How to Hold a Deathbed Vigil

Recently, I had an internet conversation with a number of fellow Catholics and one of them came to learn of a man who was dying in a Catholic Hospital. When he got close to death, a nurse called a priest who stated he was “unavailable”. The nurse was mightily upset and disappointed with him, but still trying to get a priest to the bedside called her parish priest expecting him to jump at the request.

Many people engaged in that internet discussion about this incident “piled on” in condemnation of the priest’s refusal to drop whatever he was doing and go to the man’s bedside. After all, he was the hospital priest (so ostensibly responding was his job), but as he gave no specific reason for being unavailable. We cannot judge the validity of his reason for not responding. I then shared with the group that I had studied Hospital Chaplaincy (as a lay Catholic, something that is accepted even in conservative circles) in a Clinical Pastoral Education program after experiencing a similar situation in a Neonatal ICU.

Not Just A Priestly Calling

While it is true that I likely had a bit of the “shame on him, I will become a chaplain and show him how its done” hubris when I first set out to serve in that capacity, what I learned in my studies and service led me in this discussion to defend that priest. I now see situations like this as teachable moments to engage my fellow lay Catholics to better understand how we can minister to one another in the actual process of death. In my 30 year career, I have worked in Pediatric ICU, Neonatal ICU and Hospice (Adult and Newborn with a few Pediatric cases mixed in) plus practical Chaplaincy work while studying (Emergency Dept, Traumas). Yet, oddly enough, with all that experience I thought I had “seen it all”. But then in my own life, I also experienced the unexpected of finding my husband dead in our house when I was only 47. For a person who has never been in a war or major natural disaster, I have seen a lot of death.

For the priest in question, with no additional information than what was offered in the retelling, we need to use charity to assume the best of him. He could have been violently ill himself or actively engaged in another death situation or life-and-death crisis. One of the arguments originally made against him was that “no one should die alone”; ideally that is true but that doesn’t mean that we can or should leave the vigil process only to priests.

The Death Vigil Process

In the best of situations, a person receives the Sacrament of the Anointing of the Sick early in their illness. While they are still conscious, we should use those precious and fleeting moments to get the person some private moments with a priest for Confession and Viaticum (“food for the journey” last Communion). When it comes to “getting the priest to the bedside” these are the times that are the most crucial. Once a person is unconscious, it is nearly impossible for them to participate in the Sacraments. I have seen a few exceptions to this, and some people may offer some very powerful personal testimonies. I do. I once baptized an adult in an ICU just before she died. She could not speak or open her eyes, but she shed tears and died within the hour. However, waiting for the last possible moment is a bad plan as there is a possibility that no priest will be available.

We know there is a priest shortage. It seems theoretical until we need one and there isn’t one. If you think it is bad now, imagine if we took this original argument to its logical conclusion and reassigned priests to hold all vigils for dying Catholics. You go to Mass and its canceled. You plan a wedding for a year and spend $50,000 but when it comes time for the ceremony, the priests and deacons have been called away to hold a death bed vigil. No, we need priests to do what they do. But holding vigil, letting loved ones cry on shoulders, being there, holding the hand and wiping the brow…that is our job.

Respecting Their Wishes

When I used to do overnight Chaplaincy shifts at the hospital where I studied Clinical Pastoral Education, I would make rounds of anyone who was “actively dying” (as the process is known in that world) and often I found middle aged siblings 2 or 3 at a time sitting at the bedside of an older parent. They often seemed anxious and uncertain of what to do. I used to say to them “this thing you came to do, this (gesturing in reference to their quiet, loving, sometimes prayerful presence) is how it’s done, no one teaches how to hold vigil anymore, but you are doing it right”. Many hospices have volunteers who have held their own vigils in the past and help others in need. The dying person may have expressed the preference to have some time of solitude before death – I argue that it is a good thing to ask about while the person can still converse. I am often curious if this was the case when you hear of families holding intense vigils never leaving the person alone, but they die when everyone steps momentarily into the hall.

I found that in the vast majority of situations, very much like in births, the right nurturing actions come to people in the moment and things go well. I have come across a few family members who experienced last minute panic that resulted in them reacting in ways that likely weren’t comforting to the dying person (like the son I found screaming into his father’s face to “take one more breath daddy, ONE MORE BREATH!!!” over and over) but even that panic calmed when we gently modeled alternative nurturing behaviors to the panic stricken man.

Knowing What To Provide

In practical terms, its good to remember that at the very end, there is a natural loss of hunger and thirst and even though food and water should be easily available to them, allowing a person who has stopped eating and drinking to just be without forcing intake isn’t “starving and intentionally dehydrating” them, it is letting their body do what its doing. Good pain control is a goal within the parameters that the person expressed as their wish while they could talk – some don’t want to experience any pain even if it leaves them sleepy, others don’t wish to limit their capacity to interact even if that means some pain. Additionally, addiction is not an issue of concern at the end of life. People likely maintain their capacity to hear well and feel touch long after they lose the capacity to speak. Knowing what they want to feel and hear may be a real help in you knowing what is best at the end of your loved ones life.

You may have noticed that a number of nurturing options I mention will work best if you know the preferences of the person you will be holding vigil for. You can go a LONG way to show love for them by giving them a chance to tell you what it is they want, knowing them and being willing to let this be their experience, about them, not us – be brave and if they are willing, have the conversation. I cracked stupid jokes to one lady to her very last breath because she liked stupid jokes and she died laughing – that would have been a horrible thing to do to someone else, but it was great for her. The only pediatric hospice home death I worked on, the young man did not want me to touch him, at all…his mom was his caregiver and that was that. I honored his wishes and never touched him until after his death.

Strength Of Our Collective Faith

For me, I might be fine dying in a hospital someday because I have spent my whole life in them, they feel like home to me. I want enough drugs on board to keep me comfy and I want my daughter’s breathing to be the last sound I hear on this side.

I suspended my study of Chaplaincy when I had to move and decided to not resume because I realized that I still liked being a nurse; so I no longer function as a chaplain. I tell people I listen with chaplain’s ears, think with a nurse’s brain and speak with a mother’s mouth.

When your friends have held a vigil, let them tell their story – over and over if necessary and tell them that they did a good job. Remind them that they were like John and the 2 Marys at the foot of the cross when they held vigil.

“Brothers and sisters, we do not want you to be uninformed about those who sleep in death, so that you do not grieve like the rest of mankind, who have no hope.”  -1 Thessalonians 4:13

When we hold a vigil, we are demonstrating the strength of our collective faith for all to see …that our Traditions have prepared us to walk this hard path and do so with strength and certain capacity. It can be a powerful witness to those around us who find themselves with no rudder in life…we can minister to the dying and help the living in the same moment.

There are differences in newborn death situations (like Baptisms) that I may write about in the future, there isn’t space here to address that and most of us will hold death bed vigils for adults.

I invite priests / deacons and those who have been the midwives of souls in holding vigils to add comments and present other ideas and experiences – even if you disagree with some of my ideas, we’re all still ahead because we’re talking about it and we need to so that we can be ready when we are called to the sacred task of being at the bedside of the dying.