➣ Bringing Death out of Hiding: Honoring Veterans’ Deaths
by Deborah Grassman
Rituals are especially important in our under ritualized, death-denying, “we-don’t-need-a-funeral” culture. More than a decade ago, we started a ceremony that honors veterans after they die by placing an American flag quilt over the body when a patient dies. Family members often appreciate this gesture as a sign of respect as they sit with their loved one after he has died and as the body is transported down the hallway.
We didn’t initially realize the impact this would have on everyone in the environment. Previously, we had used a white sheet to drape over the body as we transported it to the morgue. People in the hallways often looked away as the body passed. Then, we had a volunteer quilt an American flag that we draped over the body, which prompted a totally different response. People no longer looked the other direction; they would actually stop and either place their hand over their heart or they would salute.
I then began a campaign across the country to teach others to similarly honor veterans wherever they are dying. Now, hospices, nursing homes, and funeral homes are routinely providing similar rituals. Many agencies play Taps as the body is transported. Others have staff gather to escort the body down the hallway along with the family. Some agencies use an authentic flag (rather than a flag quilt) which is more effective. However, flag-folding protocols and infection control procedures might prohibit this.
If your agency has not yet initiated a veteran ritual upon their death, consider it. It’s one last opportunity to pay honor and respect to a fallen hero.
The patient is also honored by placing on the bed a rose and footprint with his/her name and date of death. The six-inch footprints are made by staff from baked dough that is molded into the shape of footprints. When the dough hardens, it is painted. These footprints honor the veteran and also highlight his separation from us. Other patients see the footprint and anticipate that they, too, will be remembered and treated with respect. This footprint also acts as a trigger in the environment for them to anticipate and prepare for their own deaths. The footprint remains on the bed until another patient comes to occupy the bed.
Then it’s moved to a wall in the hallway that depicts a rainbowed road with the inscription, “Together we walk, one step at a time.” The wall with all the collected footprints acts as another trigger in the environment for death preparation.
In November, the footprint is moved to a white-lighted holiday tree and later given back to the family members at a holiday bereavement program (see bereavement rituals).
The idea for the footprints was initiated by Sheila Lozier. “I keep having this vision of footprints that we could make for the family members. Then, we could have a ceremony during the holidays where they get the footprints back.” No one else paid too much attention to her idea, even though she brought it up several times. Sheila surprised us all, when one day she arrived with several dozen, gold-speckled footprints that she had baked. She had not let our lack of support stop her from achieving what she knew was important for families as they faced the holidays. Now, we had no choice, we developed a Holiday program. So many people showed up for the program, that we had to move it into the auditorium.
The wall that displays the footprints from the time they are removed from the bed and before they are placed on the Holiday tree in November, developed in a similar way. It started with a wall that had been temporarily erected in the hallway while some construction was going on nearby. We all hated it. We thought the cold, gray sheetrock interfered with the healing environment we tried to maintain. “Maybe some hospice graffiti would make it look better,” one nurse suggested.
“Maybe we should put some furniture in front of it,” said an aide.
“What about the painting we had made for our pins?” Sheila, a nurse on the unit, asked. That suggestion was it. We couldn’t wait to get working on it. The pins she talked about were bought the year before when we had created a ceremony for new hospice staff. The ceremony included each person’s receiving a tiny pin in the shape of three tiny footprints along with the words, “Know that your journey is sacred, and your footprints are holy.” Then, each staff wrote their personal perspective of what their footprints pin symbolized for their role in helping people die healed. We then created a painting to depict the theme so patients would understand the meaning of the pins we wore.
It was a small painting, and we needed something to cover the whole ugly wall. We decided to reproduce it in an enlarged form. One evening, the Hospice physician brought paint and brushes. Through the night, Dr. Hull and the staff worked to reproduce the painting on the wall. One of our patients, Sydney, joined them. When difficulties with the re-creation of the rainbow were encountered, she had the solution. She wheeled back to her room and returned with some dental floss. “Now go get a tack and use my floss to draw the arc,” she directed.
The next morning, Sydney asked a nurse to take her out to view the finished product. At first she just grinned at it, but then something moved her. Suddenly, years of uncried tears erupted into sobs. It was the first and only time Sydney surrendered to the pain of her experience. No one spoke. We sat with her as she cried, and when she looked back at us, her smile was peaceful.
The mural would come to have similar effects on others: family groups, employee bereavement groups, private patient sittings, hospice staff on retreats. All found solace in the metaphorical image. “It’s like a pathway to a new beginning,” said one patient. “Everything levels off over the last hill and gets beautiful,” a social worker commented. “The further along on the journey you go, the lighter it gets.” One dying patient stared at it for a long while, then said, “I’m meeting my Maker, who is waiting to walk with me over the last hill, and than a new day is born.”
