
News
Stage 5
Treatment /
Management
Standard
Living into
Feeling
unwell /
Travelling /
Aging
Hospital
visit /
Accident /
Aged
gracefully
Actual
Diagnosis /
Results –
Outcome /
Aging-
weakened
body organs
Transformation
/ Disclosure
Coping and
Adjustments
/
Modifications
and
Amendments

Eye in the Needle …Find out …
- After the news and you have calmed down, it is
imperative that you grasp the situation. If possible,
find out the following:
- Nature of illness / Extent of injury.
- Detailed medical analysis.
- How much time you have 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.

Amidst all these, sort
things out if you are
starring death in the
face.

What to Expect …
There will be changes, deep transformations in your life:
Change in health (at worst deteriorating health)
Change in your attitude towards life
Financial adjustments with implications
Other changes such as memory loss
Some people will try to assure you that ‘everything will
be alright,’ but the truth of the matter is that your life is
changing, and certain aspects of your life will change as
well. For example, you may have restricted movement,
drugs to sustain your health, and medical bills. You will
also be concerned about leaving behind your parent,
child/ren, relatives, friends, colleagues or acquaintances.
It is important that you adjust and accommodate these
changes, alterations and/or modifications.

Ensure you are safe and comfortable.
This includes adequate 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
Sorting Things Out … All Change!
Psychological /
Emotional Needs
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Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Medical Needs
Psychological /
Emotional Needs
Physical needsPhysical needs You require 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.
7/7/2018

Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Medical Needs
Psychological /
Emotional Needs
Renew your energy by making yourself
comfortable, not miserable. In addition,
accept and appreciate the presence of
family members (parent/s, spouse.
Child/ren), friends and colleagues.
Prayers and general comfort raises your
self esteem and reminds you how
valuable you are to all these people and
others.
You can disclose anything to the family
such as nature of illness and other
aspects (such as property hitherto
unknown, will, trust).
7/7/2018

Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Medical Needs
Psychological /
Emotional Needs
There are several issues that may
require legal consultation, such as
preparing a will or trust, unpaid or
uncleared debts, and other pending
legal issues. As much as possible,
ensure that they are resolved.
7/7/2018

Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Medical Needs
Psychological /
Emotional Needs
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 defendant
persons. There is need to clear the
burden of loans and debts to provide a
more relaxing environment.
7/7/2018

Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Medical Needs
Psychological /
Emotional Needs
Religion and spiritualism, as well as
faith and prayers, are very important to
many people. This is an opportunity to
access more of your spiritualism and
hence a glad opportunity to talk to your
spiritual leader or a member of the
clergy. Prayers and meditation come in
hardy. But do not force yourself into
religion or faith at this time as a result of
the imminent condition.
7/7/2018

Additional Support
Services
Spiritual needs
Legal aspects
Financial needs
Medical Needs
Psychological /
Emotional Needs
You may feel withdrawn and a greater
tendency to refrain from social activities.
You might also tend to spend time
alone. Some people also experience
increased anxiety, discomfort,
confusion, agitation and/or
nervousness.
Counselling and Therapy are significant
at this juncture. Additionally, friends and
family provide a lot of support. This
includes sharing fond memories.
7/7/2018

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

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, to
tell your 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.

- Oftentimes, the impending death is an open secret
especially when it is obvious to everyone that the
situation is critical or circumstances have changed
and chances of living have diminished.
- Lets admit it; there is a time for everything. And
certainly, in disclosing one’s fatal condition and/or
health. Even in the more traditional societies the old
would gather the children around in old age or in
times of sickness and talk about life in their absence.
This was to prepare the family for the inevitable.
- However, even in disclosure there are pertinent
issues to be resolved beforehand. There are also the
reactions, both the positive and the not so
encouraging, as well as the implications.

Disclosure – Preparation and Rationale
- Disclosure of personal information is a pertinent issue though
obviously precarious and emotional. Therefore, prepare
yourself well after establishing all the facts as follows:
(1) Time and timing. This is highly critical. You must be ready, just
as the other persons must be prepared. Also, you must have
all the information to avoid creating confusion.
(2) Spouse, child/ren, family, friends, colleagues. Find out and
identify person/s to reveal the information. It is possible you
don’t want to publicize personal information.
(3) Information to disclose. Establish clearly what you want to tell
them. This implies a rationale precariousness or action of
making new or unknown or secret information known.
(4) Professional expertise. Ensure that there are several
professionals, including doctors and nurses, counselors and
members of the clergy to assist with various needs.
- Disclosure can be done at home or in hospital.

