1. A Path
Through
the Valley:
A personal guide
for those sharing the experience of life’s
final stages with their loved one
at the Grand Rapids Home for Veterans
Chaplain Bruce Kalish
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Psalm 23
A PSALM OF DAVID
1
The LORD is my shepherd; I shall not want.
2
He makes me lie down in green pastures. He
leads me beside still waters. 3
He restores my
soul. He leads me in paths of righteousness
for his name’s sake.
4
Even though I walkthrough the valley of the
shadowof death, I will fear no evil, for you are
with me; your rod and your staff, they comfort
me.
5
You prepare a table before me in the
presence of my enemies; you anoint my head
with oil; my cup overflows. 6
Surely goodness
and mercy shall follow me all the days of my
life, and I shall dwell in the house of the LORD
forever.
(EnglishStandard Version)
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A Path Through the Valley
In the deep valley of a loved one’s approaching
death, it is not uncommon to lose your way
emotionally,mentally,orspiritually.Questionsarise
that you may never have considered before.
Answers don’t come easily. It can be a very
confusing and exhausting time for you. Thankfully,
you are not alone. Others have taken this journey
before you and have marked out a path that you
can follow.
This is a guide book to help you walk through your
valley in death’s shadow. As your loved one enters
his or her final stages of life at the Grand Rapids
Home for Veterans, letthe following pages comfort
and help you. There are three stages on your
journey:PreparingforDeath;UnderstandingDeath;
and After Death – What Now? While others have
led the way, your experiences will be uniquely
yours.Hopefully,however,the following pages will
assist you in your journey.
Preparing for Death
What happens when there is no cure?
You may have entered this valley with a phone call
or by talking with a medical professional who
reported a significant change in the health of your
loved one. Very likely the term palliative care was
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used. What exactly does this mean? Palliative Care
is the medical specialty focused on the relief of pain
and other symptoms of a life-threatening illness.
Palliativecare issometimesconfused with hospice,
but it is a much broader practice that is used even
whenhealingisstill the goal. A person may receive
palliative care without entering hospice.
Hospice accompaniespalliativecare when people or
their legal representative, along with medical
professionals, decide that no further treatment will
result in healing.The goal of care changesfrom cure
to comfort only. Such a decision is made when all
appropriate medical attempts to heal have
surrenderedtothe irreversible progressof anillness
or injury that will lead inevitably to death.
As a family member, you may be having difficulty
adjusting to this significant change in the health of
your loved one. Talk with the doctors or attending
nurses about any medical questions you have.
Grand RapidsHome for Veteransalsoofferscounsel
from social workers familiar with your loved one’s
personal information, and from chaplains for any
emotional or spiritual care you or your loved one
may need. You do not have to carry the burden of
preparing for death alone.
Be assured that whether your loved one is being
treatedwiththe goal of healingorof comfort, we at
Grand RapidsHome for Veterans respectand honor
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the inherentvalue anddignityof everymember.No
one’s worth is diminished by disease, disability, or
even a terminal diagnosis. We will walk alongside
you in providing the best possible care for your
loved one.
How much time do we have left?
It is natural to want to make the most of the time
youhave leftwiththose youlove.So,when you see
themdeclininginhealth,thoughtsof living without
themmay crowdinto your mind and make you sad.
If theyget to the pointwhere nomedical cure exists
for their condition, you may wonder aloud, “How
much time do we have?” The truth is, no one
knows, but God. Even when death is near, it is
impossible to exactly predict its arrival.
That is why as long as your loved one lives, you
should be hopeful. In the course of an illness or in
the aftermath of a trauma, hope wears many
different faces. At first, you may simply hope for a
cure. But when that is excluded you can hope for a
painlessdying,apeacefuldeath,or life after death.
Sometimes in the process of dying a personal
offense is recalled that causes distress, so you or
your lovedone will hopeforarestoredrelationship.
The focus of your hope may change, but hope
should always remain and never be lost.
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When you sit with one who is dying, you must be
careful not to steal his/her hope thinking you are
somehow more straight-forward and honest that
way.Hope is essential to one’s emotional life even
when physical life is ebbing away. So, hope should
always be cultivated, sometimes re-directed, as
fromhealingtolivingwithoutpain;buthope should
never be discouraged or denied.
What are some signs that death is near?
While we encourage hope and do not know the
time of death, eventually death’s dark shadow
becomes more visible than the loved one we have
known. It may calm some of your fears to better
understandthe deathprocess. Whatare some signs
that death is more likely measured in hours than
days?
First, it should be said that each death is unique,
just like each life. And everyone is fully alive until
they die. It may seem as though they have slipped
behind an impenetrable curtain of bodily changes,
but theyare still worthy of our dignity, respect and
love.
Second, unlike what you may have seen in media,
dying is not easy; it is hard work. More often than
not, dying is a drawn out process with several
transitions before death comes.
