Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

by Maggie Callanan, Patricia Kelley


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In this moving and compassionate classic—now updated with new material from the authors—hospice nurses Maggie Callanan and Patricia Kelley share their intimate experiences with patients at the end of life, drawn from more than twenty years’ experience tending the terminally ill.

Through their stories we come to appreciate the near-miraculous ways in which the dying communicate their needs, reveal their feelings, and even choreograph their own final moments; we also discover the gifts—of wisdom, faith, and love—that the dying leave for the living to share.

Filled with practical advice on responding to the requests of the dying and helping them prepare emotionally and spiritually for death, Final Gifts shows how we can help the dying person live fully to the very end.

Product Details

ISBN-13: 9781451667257
Publisher: Simon & Schuster
Publication date: 02/14/2012
Pages: 224
Sales rank: 25,603
Product dimensions: 5.40(w) x 8.30(h) x 0.70(d)

About the Author

Maggie Callanan has specialized in the care of the dying since 1981. She lectures widely to lay and professional audiences on death and dying, bereavement, and hospice care. Maggie is also the author of Final Journeys. She lives on the New England coast.
Patricia Kelley has worked in hospice care since 1978. She formerly held positions as Clinical Director of Montgomery Hospice in Maryland and as Director of Health Systems Leadership at the National Hospice and Palliative Care Organization. She now works as a national and international consultant providing education and training on issues relating to hospice and palliative care. Patricia is also the author of Companion to Grief: Finding Consolation When Someone You Love Has Died.

Read an Excerpt

"It's Time to Get in Line."


Joe paced anxiously–back and forth–at the foot of Laura's bed. There was an odd stillness in the room. He edged around the nurse's aid and the corner of the dresser so he could sit by his wife's side on the bed. Deeply concerned, he picked up her hand and began rubbing it.

"Laura, are you all right?" he asked. "Talk to me!"

She smiled dreamily and nodded, but said nothing. This upset Joe.

"Laura, it's me," he said. "Say something! I'm worried about you!"

"Joe, I'm okay," she whispered.

Joe looked to the nurse's aide, who responded with a look of uncertainty.

"Sweetheart, do you hurt?" he asked. "Do you need anything? Is something wrong? Darling, please tell me what it is?"

Laura smiled again, closed her eyes, and shook her head. Joe signaled for the aide to join him in the hall.

"What's wrong?" he asked. "She was fine this morning. A little weak, maybe, but fine. We had a cup of tea together."

The aide patted Joe's shoulder. "She just got this way. I don't know what's wrong. She's taken her medicines on schedule and she ate a little breakfast. Does she seem a bit confused to you?"

"It's had to tell," Joe said. "She's not talking much. She seems real strange. We'd better call the nurse. I know something's wrong! Joe nervously reached for the phone.

SOMEONE YOU CARE ABOUT may be very ill, perhaps dying. There's so much to do–tests, hospitalizations, visits to doctors' offices. Sometimes there are two or three physicians to deal with–a surgeon, oncologist, radiologist, other specialists.

The medicine chest is jammed with partially used medicines–some bottles nearly full, others almost empty–as new and different ones are tried. Medical equipment seems to occupy every corner of the house. All the furniture has been rearranged, whether to allow a wheelchair to pass or to permit a fast trip to the bathroom.

Coping with terminal illness is more than hard work–it's all-consuming and creeps into every corner of your life. There are so many people to talk to, so many questions to ask, so much to do. The hopes and triumphs of new or different treatments can change quickly into fears and failures. It's an exhausting, emotional roller-coaster ride. It's like having an unwanted and uninvited stranger in your midst, who seems to take up more and more space.

A terminal illness doesn't belong only to the one who is sick–it affects family members, friends, neighbors, coworkers. Not unlike a still pond disturbed by a falling stone, an impending death sends ripples through all the relationships in the life of the dying. Each person involved has his or her own set of issues, fears, and questions.

Beyond coming to terms with the loss of someone we care about, we find ourselves with a jumble of conflicting emotions shaken loose by confronting human limitations and mortality: How can this be happening? I feel powerless–what can I do to help? I don't want to face this–what's it like to die? Is there anything after death? Why are the people around me behaving this way? I feel lost and helpless. What do I do? What do I say?

