My post Accompanying the dying process has been quoted in an article by Sue Fox ” Retirement and other endings – part 5″ on Fulcrum, Issue 76. Fulcrum is a triannual magazine issued by Craniosacral Therapy Association. Su’s article makes me realise the question of how we can support or be supported in the significant transition is not only my personal issue but also others’. Here is the whole article by Su Fox.
Retirement and other endings – part 5
In the first of these pieces about retirement and other endings, published in September 2017, I stated my intention for the final one to be about, well, the final one – death.
The more comfortable we are with the idea of our own death, and have addressed issues arising from traumas that bring us into contact with our own mortality, the better we’ll be able to live fully while we are alive and be present in stillness with our clients who are facing the end of life.(1)
Little did I know that one year later my partner’s cancer diagnosis would bring me so much closer to the personal reality of death. We don’t talk about it because we’re too busy getting on with living, but it’s there.
When it happens, it will be the first time I’ve been there for the event. I’ve had my fair share of bereavements and funerals. I lost grandparents and family pets during my childhood, then a brother-in-law and other friends to AIDS during the crisis years, and my sister’s first baby was stillborn. Two of my previous partners managed to commit suicide within the same month. And more recently, both my parents died, in their own beds in the early hours of the morning, one quietly succumbing to prostate cancer, the other to old age. As the gravestone legend has it, they ‘fell asleep.’
So what actually happens? Unless death is violent or accidental, it appears, like birth, to be a process rather than an event and one that takes an unpredictable length of time, like birth. For every person the process will be unique. No two deaths – like births – are the same, although there are stages that indicate a gradual shutting down as life comes to an end. The individual becomes drowsy and needs to sleep more and talk less, gradually withdrawing from the world. The desire for food and drink lessens and it may become difficult to swallow. The digestive system shuts down as its function in providing energy becomes redundant. Breathing may become erratic, and there may be short periods when it stops. The extremities of the body become cold and the skin may look blue, as the circulation slows.
There are two markers for the end of the process, as far as the physical body is concerned: clinical death, which is when the heart stops beating and respiratory functions cease, and biological death which is when brain activity ceases. Deprived of oxygen, brain cells begin to self-destruct and die within minutes and once brain-dead a person can’t be resuscitated. Clinical death is a different matter. Patients experiencing open heart surgery are suspended in a state of clinical death for the duration. The person who is lucky enough to be near a first aider trained in CPR when she has a heart attack can come back from the brink and resume living.
Throughout time and across cultures human kind has evolved belief systems to explain what happens next. Whatever the reasons informing these traditions, they all share a recognition that physical death is not the end of the process. Depending when and where you died, you might expect to meet hungry ghosts or St Peter, or to see your heart weighed on a golden scale. Your body might be buried with food for the next part of the journey or set alight on a funeral pyre or left on a hilltop for a sky burial. If the rites weren’t performed, if your body could not be found to be buried or you didn’t know you were dead, you’d likely stay to wander the earth as a ghoul or ghost.
Our profession pays a lot of attention to the beginning of life and very little to the end. New graduates have the skills to work with babies. None of the professional trainings mention death in their curricula. A trawl through back copies of The Fulcrum shows that since 1999 only 7 issues have a significant word search for death or dying, and most of these are in obituaries, whereas only 7 of the 75 issues on line do not mention birth or babies. I could speculate on the reasons for this: babies have advocates who believe that CST will help and are willing to pay for it and the dying don’t; the reluctance in our profession to think about death mirrors that of society as a whole; like the medical profession, we are more invested in restoring health than providing palliative care. There’s room for a whole other article here. But it seems obvious to me that cranial contact is the ideal way to be with someone making that final transition. When the Breath of Life stutters and fades who better to accompany the dying person have than someone who can sit in stillness and hold the space with no expectation, who can witness with compassion and assist a dysregulating system to settle?
I found 3 accounts of working with a dying person written by craniosacral therapists. In 2000, Al Pelowski wrote ‘A little slice of Life’ (2) which describes his experience of being with Joy, an elderly family friend as she chose to slip away. In 2005 Vivien Ray offered us ‘Working with Hilary’,(3) an incredibly moving account of her involvement in the dying of her beloved partner. Last year, Katsura Isobe wrote on her website about treating her grandmother in Japan just before she passed(4).
Both Al and Katsura refer to the stages of physical change preceding death.
Al: It seemed to me that slowly and surely, almost precisely, Joy was living and choosing her dying, in little bits or stages…………… The rhythms of Joy’s physically embodied life become intermittent, unpredictable. Her breathing seemed to stop for seconds, minutes even, but then came back in gasps and sighs. Her heartbeat fluttered and stopped too, at times. But I began to understand that these were merely little steps in the process of leaving, that it wasn’t a case of ‘once and for all’.
Katsura: My grandmother passed away on 4th June at the age of 93. She admitted to a hospital on the day I arrived in my hometown Tokyo 12 days before, after having stopped eating. During those days, I have witnessed how she was diminishing, and tried to hold the space and support her to process whatever she needed to process so that she could transition with ease.
My first visit was on day 4 for her in the hospital. She was already bedridden and almost non-verbal but I was still able to see some momentary expressions.