Disclosure – The Process, What Happens
- Disclosure is not just talking or calling people to give them
news or briefs; it involves communicating essential and
imperative information to persons who matter to you, because
you are highly significant to them. Hence, what you say and
how you say it are all important. Do not create panic but aim at
positively encouraging everyone, which includes cheering
yourself as well.
- The disclosure session should be well organized so that there
will be the person/s guiding it (doctor, nurse, specialist/s,
family member, family doctor, family friend, member of the
clergy, counselor).
- The person/s will explain that the members are there to obtain
additional information regarding the condition of the person (or
patient) and hence the presence of others, including the
professionals. Lastly, the professionals will reassure the family
of continued support.

Disclosure – Who Should be Present
- If possible, all members of the family should be present at
this moment of crisis. The family meeting enables people
to find support in each other. Also, the predicament helps
bond the family together so that they can deal with the
predicament collectively as a team. This synergy is
important at this critical period.
- Additionally, as many professional members as possible
should be present to:
(1) Clarify professional issues such as type of illness,
condition and anticipated progression (including chances
of recovery, suggested medical procedures and other
issues; this includes family doctor and a specialist); and,
(2) Assist any member or members who may be
overwhelmed by the information.

Disclosure – The Process, What Happens
- If at all possible, you can tell the members present about the
purpose of the meeting and why you have called them. It is
healthy to do the disclosure yourself, unless you are unable
owing to the circumstances.
- There will be a lot of commotion as some members may cry,
others scream and others even faint. The initial outburst of
tears and moment of sadness is healthy as everyone,
including yourself, comes to terms with the reality.
- Pertinent questions may be asked. It is essential that these
be answered, explained and issues revolving around the
family resolved.
- This is why the professionals and family members are
indispensable. The question-answer session will include:
What? Who? Where? How? Why? (medical diagnosis,
progress, options, estimated time).

Disclosure – The Process, Why it Happens
- People will react differently to the news. After the initial
outburst of obviously strong and immediate emotions, some
people will reconcile to the inevitable, though some people will
take time. This depends on several factors as follows:
 Relationship with you - spouse, child/ren, parent/s, family
(relative and close and greater proximity), friend/s and
colleague. Some of the emotions may intensify with time.
 Gender (females may display their emotions while males will
tend to hide their tears especially in the more traditional
societies. It is alright to cry.
 Age (children are more likely to be greatly overwhelmed).
 Personality (some people are more resilient than others, also
depending on their love experiences).
 Intensity (and meaning hence implications) of relationship (you
may be the family provider, but even friendship and
interconnectedness varies in intensity).

Disclosure – The Anger, Why it Happens
- There is also the anger and resentment. Depending on
the circumstances, people will be angry with anyone they
can lay some blame on: the person who caused the
accident; relatives who had neglected you; doctors for
failure to conduct a proper diagnosis; doctors and nurses
for neglecting their patient and all the other reasons.
- People react differently to anger – some are able to
control the intensity of anger and resentment, while
others will pour it all out in a rage. Assure them about
everything that has been done to uplift your welfare.
- This is also the time to deal with your own anger; forgive
to enable you regain inner energy. Also, if anyone is
angry with you or you are aware of past mistakes done to
others, seek their forgiveness.

Disclosure –Left out …Not able to give in
- It may not be possible to tell everyone at the same time. Also,
some of the members of the family may not be immediately
present. The family meeting to enable disclosure cannot be
postponed endlessly just to get people together and one has
to do with the available members. In the same way, not
everyone can be told everything. For example, it is unwise to
divulge certain details to children of tender age (below 10
years, depending on child). In the same way, persons who are
aged, critically ill or suffering from psychological illness may
not fully comprehend the situation or benefit from the news
and hence may be left out. Also, there are persons in special
circumstances such as a child who is ailing or undergoing a
crisis, and those facing certain situations such as an upcoming
examination.
- Consideration should be given to the intensity of information
and whether to wait for a better opportunity so it is not hurried.