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Finally,there isnoexact sequenceof eventsleading
to death. However, there are markers along the
path as death draws near. Becoming familiar with
these may help you prepare yourself or comfort
others who are on vigil at bedside with you:
1. Sleeping increases
2. Eating ceases
3. Bladder and bowel control ends; kidney failure
develops
4. Breathing changes, becoming shallow or more
labored with increased periods of no breathing
5. Headaches, confusion, or unresponsiveness
6. Bluish-gray discoloration of lips and skin
7. Heart rate increases
8. Fever and sweating develop to fight off terminal
infections
9. Restlessness increases
10. Hands and feet become colder
11. Bruising (mottling) occurs as circulation
decreases
12. Secretions increase in airways: when unable to
be cleared, these cause a rattling sound
*adaptedfrom Kessler, David. The Needs of the Dying: A Guide
for Bringing Hope, Comfort, and Love to Life’s Final Chapter.
Harper-Collins. NY:NY, 2007. See also www.DavidKessler.org
I feel helpless. What can I do?
As deathapproaches,apersonturnsfrom the outer
world and increasingly inhabits an inner world of
thoughts, emotions and memories. This is a time
when reflecting on past experiences and
relationships, emotions like anger or sadness may
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surface. Often there is a desire to make peace and
seekor grantforgiveness.The one whoisdying may
feel alone,even isolated by the effort given to this
inward processing.
So,your verypresence isagift.Simply listening in a
non-judgmental way provides the caring
companionship your loved one needs at this time.
If you hear things that upset you or that aren’t
reality based, it’s important to encourage such
sharing rather than becoming argumentative or
denying the other’s experience.
If this is too difficult for you, ask for a chaplain to
assistyou.Theyare trainedtowalkalongside youin
such an event. Still, because you are a friend or
family member, you may be able to reach levels of
emotional intimacy where a chaplain or other
professional cannot go, if you are willing to do so.
There may be guilt or shame that needs to be
forgiven or a broken relationship begging
restoration. Just by being present and attentive at
the bedside, you can be the bridge to peace at the
end of life’s journey.
How can I prepare for death?
Whenit becomesclearthatlife is ebbing away, you
may find it is a good time to make those practical,
but necessary final arrangements that remain
unresolved. It is better to deal with these before
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death, rather than after, when the swirling
emotions of loss and grief often create a mental
fog. Again, if this seems too difficult, ask for help
from a social worker or chaplain. They are familiar
with answering some of the questions you may
have. Particularly, there are at least five questions
you should settle as soon as possible.
1. How do you want to celebrate the life of your
loved one? By a funeral, or memorial or by no
service?
2. If you want a service, where should it be? In the
Grand Rapids Home for Veterans Chapel, your
family’s place of worship, or a private location?
3. How do you want the body to be prepared? By
cremationor by full - body burialor do youwant
the body present at a funeral and cremated
afterward?
4. What is the name of the local funeral home or
cremation society you have chosen to receive
the body?
5. Where is the final resting place, a family plot, a
VA Cemetery, the GRHV Cemetery, or other?
Understanding Death
What is death? Most people think of it as a time
when everything stops. From a medical standpoint
that is accurate. As a result of disease, trauma, or
deterioration, death occurs with the irreversible
failure of the brain, respiratory and circulatory
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systems. But that is only part of the picture. From a
spiritual standpoint, death occurs when one’s soul,
or essential person, leaves the body. Death is seen
as the gateway to a new kind of life. From an
emotional standpoint, death stills any response to
our love orunresolvedissues.Itisafinal separation.
How should I feel?
Like dying, grief is a process that comes in many
forms. On thisstage of your path youremotionsand
feelings will change from day to day or even
momenttomoment.Some people busythemselves
inactivity;others needstillness.Some tellstories or
jokeswhile other people can’t stop crying. There is
no “right” or “wrong” way to grieve. Grief is the
darkest stretch of the path we all take when we
endure loss. Comparisons are not helpful.
Nonetheless,aswithdying,there are some markers
alongthe path that can be expected in the territory
of grief.
Shockand numbnessmaysetinalmostimmediately
like an emotional anesthesia or mental fog. You
may have trouble making decisions or
communicating. You may be confused about your
feelings and even think something is wrong with
you. It is common to feel sad or immensely tired
and unable tohandle simple daily tasks for a while.
(If this continues beyond a couple months you may
benefit from consulting with your doctor or a
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professionalcounselor.) Similarly, anger commonly
follows a death. You may be angry at the one you
lostfor leavingyou;orat the medical staff, or angry
withyourfamily,withyourself, or even God. This is
a short list of markers that grief is present. There
are others as well.
If this processisnew to youor you are fearful,don’t
hesitate to seek help. Again, the Grand Rapids
Home for Veterans chaplains are here to walk
alongside you.
