1. Donnelly, Gloria F. PhD, RN, FAAN

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My mother died on a crisp fall morning with my father by her side. The night before, I had spent a few hours at my mother's bedside as I had done every night for the 5 months she was in hospice care in my home. The night preceding her death was especially difficult. Her Cheyne-Stokes gasping lasted into the wee hours. When my dad appeared to say goodnight, he did not stay his usual 15 minutes. Instead, he leaned over the bed rail, kissed his wife of 67 years, and whispered "Good night, honey" as if he knew it would be for the very last time. After that fitful night, my mother slipped peacefully away, ending an agonizing 8-year cognitive and physical decline. For my mother, death was a release from the suffering and fear of end-stage dementia. For my father and me, death was a release from the nagging sense of helplessness we experienced in trying to preserve the quality of my mother's life in her final years.


There is no good way to die even though we tell ourselves the contrary. Death, after all, separates us from all that is familiar. Despite faith, cultural belief, theory, or clinical explanation, death is the ultimate unknown. Therefore, caregivers should attend to the dying and their loved ones with awe and reverence.


My mother's hospice nurse respected death. She was intimate with its mysteries and processes. She did not consider death the enemy. I knew at our first meeting that she could guide us through this process of separation as gracefully and humanely as might be expected. And, she did.


What seemed to be casual conversation with my father and me about my mother's life was really history taking. I realized this when Sinead suggested that we play Charleston music when my mother was agitated. "She loved to dance, didn't she!!" Sinead exclaimed. "Try the music before the morphine and see what happens." The music worked its calming effect on more than one occasion.


Sinead visited more than 25 times over the final 5 months. On occasion she would stop by if she had a feeling that my father needed to talk or that my mother might be having difficulty. She had a sixth sense about our needs. She knew we were novice witnesses to the dying process.


The most comforting aspect of Sinead's care was her quirky, one-sided talks with my mother. She encouraged my mother to relax, to realize that we were with her, and to go when she was ready. It is difficult to say how much my mother understood. However, she did seem more at ease after her interactions with Sinead. On the morning my mother died, Sinead and I arrived at my home at about the same time. She took care of the details while my father and I comforted each other. She stayed until the undertaker took my mother's body. She came to the funeral and mourned with my family. She stopped by a few times in the succeeding months, and then she disappeared. I suspect she is back in Ireland caring for her own dying mother.


There is a crisis in caring for the dying in this country. Hospice remains an underutilized form of care as practitioners engage in conceptual battles with death. Too many individuals die high-tech deaths. Too few hospice facilities exist. Home hospice care is too infrequent or is offered too late. With the number of aging persons growing exponentially in the United States, the need to focus on care through the dying process becomes ever more prominent.


This issue of Holistic Nursing Practice (15:2) is about caring for individuals who are in the process of dying. The authors highlight comfort and freedom from pain in their articles. They also acknowledge the importance of spirituality, cultural sensitivity, and family support.


Caring for the dying requires a special breed of nurse-one who is not seduced by technologies or rates of cure. Hospice nursing is about facilitating a journey to the unknown. It demands an extraordinary capacity to care and offer support through life's most mysterious transition.