Dr. Felicia Chang was asked to give a talk to the Pastoral Care Team in Assunta Hospital about helping relatives "let go" of dying patients based on her experience in palliative care. In preparing her talk, she realized that family members always struggle to let go of dying loved ones. Letting go can be defined as acknowledging impending death without impeding its natural progress, but this is difficult for humans due to the emotional attachment broken by death. Common issues families face include the finality of life's end, loss of relationships, feelings of filial failure, losing companionship, and fear of the unknown. Focusing on achieving meaningful experiences like mending relationships before death can help transform the fear of death into hope

1. When the one I love passes on…
Death, you’re standing rather near!
Don’t you understand the fear
You trigger deep within my soul–?
The terror sprung by such a ghoul
Of dark and hideous hue!
Mark R. Slaughter
What transpires when a love one passes on?
What truly matters at the end?
What are the emotions at play when we see our loved one heading
towards the inevitable?
Hope this inspirational, factual (from a medical standpoint) and
testimonial/experience based sharing, helps to shed a light in this eventual
event for all human beings.
Contributed by,
Dr. Felicia Chang
(Writing Team)
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2. Recently, I was asked to give a talk to the Pastoral Care
Team in Assunta Hospital. Knowing that I have a
background in Palliative Care, they asked me to share my
experiences and provide some guidance for them in the
matter of helping relatives to “let go” of dying patients.
This got me thinking deeply – what is it about death that
makes it so difficult for us as human beings to “let go” of
our dying.
As I was preparing my lecture, I asked myself this question: how often do family
members and relatives find it hard to let go of their dying loved ones? The answer is
this – every single time. Every single dead person is special, and somehow, there are
always others affected besides the patient himself/herself.
As I was pondering on this, I tried to find an appropriate
understanding for the concept of “letting go”. In medical
terms, “letting go” can be defined as a shift of thinking
where there is acknowledgement of impending death
without impeding its natural progress. What this simply
means is this: relatives acknowledging that death is
inevitable and for them to freely allow death to take place. If
death is the most natural and predictable way to leave this
earthly home, why is do so many of us struggle to accept it?
Letting go may mean saying goodbye forever, but since
nothing lasts forever (at least in the mortal sense) anyway,
why do we struggle so hard with our final goodbyes?
Ecclesiastes 3:19-20 reminds us of our own mortality.
“For the fate of the sons of men and the fate of beasts is
the same. As one dies so dies the other; indeed, they all
have the same breath and there is no advantage for
man over beast, for all is vanity. All go to the same
place. All came from dust and all return to dust.” As I
was reflecting on the many patients and their families
that I had served over the years; in tying their
experiences back with contemporary research on grief and bereavement, I found a
common thread running through it all. It is the emotional attachment broken in death
that people have difficulty comprehending and dealing with.
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3. The issues that one has to deal with in death are universal regardless of faith (whether
Christian, Hindu, Muslim or any others) or ethnicity (whether Chinese, Malay, Indian
or Orang Asli). Here are some of the themes commonly faced by many families of
dying patients.
The Finality of Life
“This is it! No more! The end!” Death will always be
perceived as being too sudden and coming too soon. Even
though we might have spent weeks preparing the family
for the patient’s death; to the family, death is still too soon
and too sudden. The daughter of a late patient related this
to me, “I cannot believe it. He left us when we were all
asleep. We were not at his bedside. We miss him so much.
I cannot see him now. I cannot hold his hand or feed him.
Although he was in a coma for 3 weeks, at least he was physically here. Now… no
more.” Even though her father was already in a coma from the brain tumour over the
final few weeks, they could still touch him and hold him. When he finally passed
away, even that remaining bit of physical contact was disconnected, and it was this
that made it so hard for his family members. Death signifies the end.
End of a Relationship
Every one of us holds multiple roles in life. For
example, my patient was not only a father to his
children, he was also an uncle, a brother, and a son to
his siblings and immediate/extended family. At the
same time, he was also someone’s friend, employee,
or employer. When one faces death, some of the roles
he once held are dismissed. When he no longer works,
he will lose the role of breadwinner and employee.
However, he will always be someone’s dear one. The
wife knows that when the patient dies, she will lose a husband. A child will lose
his/her father. Many people just cannot bear losing a relationship that has been built
over months and years. So when one faces death, relatives still cling on to them trying
to make the relationship (at least in one’s memory) last as long as possible.
Filial Children
Many cultures teach us how to take care of our
loved ones – we must love them as we love
ourselves. Children are taught about being filial to
their parents. As they grow up, there will be a
gradual reversal of roles. An adult daughter will
start to take care of her elderly parents. Therefore,
when one faces death, the children may think that
they have failed their parents. They feel responsible
for their parents health, and they blame themselves
for not doing enough when their parents’ health
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4. begins to fail. So when their parents are dying, children find it hard to let go because,
against all odds, they still want to do something to restore their parents’ health.
Losing Companionship
How often have we observed old couples who are
always shouting at each other, and we realise that
they have stayed together through thick and thin for a
long, long time. Sometimes, I wonder what’s the
point of having such arguments. But one of my
patients used to tell me, “This is how we
communicate. If she [my wife] dies, there will be no
more shouting matches. Life will be so lonely. My
children are all grown up now and have their own
families. I will definitely miss her if she dies. Probably I will follow her soon because
it would be unbearable to live this life alone.”
Fear of the Unknown
To quote John Dryden. “Death, in itself, is nothing; but we
fear, to be we know not what, we know not where”. “Do you
think she knows what is going on around her? Do you think
she will go to heaven? What if she got lost on her journey to
meet God?” These are some of the fears the family has for their
dying loved one. They are also fearful that once the patient dies,
they would be lost too. One wife shared that her husband had
always been the one who settled all the bills for the household.
After he died, she was lost because she did not know what to
do. The uncertainty of the future scared her more than anything
else in this world.
But as it is written in Ecclesiastes 3:20: “All come from dust and all return to dust” –
it is not possible for any of us to escape death. So then what can we do when the time
comes? How can we let go of our loved ones?
I have come to understand that if we can just
shift our mindset to acknowledge that death is
inevitable, and to focus on what is achievable
before death, we may learn that the prospect of
death need not be so fearful after all. In fact, it
can be peaceful and meaningful for both
ourselves and our loved ones. We can mend
broken relationships and build new ones. We
can find true meaning in our lives by going
through a life review. As children, we usually know hardly anything about our
parents’ youth and achievements. By doing a life review with them, we may discover
something of the hidden talents and hidden desires of our parents. Knowing all this
helps us (and them) to prepare for their departure. We can help them to fulfil their last
wishes.
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5. For some relatives, there may be misunderstandings that
need to be addressed, or broken relationships that need
mending. Time and time again, I have seen how powerful
it is when there is forgiveness given at the end-of-life,
where both patients and families cry so hard with relief
once the relationship is restored. At the end of it all,
ultimately, it is relationships that matter. When there has
been love and restoration, letting go suddenly does not
seem too difficult anymore. The finality of life is
transformed into beautiful memories and the hope to meet again in another lifetime in
eternity. The fear of the future has been transformed into hope and new life.
“Death is the condition of higher and more fruitful life.” Perhaps once we can accept
what E.H Chapin says about death, we will embrace it better; both for us and the one
who is leaving us behind.
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