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

You need to be happy. Finding happiness is the sort of
feeling that brings about hope. It goes beyond ordinary
life (routine) activities to reach the heart and express
warmth. This includes special outings other than the
regular hospital (medical visits). You can also go for a
walk, drive or take time to look out and admire the
sunshine, trees and the flowers. You can also watch
television or listen to music. If possible, you can 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

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.

Meanings; Clarification of Life and 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 and 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

Meanings, Clarification of Life and 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,
the human body just like other aspects of life expires.
- It must be admitted that even modern medicine,
science and technological advancement may not
have found a cure for various diseases and ailments.

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 circumstances.

Why not so afraid of Death …
 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, counsellors and clergy) experience
death situations which reduces their panic 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 the death of their
child/ren.
 The unexpected news of death can be traumatic as people tend 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 those depressed are
actually scared of death as it marks their failure.
 People who are not religious / spiritual dread the 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.

Why so afraid. Or not Death …
However bad or challenging life is, there is always
hope. There will be love and laughter, just as there
will be frustrations and disappointments, including
when it appears as if there is nothing left. We must
cling to the hope and faith we have in God.
Search for positive prudent living such as a loving
spouse, happy children, great friends, wonderful
colleagues, caring doctors and nurses, fantastic
pastor and endless acquaintances.
Take the chance as a window of opportunity, not as a
death sentence, and you will make the best life - or
what is remaining of time.

Write down some
of the things you
would like to
accomplish in
life…

Write down
some of the
things you would
like to do before
you die …

Write down
some of the
things you have
accomplished in
life ….

I truly admire and cherish these words by Sir Winston
Churchill

- People are able to adapt more positively if they are able to
make sense of a loss. Writing creatively (letter, poem,
song, book, painting, journal) can aid greatly in the
grieving process. This is because of the expression and
reflectivity involved.
- In order to survive and thrive after loss, the person
requires making sense of what has been suffered, that is,
the loss. When a person makes sense of a loss, they are
in turn able to deal with the ensuing emotions.
- Writing and creativity help you to move from the anguish
and pain to healing, in that the process is inherently
calming and thus offers solace.
- If possible, you can express some of your experiences as
it is part of healthy grieving.
Writing and Creativity – Meaning-making
after a loss

- The expression (writing and/or creativity) reviews the
experiences, while at the same time threading them – the
loss (person) is acknowledged but adored and cherished,
thus crystalizing the experience. This helps to locate and
position oneself in relation to the goings on, particularly the
loss.
- Together, the loss and the writing constitute constructing new
life-giving experiences. It is also a way of passing time in
rather constructive ways rather than grieving. Thus, the
expression through writing and other creative constructs
enables the person to ‘write about’ the experience, and share
by ‘writing to’ others.
- Overall, it is a way of relieving the bad experience and at the
same time sharing with other(s).
Writing and Creativity – Meaning -making
after a loss

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

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)
68
Care
Self Care and
Personal
Elevation
Regular
exercise
Regular
exercise
Healthy
diet and
Nutrition
Healthy
diet and
Nutrition
7/7/2018
University of Nairobi

More by good luck than necessarily
good management, it is noteworthy to
have a strong network of family and
friends. Family members, friends,
colleagues and a strong support
mechanism are highly significant
when we are facing a major crisis. In
addition, your spouse, parent/s,
child/ren, friends, relatives and
colleagues can be a source of comfort
if they are by the side when the doctor
discloses the dismal diagnosis.

Some people, including family and
friends, may treat you differently after
learning that you are dying. Some will
abandon you completely. The reason is
because some are adjusting to the new
circumstances while others are unsure
of their own reactions. Accept the
reality of life and move on. At the same
time, be patient as the situation may
improve after a brief adjustment period.

- Understand and accept the positive
part of knowing that as a result of
certain circumstances (old age, an
unfortunate accident, terminal
illness), you are going to die – it
gives you a somewhat golden
chance to prepare. The reality is, we
are all going to die – this may be
sooner or later, but at least, it is
worthwhile being able to organize a
lot of things.
- Think, plan and prepare.

