A Path Through

the Valley:

A personal guide for those sharing the experience of life’s

final stages with their loved one at the Grand Rapids Home for Veterans

Chaplain Bruce Kalish

Psalm 23A PSALM OF DAVID

1 The LORD is my shepherd; I shall not want. 2 He makes me lie down in green pastures. He leads me beside still waters. 3 He restores

my soul. He leads me in paths of righteousness for his name’s sake.4 Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me.5 You prepare a table before me in the presence of my enemies; you anoint my head with oil; my cup overflows. 6 Surely goodness and mercy shall follow me all the days of my life, and I shall dwell in the house of the LORD forever.

(English Standard Version)

A Path Through the Valley

In the deep valley of a loved one’s approaching death, it is not uncommon to lose your way emotionally, mentally, or spiritually. Questions arise that you may never have considered before. Answers don’t come easily. It can be a very confusing and exhausting time for you. Thankfully, you are not alone. Others have taken this journey before you and have marked out a path that you can follow.

2 | P a g e

This is a guide book to help you walk through your valley in death’s shadow. As your loved one enters his or her final stages of life at the Grand Rapids Home for Veterans, let the following pages comfort and help you. There are three stages on your journey: Preparing for Death; Understanding Death; and After Death – What Now? While others have led the way, your experiences will be uniquely yours. Hopefully, however, the following pages will assist you in your journey.

Preparing for Death

What happens when there is no cure?

You may have entered this valley with a phone call or by talking with a medical professional who reported a significant change in the health of your loved one. Very likely the term palliative care was used. What exactly does this mean? Palliative Care is the medical specialty focused on the relief of pain and other symptoms of a life-threatening illness. Palliative care is sometimes confused with hospice, but it is a much broader practice that is used even when healing is still the goal. A person may receive palliative care without entering hospice.

Hospice accompanies palliative care when people or their legal representative, along with medical professionals, decide that no further treatment will result in healing. The goal of care changes from cure

3 | P a g e

to comfort only. Such a decision is made when all appropriate medical attempts to heal have surrendered to the irreversible progress of an illness or injury that will lead inevitably to death.

As a family member, you may be having difficulty adjusting to this significant change in the health of your loved one. Talk with the doctors or attending nurses about any medical questions you have. Grand Rapids Home for Veterans also offers counsel from social workers familiar with your loved one’s personal information, and from chaplains for any emotional or spiritual care you or your loved one may need. You do not have to carry the burden of preparing for death alone.

Be assured that whether your loved one is being treated with the goal of healing or of comfort, we at Grand Rapids Home for Veterans respect and honor the inherent value and dignity of every member. No one’s worth is diminished by disease, disability, or even a terminal diagnosis. We will walk alongside you in providing the best possible care for your loved one.

How much time do we have left?

It is natural to want to make the most of the time you have left with those you love. So, when you see them declining in health, thoughts of living without them may crowd into your mind and make you sad.

4 | P a g e

If they get to the point where no medical cure exists for their condition, you may wonder aloud, “How much time do we have?” The truth is, no one knows, but God. Even when death is near, it is impossible to exactly predict its arrival.

That is why as long as your loved one lives, you should be hopeful. In the course of an illness or in the aftermath of a trauma, hope wears many different faces. At first, you may simply hope for a cure. But when that is excluded you can hope for a painless dying, a peaceful death, or life after death. Sometimes in the process of dying a personal offense is recalled that causes distress, so you or your loved one will hope for a restored relationship. The focus of your hope may change, but hope should always remain and never be lost.

When you sit with one who is dying, you must be careful not to steal his/her hope thinking you are somehow more straight-forward and honest that way. Hope is essential to one’s emotional life even when physical life is ebbing away. So, hope should always be cultivated, sometimes re-directed, as from healing to living without pain; but hope should never be discouraged or denied.

What are some signs that death is near?

While we encourage hope and do not know the time of death, eventually death’s dark shadow

5 | P a g e

becomes more visible than the loved one we have known. It may calm some of your fears to better understand the death process. What are some signs that death is more likely measured in hours than days?

First, it should be said that each death is unique, just like each life. And everyone is fully alive until they die. It may seem as though they have slipped behind an impenetrable curtain of bodily changes, but they are still worthy of our dignity, respect and love.

Second, unlike what you may have seen in media, dying is not easy; it is hard work. More often than not, dying is a drawn out process with several transitions before death comes.

Finally, there is no exact sequence of events leading to death. However, there are markers along the path as death draws near. Becoming familiar with these may help you prepare yourself or comfort others who are on vigil at bedside with you:

1. Sleeping increases2. Eating ceases3. Bladder and bowel control ends; kidney failure

develops4. Breathing changes, becoming shallow or more

labored with increased periods of no breathing5. Headaches, confusion, or unresponsiveness 6. Bluish-gray discoloration of lips and skin7. Heart rate increases

6 | P a g e

8. Fever and sweating develop to fight off terminal infections

9. Restlessness increases10. Hands and feet become colder11. Bruising (mottling) occurs as circulation

decreases12. Secretions increase in airways: when unable to

be cleared, these cause a rattling sound

*adapted from Kessler, David. The Needs of the Dying: A Guide for Bringing Hope, Comfort, and Love to Life’s Final Chapter. Harper-Collins. NY: NY, 2007. See also www.DavidKessler.org

I feel helpless. What can I do?

