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  • Gabrielle Elise Jimenez

Rituals and end of life offerings

Over the years as I have started to evolve in the care of patients at the end of life, I have found that what I am drawn to most is how their loved ones are cared for and what they take away from those last few moments before they say their final goodbye. As a hospice nurse, once a patient has died and all of our paperwork is completed, we walk out the door, and then the social workers and bereavement team take over. I feel confident they are being taken care of well and I know they are all in good hands, however, sometimes I feel as though I am abandoning them when I walk out their door, never to talk to them again. This is the rule, the protocol, the way it is supposed to be, and I accept, respect and understand that, but I don’t like it. I don’t always feel this way… it is usually only the ones I spend a little more time with, the ones I share some really intimate conversations with, and the ones who I have earned their trust to the point where they let go and give in to the death and participate and have those beautiful last goodbyes, and we both know… I had something to do with that. THOSE are the ones I struggle with walking away from, never to speak to them again.

As I delve deeper into the end of life doula role, I find that what comforts me most is that I can linger a little longer with the family and loved ones who will be left behind. I still feel the roles of the social worker and bereavement teams are far better qualified than I, for the grief support that might be needed, but there is something I enjoy doing, which I feel softens the ache just a little, and that is the rituals I encourage moments before last breaths are taken, and shortly thereafter.

Whether you are a hospice worker, an end of life doula, a caregiver, a volunteer or a friend or family member, you have the capability to create a moment just before someone dies that can be the difference between painful and beautiful for those at the bedside. Reminding them to say certain things and/or encouraging their presence in a kind and gentle way is lovely and will make a difference, but I think it is more than that. I want to give them a take-away, a reminder that they might have provided the care that made their loved one feel a little less alone, a little safer and a little more at peace. I believe that knowing that, will ease their ache just a little. Words can be powerful, especially when they are the last ones spoken by someone you love.

There was a gentleman I cared for who wanted to leave his wife something after he died. I suggested I get him a small ceramic heart, that he could hold and after he would pass, she could hold it too, knowing that his hands touched it last. The moment I handed her the stone after he passed away, I knew I had given her something she would treasure forever. I have done this a few times since, and I love the reaction that is received.

I was with two siblings, who moments before their father was about to die, wanted to send him off with something that they could give him. I looked around the room and found colored ribbon tied around a vase; I suggested they each take a long strand of the ribbon and cut it in half. I encouraged them to tie one half of the ribbon around his wrist, while saying goodbye to him, and save the other half around their wrist for after. They both did this. They told him they loved him, they would miss him, and they said goodbye, all while tying this brightly colored ribbon around his wrist. They took turns wrapping the other half around their wrists, both in tears. After their father died, I watched them as they both fondled the ribbon, knowing that was their take-away. I ran into one of the siblings about a year after, who told me the ribbon had fallen off a few weeks later, but he saved it. He was thankful to have that memento, that take-away.

There are so many things that we can offer to someone at the bedside who is about to say goodbye, that can be their take-away, and can bring them even the smallest amount of comfort as they start to navigate their grieving process. I have so many more stories like these that I can share with all of you, but I want to encourage you to create your own for each loved one you might meet at the bedside. Be creative, be thoughtful, and take the time to offer them a special and unique gesture that can be their own personal take-away.

After someone has passed away, I always offer a bathing of the body before I go. Not everyone wants to do this, or be a part of this, but I have changed it up a bit over the years, making it a little less awkward. I keep a bowl in my car, because it is a special bowl, made just for this purpose, and feels a little more symbolic at the time of the bath. I ask someone to get enough washcloths for each person who wants to participate. I fill the bowl with warm water and put a drop or two of oils that I bring, and sometimes flower petals, and I soak each washcloth completely. I hand one to each person and encourage them to wash the hands, the feet and the face of their loved one, and as they do this, I suggest they wish them a safe and peaceful journey. There are always tears, because this is a very intimate moment, but it is also a very cleansing, special and powerful moment for all who participate. I step away to give them privacy and my heart fills as I witness their gentleness. This gets to be their take-away.

As I begin to combine hospice nursing with being an end of life doula, my ultimate goal is to focus on those who will be left behind. I will continue to create the very best last moment memories for them to take away, so that when I do walk out their door for the last time… I know I eased their ache even in the smallest of ways.



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