by Jacquie Molloy

During last month’s Spiritual Care Practitioner Drop-In gathering, our discussion centred on death and dying — and quite specifically around the question often asked, ‘am I dying?’.

This led to an incredible sharing of personal stories and peer-to-peer support and mentoring. What also emerged as a common dynamic was the reticence of clinical staff to transparently disclose without any doubt the answer to that question.

For clinical staff (and this will be a generalisation coming from someone who is not clinically trained in any way), the focus will always be healing and therefore the sustaining of life. So the question of death is often answered through this lens.

I had no idea that less than a week later I would be in a situation where I was to realise the full power that the clarity of this kind of question and answer can have – especially when it relates to the dynamic of spiritual care in palliation.

If you have been in meetings with me online then you will have certainly met Arch, the charismatic ginger boy who we considered a teammate here at Meaningful Ageing Australia.

That weekend he was a whisker away from renal failure with an astonishing creatinine level of 604. And I only caught that because I had noticed something ‘not quite right’ in him. That Saturday the emergency hospital vet gently volunteered that it would be palliative from here on and not to expect many months.

Arch was 8 and a half years old and still eating, toileting, cleaning, physically relaxed, hanging with his brother, doing all the normal things just missing some of his spark.

I left the hospital (Lort Smith) feeling sad but very grateful to have that information. Still, it felt like there was worse news to come. I couldn’t put my finger on it but the speed and severity of his condition felt more ominous than kidney disease – what had pushed the level up so high so quickly?

On the Wednesday he had an ultrasound and an aggressive cancer was found to be rampant in his liver and kidneys. I was told very clearly that Arch had 1-2 weeks to live.

I was given the courtesy of that notice. Of the clarity.
We had a meds schedule for his comfort and I was clear of the signs that would signal his approaching death.

Because of that, I was able to arrange for the splendid Melbourne service My Best Friend to come to my home and ease Arch’s death in the most peaceful, loving and supported way. (Did I want to? Of course not. Did it break my heart? It did, but I was able to plan appropriately because I knew.)

Those of you who love your animal companions know that our biggest concern always is that we need to understand that which is unspoken and be ready to make a decision when the time is clear.

This is part of spiritual care. And it’s why we need all the clarity we can get from the clinical side of things.

With the last week of Arch’s life, we snuggled a lot. He enjoyed the sun on his face, loving licks from his brother, indulgent foods that he still ate with gusto if in much (much) smaller quantities than usual (tuna and yoghurt were his chosen favourites) — and no vet appointments. I was able to administer all of his meds. And because we knew he would die in a matter of days it was clear that we did not need to do anything more than cater for his comfort and joy.

Rather than draw a parallel here with VAD, I would instead like to ask how we can best serve the spiritual care of our elders in their final months, weeks and days. Rather than be a case of admitting defeat, what would it take to shift our perspectives on death and dying to prioritise the comfort (and often relief) that clarity and transparency can provide.

‘Am I dying?’ is a question that many ask … and often the person being asked does not feel they have the authority or latest information to answer well. (But there is a reason that this is the person being asked and that is usually because there is a familiarity and trust in place.) As fellow humans, we know what the person asking needs to hear — and more often than not it is a confirmation of what they feel to be true but have yet to be told.

We need to find how to bring the best from both the clinical and the spiritual sides of care and create a fully supportive dynamic that places the emotional wellbeing of the older person at the very centre of the care dynamic.

If you are in Melbourne and live with animals, please get to know My Best Friend – an incredible team of vets who provide a dedicated home euthanasia service. It is spiritual care in action.
If you are a spiritual care practitioner and work for, or with, one of our member organisations, you can join the monthly drop-in to connect and share with peers around the country. It is indeed a group of beautiful humans. Contact Jacquie for more information.