On the last day, when my mother and I arrived, she looked very shrunk but calmer. She had been suffering from a breathing difficulty but now calmer. Through touch I felt no more kicks and pulls in the tissue but peaceful. Two hours later, a nurse rushed into the room as she had noticed her breathing stopped on the monitor.
Vivien gives a detailed account of changes she felt as Hilary’s internal organs shut down:
I am drawn to the organs: dry, massed, confused, they lie inert against my hand. I feel confusion, a literal loss
of identity, loss of purpose. I stay there, startled at first. I feel a wave of recognition and grief wash through me as
I realise the reality of this perception: these organs have finished their work forever.
Now the component parts are becoming apparent. Adhesions and a glue-like absence of fluidity. Her old appendix wound rises and falls. The hepatic flexure is kinked tight and that whole corner of bowel is thrust up against the liver. The small intestine is tired, quiet and distant. A bubble of air is struggling through with nowhere to go.
As these sensations come into my hands there begins to be some relief, as if the organs are explaining themselves to themselves. Announcing to themselves the end of their life.
And here they are writing about changes in the energy, in the tides.
Al: There is a light that forms when the heat, when the animation of the body starts to depart. So many people see this, and it is obvious now with Joy……..over the next several hours that evening with Joy, I had the spell-binding experience of holding her, being hands-on with her, throughout the transition we call Death.
Katsura, describing what happened in an early treatment:
As I treated her with my hands gently on her back, I felt quite powerful resentment that made me slightly dizzy. Now looking back, I feel this experience set my intention to support her to process any unhelpful left-over emotions so that she can transition light.
And when her grandmother’s breathing stopped:
I placed my hand again behind her heart, and I was invited to the purest and very wide cellular breathing; expansion and contraction (CS rhythm in Craniosacral Therapy). She did a few little gasps, and then after the last one, the craniosacral system turned to subtler and wider (mid tide in CST).
Vivien, in a treatment in the days leading up to death:
And there is a tide. Stiff and creaky, the familiar rhythm, about two and a half breaths long, starts to drag my two hands with it. Longitudinal, sometimes hovering at an edge, sometimes starting to turn and then finding a new surge of potency.
And at the end:
I was with her as her spirit finally broke free of the clinging body and, floundering at first, began to expand into the dimensionless realms of death. We were in craniosacral communication as she died.
All three were also very certain that the process continued after breathing stopped.
Al: ….it felt right to leave her alone in the contracting bubble of light, in that cool morning air, undisturbed, giving her all the time needed to gather up every last bit of spirit, for that core heat itself to finally leave the body behind. I had to accept that Joy couldn’t feel my hands any longer. That I had to let go too. As far as I could tell, and deep as I could feel, that deepest heat and that softest light disappeared some ten hours later. The body was there of course, but the room was empty
Katsura: A moment later, a doctor came so I left her. He examined and announced her death. After they left, I went back to placing my hand on her back, where I still feel the warmth and mid tide same as just before the doctor came. It was very strange to hear she was dead while this energy was still in the body. I have heard before that Craniosacral system remains for a while after the heart stopped. I guess that’s what it is. But for a person who has been accompanying the transition, it did not make sense to have the definite point of death predominantly defined by the heart function. For me, my grandmother was still alive when the doctor announced her death, and still when we were asked to leave the room while the nurses clean and sort out her. I felt like a new born whose umbilical cord gets clamped while the placenta is still pulsing.
Anyway, after I sat for a while next to her with the face covered with a white handkerchief, I felt she was dead.
After her last breath, in the stillness, I became aware of floundering and confusion.
‘She doesn’t know she’s done it,’ I said to her doctor and beloved friend.
‘You must tell her,’ he said.
And I did. ’Well done beloved, you’ve done it; don’t fight anymore; allow yourself to go with the light.’
For the first twenty four hours the energy was also still palpable in her body-directionless like a static buzzing without flow.
Over the next two days I was able to experience that expansion as she let go of the imprint of her bodily existence.
I contacted Vivien and Katsura to ask permission to use their material and showed them the draft article.
Vivien: I found it a beautiful introduction to the complex issues around working with death. There is a real need to keep this in our consciousness. I really appreciate your emphasis on the possibilities of working with this profound transition through our CST skills.
Katsura: It is very interesting and also touching to read other people’s experiences. As you say, in the article, death is as important as birth. I really felt so during my experience with my grandmother. I am glad that you have brought this theme forward, and I hope more people support and are supported in the significant transition.
Al Pelowski died in 2009. I hope there was someone in cranial contact with him when he died.
I hope there’ll be someone in cranial contact with me, too, when my time comes.
- Fox, Su (2017) Retirement and other endings part 1. Fulcrum, Issue 72
- References for the physiological info on dying: Private conversations with Dr. Rik Fox, consultant anaesthetist, Royal National Orthopaedic Hospital, Jan – Sept 2018; End of Life Care; NHS website and others
- Pelowski, Al (2000) A Little Slice of Life. Fulcrum, Issue 20
- Ray, Vivien (2005) Working with Hilary. Fulcrum, Issue 35
- Isobe, Katsura (July 2017) Accompanying the dying process. katsuraisobe.net