Is it possible to find anything positive in this devastating event? Can this remaining time be used to share treasured moments of living, while coping with the many losses death brings? Rather than dying on a continuum, can this person be helped to live until he or she dies? Can this be a time of personal growth for all involved?


LAURA HAD SPENT HER LIFE as a teacher, but when she retired and her first husband died, she decided to become a student again. This time her university was the world and she quenched her thirst for knowledge and new experiences by traveling–seeking new faces and new places.

In India she met Joe–a fellow traveler in her tour group. An enthusiastic widower of seventy-nine, he had an inviting twinkle in his eye and shared Laura's touring style–each lived out of a backpack, like the far younger vagabonds they encountered on the road. They were immediately drawn to each other, fell in love, returned home, and–much to the surprise of the grown children they both had–announced their engagement.

The wedding was small and charming, attended by their children and grandchildren. Laura wore a sari she'd bought in India and was given away by one of her grandsons. She'd chosen Robbie to do the honors because she wanted to feel a sense of connection with his mother–her daughter Susan, who'd died of breast cancer the year before at the age of forty-five.

Joe's best man was his son. After the ceremony, everyone feasted on Indian food served on Laura's treasured antique Russian china.

Laura sold her house and gave away much of her furniture; Joe moved out of the apartment he'd occupied since his first wife's death. They rented a one-bedroom apartment in a retirement complex, which was crammed with the belongings that once had filled their two large houses. It was a squeeze for them to pass each other in the narrow hallway, cluttered with cabinets, mirrors, storage shelves, and clocks from Joe's collection. But they were happy, and Laura was able to indulge her passion for gardening by working on the building's grounds.

Once settled, Joe and Laura returned to traveling–now as a twosome. The once-tedious aspects of the tourist life–baggage lines, ticket lines, customs lines, lines for planes and buses and trains–now were occasions to enjoy one another's company.

Joe was quite forgetful, so he relied heavily on Laura as an organizer and manager–roles she loved.

They had to cut short a trip to Mexico celebrating Laura's eighty-third birthday, when she came down with dysentery. Her condition persisted until she had to be hospitalized for dehydration. But X-rays showed a tumor in her colon, which when removed was found to be malignant. The cancer had already spread to Laura's liver and, considering her age, aggressive treatment wasn't recommended, the doctors said she had about six months to live.

Joe took this news badly, seeming to become more muddled than usual. Laura decided to spend her remaining time at home with Joe, who was eager to help in any way he could. They decided to call the hospice for help and support.

The next four months passed uneventfully. Laura's discomfort was minimal, and easily controlled with medications. Their families visited often, bringing meals or simply spending time with her. She and Joe would sit for hours paging through albums of photos from their trips and their younger days. These weren't always happy interludes; pictures of Susan as a healthy young woman always made Laura cry.

"Mothers aren't supposed to outlive their children," she'd say. "I miss her so much. It should have been me, not her."

However, Laura was stoic about her own situation, and did her best to maintain her social contacts and gracious manners. But her terminal diagnosis and increasing dependency were beginning to overwhelm Joe. His distress showed in his behavior. When Laura asked for a pain pill, he would dash off with great purpose, but distract himself along the way with a series of meaningless activities, and forget the medicine.

Laura's children dealt with this by hiring a home health aide, who wound up spending nearly as much time and energy helping Joe as she did Laura.

They managed quite well until the morning Laura's behavior changed. She refused the bath that she usually enjoyed, and seemed distracted and distant. Joe was alarmed when he called our hospice.

I arrived to find him agitated and impatiently waiting for me at the apartment door.

"She's different today," he said. "She's looking at us–but through us–like we're not there."

Laura seemed restless and preoccupied, picking at the bedcovers and staring into space with a faraway look in her eyes. A quick physical check revealed no apparent reason for the change in her behavior.

"What's happening to you, Laura?" I asked. "Where have you been?"

"It's time to get in line," she said.

"Tell me more about the line," I said. "Is there anybody there you know?"

"Susan is in the line," Laura said, breaking into a radiant smile, but continuing to stare into space.

"How nice for you," I said. "Would you like to get in line? Can you tell me more?"

Laura became thoughtful, and sad. After a few moments she said, "But Joe can't go with me."