Another simple, yet powerful, ritual is to position a table in a public area with electric candles that can be lit upon a patient’s death. This accomplishes four purposes:
• Notifies other patients/residents that there has been a death and that the agency acknowledges and honors that person’s life (deaths are a matter of public record so this is not a violation of privacy).
• Communicates to other patients/residents that their own death will be acknowledged and honored. This can be reassuring to the surviving residents.
• Provides the reality of death so that the illusion of immortality is not perpetuated. Death doesn’t have to be hidden which conveys a message to the residents that staff can deal with any fears of death.
• Provides a “gathering-place” for a family ritual when the patient dies. This is also important for staff, especially in a long-term care facility where there may be close bonds; staff need to grieve too in order to remain healthy. (see candle-lighting ritual below)
A candle is lit during a ritual ceremony after a patient passes away. The candle remains lit for three days in remembrance of the patient. There is no significance of the three days, just a guideline, depending on how many deaths a facility might have each week. (A hospice unit that has many deaths may keep a candle lit for three days, while a nursing home might keep a candle lit for a week.)
An average ceremony takes 15 minutes but can be shorter or longer depending on the needs. Attendance should include anyone and everyone from the clinical team who is available. Have the 3 tiny footprints pins available for each family member. Designate one facilitator of the ceremony. Give pins out to the staff for later use in the ceremony (if there are 3 family members and 3 staff, give one to each staff. If there are 4 family members and 3 staff, then 1 staff will get 2 pins. It’s possible that if there is only 1 staff member then they will lead and do all the pinnings.)
After the patient dies and before the family leaves, educate the family on the ceremony:
“Before you leave, we’d like to do a small candle-lighting service to honor _______. It’ll only take about 15 minutes and it can be very healing.” If they consent, and after they gather, give each person a blank business-sized card. Have the name of the patient and their date of death already on the card. Then give loved ones instructions:
“There’s a time in the service when you will have an opportunity to write anything you might want to say to _______. I’m going to give you this card now because some people like to think about it beforehand. So feel free to write what you want to say now.”
Effective rituals have 3 stages. Design this one to be effective:
Stage 1 – Separation Stage.The purpose of this stage is to identify the problem: their loved one died and is no longer with them requiring them to grieve.
You want to create a safe emotional space plus acknowledge the void that is left behind. Validate their suffering. Remember your job is to take people into their pain by acknowledging how hard this is and acknowledging the grief that is there.
1. Tears- Acknowledge grief. “I know this is a very difficult time… It is a very sad time for your family.”
2. Collect the Story: Have each family/friend/staff tell a piece of that person’s life story. “I only knew your husband for a short time when I met him last week, tell me one of the most meaningful ways _____ impacted your life.” (Go around circle with each person telling something, including the staff.)
Stage 2 Transitioning.The purpose is to start transitioning from the world with their loved one in it to the world without their loved one in it.
1. Light the candle. The candle can be turned on by family member or can be turned on by closest person, whatever is easier: “I can see how he was a light in your heart. He was ________ (insert adjectives that the family just told you: funny, hard-working, stubborn, honest, etc) and those stories you just told us will remain alive in your heart. As we light this candle, know that he will continue to be a light, not even death can change that.”
2. Place card in holder. The card will have the patient’s name on it and date of death. Family members may also write any last words on this card to the patient. The loved ones may write something on the card at this time or previously but it is to be placed with the candle at time of turning candle on. This is an opportunity to say anything that was not said, and any unfinished business. Sometimes this is private and quiet. “At this time, you can write down anything you want to say to _____ on the back of the card we gave you earlier or if you already wrote something down, you can add something more if you’d like. If your _______ (husband, mother, sister, friend, etc) was standing behind me right now, what do you think he would say to you?”
This allows discussion of letting go and moving on. Completing “unfinished business” is very important in preventing complicated grief. So make sure to spend adequate time with this step. Identifying guilt, angers, regrets, etc. can be a valuable first step in externalizing the healing process.
Stage 3 Integration. The purpose is to start incorporating change of stepping into new life. “Your father’s passing leaves a gap. Tell me one quality about your father that you would like to incorporate in your own life.”
Provide a prayer or read a reflection.
Pinning of footprints “One footprint is yours. One footprint is your loved one’s. The third footprint represents all the people who are willing to help you walk this painful part of your journey. May each time you see these, you know you are not alone. May you have the courage to ask for help when you need it.”
A “hug line” often closes the ceremony with staff hugging each person, abiding their pain.