The biblical book of Psalms contains frequent
expressionsof humanemotionslike anger, despair,
or fear. Many have found reading these Psalms
helpful in processing their own grief. Perhaps you
will too. The words of Psalms 22, 40, 42-43, 51, 73,
86, and 139 may especially guide you in this part of
your journey toward renewed peace and hope.
After Death: What Now?
Once death has occurred you can rest assured that
the Grand Rapids Home for Veterans will continue
to care for your loved one with the dignity, honor
and love we extended in life.
When death has been pronounced by a doctor or
nurse, your loved one’s body will be washed and
honorably transported to a holding area where the
funeral home you have chosen will receive it for
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final burial orcremation care. They will contact you
to understand your wishes regarding burial or
cremationandto arrange forany otherservicesyou
desire.
A Grand Rapids Home for Veterans chaplain will
also contact you to offer our ongoing care and to
make any arrangements you want concerning a
service and/or burial in our Home’s cemetery on
our grounds.
To help you work through various options, please
refer to the Quick Reference Veterans’ Benefits at
the end of this booklet.
In these pages we have shared the three stages on
your path through the dark valley of grief and loss:
Preparing for Death; Understanding Death; and
AfterDeath– What Now? We hope these thoughts
have givenyouinsightandsome measure of peace.
If any further questions or needs arise as you
accompany your loved one through this valley,
don’t hesitate to reach out to a chaplain, nurse, or
social worker.The Grand RapidsHome for Veterans
staff is honored to be able to walk this path with
youand to support and comfort you along the way.
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Quick Reference Veterans’ Benefits
If the veteran is a GRHV Member
Members and their spouse are eligible to receive, AT
NO COST:
1. Use of the GRHV Chapel for visitation and
memorial/funeral
2. Services of a GRHV Chaplain
3. Military Honors (normally KentCounty Veteran’s
Honor Guard – eulogy, riflesalute,taps,flag)
4. VA Grave marker
5. Cemetery vault(if full casketburial)
6. Cost of casketor cremation is borneby family with
VA assistancedescribed below
IFTHE VETERAN DIES AT AVA HOSPITAL
1. The family receives $745 or cremation allowance
2. The family gets a $745 plotallowanceIF burial is
NOT in a National Cemetery. Receipt required.
3. The family is reimbursed by VA (“removal fee”) for
transportof body from a VA Hospital
4. Free burial (vault,plot,headstone, military graveside
service) in a National Cemetery is permitted for
veteran and spouse($14,645 value)
5. IF NOT buried in a national cemetery, the family pays
for body transportto placeof burial or services
IFTHE VETERAN DIES OUTSIDE A VA HOSPITAL
SCENARIO #1
If the veteran received a monthly VA service connected
disability pension:
1. The family gets $300 burial/cremation
allowance
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2. The family gets a $745 plotallowanceIF burial is
NOT in a National Cemetery. Receipt required
3. Paid transportation will begiven ONLY for burial
in a National Cemetery.
4. Free burial (vault,plot,headstone, military
gravesideservice) in a National Cemetery for
veteran and spouse
SCENARIO #2
If the veteran received a monthly VA support pension:
1. The family gets $300 burial/cremation
allowance
2. The family gets a $745 plotallowanceIF burial is
NOT in a National Cemetery. Receipt required
3. NO TRANSPORT MONEY IS ALLOWED, EVER.
4. Free burial (vault,plot,headstone, military
gravesideservice) in a National Cemetery for
veteran and spouse
SCENARIO #3
If the veteran received a 100% service connected
disability pension:
1. The veteran MUST have died from service
connection. IF SO, up to $2000 reimbursed to
family for funeral or cremation costs.
2. Free burial (vault,plot,headstone, military
gravesideservice) in a National Cemetery for
veteran and spouse
IFTHE veteran is buried in a national cemetery
All honorably discharged veterans are entitled to free
grave space for the veteran, spouse and dependent
children IF THE FOLLOWING CONDITIONS ARE MET:
1. The honorably discharged veteran served prior to
9/7/1980.
2. The honorably discharged veteran served 24 months
of continuous duty after 9/7/1980, OR for the entire
time for which the person was called to activeduty.
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3. IF THE VETERAN DIED INDIGENT:
a. The VA will disburse$1967 (casket) or $172
(urn) in 2015 to individual or business.
b. It must be certified to VA that veteran’s
next of kin could not be found OR is
unwillingORunableto assumefinancial
responsibility for burial costs.
c. VA FORM 40-10088 must be filed with the
VA.
BURIAL AT SEA
Veterans of ALL branches of military are eligible for
burial at sea as follows:
CASKET – Veteran of 20+ years of service. Spouse
included.
CREMATION SCATTERING – Any honorably discharged
veteran and spouse.