I sensed that she was feeling torn between going to be with the daughter she missed so terribly and staying with the husband who needed her so much.

"That must be a hard choice for you, Laura," I said. "Can we help Joe get ready for the time when you have to get in line?"

Laura visibly relaxed, and simply said, "Yes."

Joe was in the living room, surrounded by antique furniture and exotic souvenirs from their travels. Around him half a dozen clocks were ticking, each one set at a different time. I joined him on the sofa and told him about my conversation with Laura. He began to cry.

"I know this is hard for you, Joe," I said, handing him tissues. "What do you think Laura is telling us?"

"It sounds like she's dreaming about seeing Susan," Joe said. "Like maybe they'll be reunited."

"What else do you think she might be saying?"

"It sounds like she wishes I could go with her," he said. "But I can't–maybe she's worried about that."

"Is there any specific reason Laura might be worried about leaving you behind?"

"I depend on her a lot," he said. "I suppose she's worried about how I'll get along without her."

"Do you have plans for managing on your own?" I asked.

"Yes," he said. "I know I'm not as sharp as I used to be, so I'm going to move in with my son." Joe went on to describe in detail the arrangements he'd made.

"Your plans sound good," I said. "Does Laura know about them?"

Joe looked horrified. "You can't tell someone who's dying what you're going to do after they're gone!" he said.

I suggested that this might be exactly what Laura needed to hear, to ease her anguish about leaving him.

Joe hunched over, elbows on his knees, face hung in sadness.

"It's so hard to talk about this," he said. "I hate even thinking about it. It's just the worst thing I can imagine. . . ."

I let him continue to express his feelings and concerns for a while, then repeated my thoughts about Laura's needing reassurance that he understood what was happening to her. Joe would again lose focus, and I would gently remind him of what we were discussing. Several times he suddenly stood–as if to end the conversation–but seemed to realize there wasn't anywhere for him to go in the crowded room, and he would simply sit back down.

Finally, Joe was able to go into the bedroom, sit by Laura's side, and hold her hand. With tears streaming down his cheeks, he shared his plans and gave her permission to die.

"I hate that this is happening, but I know you have to go," he told her. "I'll bet you're worried about me, but I promise I'll be all right. Let me tell you about my plans, so you can rest easy."

Joe described what he would do after she died. He was going to spend winters with his youngest brother in Florida and summers with his son's family up North. Both homes had gardens; Joe told Laura he'd work to keep them as beautiful as she would.

"And I'll do my best to remember all the kids' birthdays–your grandchildren's and mine!" he said, kissing his wife.

After that conversation, Laura's preoccupation and restlessness stopped. She became peaceful, and remained so until she died a few days later–with Joe tearfully holding her hand.

COMMENTS LIKE LAURA'S–"It's time to get in line"–are often heard when someone is near death. It's easy to label such comments as "confusion," and stop listening. Had he done so, Joe would have missed these important messages:

I'm getting ready to die soon.
I'll be reunited with Susan.
I need to know that Joe understands and is prepared for my leaving.
I need assurance that he'll be all right after I'm gone.

Joe's honest response eased Laura's pain–not physical pain but emotional and spiritual pain. After Joe explained his plans and said good-bye, she was able to live out her last days without anguish, having the information she needed to die peacefully.

Dying people often employ symbolic language that evokes their life experiences. Laura and Joe had met while traveling, and their lives had been full of ticket lines, baggage lines, and passport lines. With her comment, she was telling him she must now prepare for her next journey–one she couldn't take with him–by getting "in line with Susan."

Laura's final gifts to Joe were the realization that she was concerned about his welfare, that she was not alone in her dying and would be reunited with Susan.

After Laura's funeral, Joe said, "I know she'll be waiting for me when I die–the way Susan was waiting for her." His experience with Laura's death was already changing Joe's expectations about his own death.

YOU, TOO, CAN GAIN the insight and understanding you need to find something good in the sadness and pain of losing someone you care about. What you learn from this book–and from dying people–you can carry forward into the rest of your life.

We are not researchers or philosophers; we're nurses who choose to work with dying people. The material in this book has come directly from our finest teachers–our dying patients, who have taught us what dying is like for them while they are experiencing it. What we have learned is so exciting and positive that it has changed our lives, and we have written this book to share those messages with you.