If you discover that you are facing imminent
death, it is important that you comprehend
what having this period of time means to
you. It is helpful to characterize life as a gift.
This in turn allows you time to prepare self,
family and significant others for a future in
which you will not be physically present. It
also grants the opportunity to tie up all the
loose ends. Take this as an opportunity for
reconnecting with those close to you. These
are people who have shared, and continue
to share, their lives with you, whose lives
you touch and who will touch your life.
Connect with those close to you.
-

- Express noble and valiant
sentiments after the prognosis.
- Be grateful and accept help and
good advice.
- Make amends with persons who
may be unhappy with you or your
actions. Apologize if necessary and
seek forgiveness as well. This lifts
a lot of unnecessary weight off
your shoulders to enable you find
inner peace.

 Attend hospital and clinics as
scheduled.
 Take drugs as prescribed.
 Eat a healthy diet full of nutritious
food.
 Regularize your life as much as
possible.
 Take a lot of water.
 Adopt regular walks and exercises
if you can.

- Sort out thoughts from worries and
anxieties. This enables you to:
(1)Lift a lot of weight off your 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).
- Avoid being desperate and a
miserable sod. Instead, you can
meditate and sort out worries from
actions.

- 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 those close to
you and thus offer them hope
amidst the difficult circumstances.

 Keep thanking your family 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 you
may demand to be with you all the
way to the final end. Allow them.

- It is significant that you maintain
and uplift your religious / spiritual
life. Your faith may face the
hardest test as you try to reconcile
with fate. If you are not spiritual,
you should consider your
relationship with the supernatural
being, but don’t be forced into it.
- Then, allow God to take your spirit
and commit it to God.

20
I eagerly expect and hope that I will in no way be
ashamed, but will have sufficient courage so that
now as always Christ will be exalted in my body,
whether by life or by death. 21
For to me, to live is
Christ and to die is gain. 22
If I am to go on living in
the body, this will mean fruitful labor for me. Yet
what shall I choose? I do not know!
Philippians 1:20-22 New International Version (NIV)

The Final Moments ..What to Expect
The following are notable developments and how to
deal with them:
You may find yourself continuously preoccupied with
hopelessness> Renew your hope.
Less interest in eating or drinking: You may have
poor appetite and not feel like eating > eat food and
drink in small quantities but frequently; vary the diet.
Try some of the appropriate things that you like.
You may have difficulty eating food and swallowing >
feel encouraged, be patient.
You may notice that you are increasingly
unresponsive to people, or you do not want to talk to
anyone > be patient, try interesting topics, chat with
your most favourite - family and friends - and then on

The Final Moments ..What to Expect
You may notice a marked change in your personality >
understand that you are undergoing a crisis.
You may not be able to move for long periods of time >
take a walk if you can and try various exercises.
Make yourself comfortable at home and/or in hospital.
This includes bathing, changing clothes and feeding.
Take in assistance, such as of those rubbing your back,
holding your hand, reading for you or adjusting the
television or music. Be happy with the visit by family,
friends, support staff (doctors and nurses, spiritual
leader) and colleagues. Talk about your feelings but
avoid being pitiful and sad – these people are there to
encourage you, and you need to inspire them as well.

The Final Moments ….

• It can be 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 your self esteem, but worst of all your
health and psychological well being. You must cheer
yourself up and encourage them with a smile. You can
also express it to them so that they can understand
how grateful you are to everyone for everything.
• There are also the feelings when you want to hug and
kiss your loved ones, greet your friends, wave goodbye,
visit your colleagues but it is just not possible. Accept
the situation as it is and continue moving on.

When you are strong enough, 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 you 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
imminent. In the end, such a demise leaves 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

• You must gain greater confidence in the persons you
love. You must also gladly accept to let go everything
especially the things you have been clinging onto with
an endless grip. Additionally, appoint someone you
trust to sort out your issues (bank account, property,
will, family and other obligations). This implies that
even as you grow weak and weary, they can resolve
certain issue/s.
• It is possible that if you have lived a happy and
contented fulfilling life, you will breathe with ease as
you 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.
Wango, G. M. (2018). ‘Living with Death so Certain for Someone Close to
You: The Trials and Tribulations of Overcoming Death.’ [PowerPoint
Presentation]. Nairobi: University of Nairobi.
Yalom, I. D., & Lieberman, M. A. (1991). Bereavement and heightened

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