We didn't set out to develop a new theory on the special communication by the dying–we simply listened, with our ears, with our hearts, and with our minds. We now invite you to open your minds and hearts to the positive, final messages of the dying.

Table of Contents

1."It's Time to Get in Line."1
INearing Death Awareness: Introduction and Background15
2.Nearing Death Awareness: An Introduction17
4.Reactions to Death43
IINearing Death Awareness: What I Am Experiencing85
5."Where's the Map?"89
6.Preparing for Travel or Change: "I'm Getting Ready to Leave."100
7.Being in the Presence of Someone Not Alive: "I'm Not Alone."115
8.Seeing a Place: "I See Where I'm Going."136
9.Knowing When Death Will Occur: "It Will Be When..."156
IIINearing Death Awareness: What I Need for a Peaceful Death179
10."We Must Go to the Park."183
11.Needing Reconciliation: "I Need to Make Peace with..."195
12.Being Held Back: "I'm Stuck in Between..."223
13.Nonverbal Communications: "My Actions Speak for Me."240
14.Symbolic Dreams: "I Dreamed About..."257
15.Choosing a Time: "The Time Is Right."275
16.Nearing Death Awareness: Practical Uses313
Recommended Reading327

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Final Gifts 4.8 out of 5 based on 0 ratings. 65 reviews.
Guest More than 1 year ago
We all understand that death is difficult to swallow, especially when it is a parent, sibling, child or someone close to our heart. Sometimes our relatinship may even be one in which there have been many ups and downs. With the help of others, like the authors who have been present with many people walking the final journey of life, they provide a familiarity of the journey so we to can see through our emotions and understand what is happening to us and the one dying. Having read this book a few months before mom's final days, we were prepared to face our issues, her issues and those close to us who refused to face death. This is a journey to remember and one in which joy may be found. This book was passed to me, I have passed it on many times because it not only gave me courage but showed me how to use that courage for my dying mother who was more courageous that we could have imagined. Those dying want our honesty and our attention to what is happening to them. It will also eventually happen to us, it is the journey of life. Dare the journey with an open heart.
Anonymous More than 1 year ago
What a great book!!!!! I am so glad to have read this book while taking care of my mom during her last months. I would have missed interpretted many dreams and visions that she had had I not read this book. The personal experiences that the hospice nurses talk about were so easy to relate to what was happening with my mom and I. As I said I give this book away to anyone who is going through the death or dying of a relative or friend. The only stipulation is that they pass it on when they are finished. Everyone I have given the book to has greatly appreciated the reading and are happy they have had a chance to read it before their love one has passed. I always keep two on hand just in case. Purchase this book you will not be disappointed!!!!!
Guest More than 1 year ago
During my mother's last days in a hospital, a chaplain gave me a copy of FINAL GIFTS to read while at her bedside. Most personal accounts discussed were about patients who could still communicate with others. However,since my mother could no longer speak, I was comforted to find a section on nonverbal communication too. The book encouraged me to watch all of her actions very carefully. A few hours before she passed away, she glanced at the foot of her bed, gazed away, and glanced back with a surprised look on her face. I noticed that she lifted the index finger of her hand, which was resting on top of a blanket. At first I thought it was an involuntary movement, but I saw that she lifted it a second time. It occurred to me then that she was POINTING at something at the foot of her bed! I don't know if it was an angel, or my father who passed away before her, but it was definitely someone. If I had not read this book, I might not have realized the significance of my mother's last efforts to communicate with me. These final moments with her have enriched my life and that of others with whom I have shared this story. I urge those who struggle with end of life issues to take advantage of the insights provided in this helpful book.
Anonymous More than 1 year ago
I lost my baby brother, and was instantly grief stricken. Our Hospice nurse recommended this book to me. While it didn't ease any of my grief, (only time will do that), it did offer me much peace as I learned about the dying experience. I now hold hope that my brother found peace in his last days. The little things he was saying to me, and even a conversation the day before we lost him... I now know and understand the messages he was trying to convey to me. I would highly suggest this book to anyone who has someone they either are losing or have lost. I do wish I had read this book before I lost my brother. It would have given me insight and I would have handled certain conversations differently. But moving forward, I too want the dying experience as he had. To be able to find peace, and see him waiting for me would be awesome. Read this book. It brought me so much peace and comfort, and I believe it will for you as well.
DP77 More than 1 year ago
IF someone you love and care about is on the journey toward the end of their life--and isn't EVERYONE? to some degree?--this book is INDISPENSIBLE!!! Buy it for yourself; buy it for a friend; but ABOVE ALL, READ IT!!! The authors write clearly and thoroughly about their experience in the field of working with the dying, and their insights are SO VERY helpful--particularly for those of us who've not before dealt with/been through the journey toward the end of life. I've had loved ones pass, of course, but never before in "journey format" this point, they've passed suddenly, unexpectedly. This content is not "cliche"--it's informative and HELPFUL! This book is SO WONDERFUL, too, because, at a time when there is so much needing to be tended is written in such a way as it is EASY to read and understand...EVEN WHEN you must put it down frequently as you are interrupted by the unexpected urgencies that come when caring for those on the "nearing-death journey" as they call it. Buy it for yourself and ALL who care for the one on the journey. a few copies for someone you know--they'll appreciate it SO MUCH when they suddenly find themself in the same situation. This book is CRITICAL to understanding and maintaining YOUR sanity when caring for those on the journey!
TrishMD More than 1 year ago
This wonderful book written by Hospice nurses inludes many wonderful stories about young and old during their last days. Though I read it after my father had passed, I found it comforting because it gave me an understanding of what he may have experienced as he prepared to leave. I have donated many copies to Hospice and have given copies to friends and everyone has loved it and benefited from it.
Anonymous More than 1 year ago
This book is a must read for anyone who has someone in hospice or facing the end of life. It helps you deal with the sorrow and to understand what your loved one is going through.
Guest More than 1 year ago
I have purchased this book for the third time for dear ones who are facing the death of a loved one. It was recommended to me by my cousin and she has given out numerous copies also. Very informative on what to expect.
Guest More than 1 year ago
As a Registered Nurse, this book gave me inexplicable insight into the dying process. It showed me that the dying and their families go through a process that is unique and very special and that we as nurses need to explore and respect that process.
Guest More than 1 year ago
I read this book 2 months after my husband of 32 years died in a hospice unit. He had been in the inpatient unit for 30 days following 4 months of hospice care at home. I was at his side constantly during this time. This book has helped me to find some closure and also to understand what my husband and I had been working our way through. This book would be very helpful to anyone with a loved one in a Hospice program, before or after death. I wish I had read it before my husband died.
Guest More than 1 year ago
My father refused to acknowledge he had a terminal illness. His thoughts were clear until death. I am a nurse and felt helpless and frustrated with how to relate to his refusal of hospitalization and it's inconvenience to family. Reading the book when hospice began helped family members accept his rapidly declining health. I felt inner strength to cope with what was soon to occur in our situation after reading Final Gifts. I was unable to put it down until I finished about 3 hours later. I cried while reading about experiences of others who had died with dignity as their families were by their side. My father died with dignity, at home with his loved ones by his side in a blessed and peaceful departure.I have bought 3 copies and given away each to those who were facing the loss of a loved one. I will buy another to have and reread and possibly share in the future.
Guest More than 1 year ago
Our daughter was barely 16 old when my mom was dying of cancer. We received this book from hospice just a few days before her death. It was at bedtime (the only time I had) that I found comfort in reading 'Final Gifts'. When I told my daughter about what I was reading, she asked me to read it aloud as she fell asleep. It helped her tremendously. Death and dying is hard enough for adults. Teenagers have such up and down emotions under normal circumstances---loosing a loved one or friend can seem impossible to endure. The night before Mom died, family and friends gathered. She knew when and where she was going. She was happy, in good spirits, and at peace. My daughter witnessed all of this. This precious time with Mom and the words from this wonderful book relieved any fear she may have had. I continued to read and finished 'Final Gifts' after Mom passed. It gave me comfort and strength as I grieved. I have given copies to many people since 1996, and will continue to do so. It's a 'must read' after death as well. NOTE: upon previewing my review as it would be posted I noticed the date. Today would have been her 74th. 'Happy Birthday' Mom
Beverly_D More than 1 year ago
One of the most frustrating things about being with a person who's dying is a sense of helplessness combined with ignorance. What is the person feeling, what does he WANT, are some of the things he says delusional or do they have a greater meaning? This book helps answer many of those questions, and gives clear examples of these things. If you will be spending time with a person who is nearing death, I highly recommend this book. And for all that many people find death depressing, I have to say I found this book both comforting and extremely uplifting. Does it cover all the messiness, ugliness, and indignity that death can entail? No, but there are other books that do. This still deserves to be one of THE books on one's bookshelf.
Anonymous More than 1 year ago
This book was recommended to me by a hospice nurse at the passing of my mother. What a comforting, wonderful read! Final Gifts is itself a gift to the reader.
Anonymous More than 1 year ago
This is an excellent book. I highly recommend this to everyone who is facing the loss of a loved one.
Anonymous More than 1 year ago
If you are caring for a loved one and they are nearing death this is one great book to read! I was given my first copy by a Hospice Nurse when I had questions about how my mom was reacting. She gave me the book which at first I only wanted an answer, but later after reading the book I found much more comforting answers than a person could have given me. I have shared this book many times and always get a thank you for sharing. This explains to the lay person or the health care professional what you need to know as people get near death. At the moment I have a real book of this and now a Nook Book of it so I will always have a copy.
Anonymous More than 1 year ago
My Mom was at Hospice, and a staff member recommended that I get this book, written by two Hospice nurses. I was able to better understand what my Mom was going through and the book explained how and why some things happen. It was a GREAT resource for me, and I'm telling all my friends about this great book.
GinnyJWA More than 1 year ago
As the person with the terminal illness, I needed to read this book. It has made me more comfortable about dying. At 47, it is difficult to come to terms with a terminal illness, yet even more difficult when your husband will not talk to you about it. I will try very hard to get him to read this book, as it would help me very much.
MoseyNH More than 1 year ago
This book changed my life, and, I believe, allowed my mother to have a more peaceful death. How could any review say more? Nurses Callanan and Kelly share their many experiences as hospice nurses with brief introductions on themes which they saw repeated in their work with the dying. Each topic is accompanied by experiences of patients and their families, such as finding the patterns in what are seemingly senseless ramblings by the dying person. I know that by finding the patterns, we were able reassure my mother about two concerns--worry about the order of her personal business and moving on to death with some peace by interpreting what might be considered symbolic language and setting her mind at rest. Useful to readers who are both skeptics and religious believers.
odonatafan More than 1 year ago
This has become my standard gift to those friends that lose loved ones. It helped me tremendously in the loss of my father and I know it has been very helpful to others as they work through their grief. I highly recommend this to anyone that has a loved one who is suffering from a terminal illness or has recently lost someone dear to them. Thought-provoking and touching.
RTL More than 1 year ago
Written by Hospice nurses, angels themselves, Final Gifts is an amazing tutorial on not just listening, but hearing the messages conveyed by a dying loved one. It is highly readable, not written in a fashion to produce copious tears, but rather to provide insight on hidden meanings of the wishes, dreams and feelings of the terminally ill. The book was given to me by my dying mother, and I found knowledge and comfort in its pages. Subsequently,I have presented Final Gifts to a number of friends who likewise have discovered significant value in its message.
Anonymous More than 1 year ago
I was given this book at the time of my best friend's terminal illness diagnosis. It was an amazing resource and provided me much guidance and comfort during one of the most challenging times of my life. I have since purchased and given many copies to others who are coping with a terminal illness. This is the best resource I have come across...and I have read many, many books on death and dying. I would highly recommend it!
Anonymous More than 1 year ago
very helpful during a difficult time, preparing for one's own death, and for their loved ones to prepare.
SilentLakeGramma More than 1 year ago
Very insightful, very helpful in appreciating and dealing with death
MargieHG More than 1 year ago
This is the best book ever! When someone is dying, they may say and do things that seem odd or out of the ordinary. This book, written by Hospice nurses, explain what these things may mean. There is such a thin veil between life and death and someone facing their final days may "bless" you with some insight from the other side. It truly is a gift if you are lucky enough to be aware of what to look/listen for. I recommend this book highly. You won't be able to put it down.