As death approaches, a person turns from the outer world and increasingly inhabits an inner world of thoughts, emotions and memories. This is a time when reflecting on past experiences and relationships, emotions like anger or sadness may surface. Often there is a desire to make peace and seek or grant forgiveness. The one who is dying may feel alone, even isolated by the effort given to this inward processing.

So, your very presence is a gift. Simply listening in a non-judgmental way provides the caring companionship your loved one needs at this time. If you hear things that upset you or that aren’t reality based, it’s important to encourage such sharing rather than becoming argumentative or denying the other’s experience.

7 | P a g e

If this is too difficult for you, ask for a chaplain to assist you. They are trained to walk alongside you in such an event. Still, because you are a friend or family member, you may be able to reach levels of emotional intimacy where a chaplain or other professional cannot go, if you are willing to do so.

There may be guilt or shame that needs to be forgiven or a broken relationship begging restoration. Just by being present and attentive at the bedside, you can be the bridge to peace at the end of life’s journey.

How can I prepare for death?

When it becomes clear that life is ebbing away, you may find it is a good time to make those practical, but necessary final arrangements that remain unresolved. It is better to deal with these before death, rather than after, when the swirling emotions of loss and grief often create a mental fog. Again, if this seems too difficult, ask for help from a social worker or chaplain. They are familiar with answering some of the questions you may have. Particularly, there are at least five questions you should settle as soon as possible.

1. How do you want to celebrate the life of your loved one? By a funeral, or memorial or by no service?

8 | P a g e

2. If you want a service, where should it be? In the Grand Rapids Home for Veterans Chapel, your family’s place of worship, or a private location?

3. How do you want the body to be prepared? By cremation or by full - body burial or do you want the body present at a funeral and cremated afterward?

4. What is the name of the local funeral home or cremation society you have chosen to receive the body?

5. Where is the final resting place, a family plot, a VA Cemetery, the GRHV Cemetery, or other?

Understanding Death

What is death? Most people think of it as a time when everything stops. From a medical standpoint that is accurate. As a result of disease, trauma, or deterioration, death occurs with the irreversible failure of the brain, respiratory and circulatory systems. But that is only part of the picture. From a spiritual standpoint, death occurs when one’s soul, or essential person, leaves the body. Death is seen as the gateway to a new kind of life. From an emotional standpoint, death stills any response to our love or unresolved issues. It is a final separation.

How should I feel?

Like dying, grief is a process that comes in many forms. On this stage of your path your emotions and

9 | P a g e

feelings will change from day to day or even moment to moment. Some people busy themselves in activity; others need stillness. Some tell stories or jokes while other people can’t stop crying. There is no “right” or “wrong” way to grieve. Grief is the darkest stretch of the path we all take when we endure loss. Comparisons are not helpful. Nonetheless, as with dying, there are some markers along the path that can be expected in the territory of grief.

Shock and numbness may set in almost immediately like an emotional anesthesia or mental fog. You may have trouble making decisions or communicating. You may be confused about your feelings and even think something is wrong with you. It is common to feel sad or immensely tired and unable to handle simple daily tasks for a while. (If this continues beyond a couple months you may benefit from consulting with your doctor or a professional counselor.) Similarly, anger commonly follows a death. You may be angry at the one you lost for leaving you; or at the medical staff, or angry with your family, with yourself, or even God. This is a short list of markers that grief is present. There are others as well.

If this process is new to you or you are fearful, don’t hesitate to seek help. Again, the Grand Rapids Home for Veterans chaplains are here to walk alongside you.

10 | P a g e

The biblical book of Psalms contains frequent expressions of human emotions like anger, despair, or fear. Many have found reading these Psalms helpful in processing their own grief. Perhaps you will too. The words of Psalms 22, 40, 42-43, 51, 73, 86, and 139 may especially guide you in this part of your journey toward renewed peace and hope.

After Death: What Now?

Once death has occurred you can rest assured that the Grand Rapids Home for Veterans will continue to care for your loved one with the dignity, honor and love we extended in life.

When death has been pronounced by a doctor or nurse, your loved one’s body will be washed and honorably transported to a holding area where the funeral home you have chosen will receive it for final burial or cremation care. They will contact you to understand your wishes regarding burial or cremation and to arrange for any other services you desire.

A Grand Rapids Home for Veterans chaplain will also contact you to offer our ongoing care and to make any arrangements you want concerning a service and/or burial in our Home’s cemetery on our grounds.

11 | P a g e

To help you work through various options, please refer to the Quick Reference Veterans’ Benefits at the end of this booklet.

In these pages we have shared the three stages on your path through the dark valley of grief and loss: Preparing for Death; Understanding Death; and After Death – What Now? We hope these thoughts have given you insight and some measure of peace.

If any further questions or needs arise as you accompany your loved one through this valley, don’t hesitate to reach out to a chaplain, nurse, or social worker. The Grand Rapids Home for Veterans staff is honored to be able to walk this path with you and to support and comfort you along the way.

Quick Reference Veterans’ Benefits

If the veteran is a GRHV MemberMembers and their spouse are eligible to receive, AT NO

COST:1. Use of the GRHV Chapel for visitation and

memorial/funeral2. Services of a GRHV Chaplain3. Military Honors (normally Kent County Veteran’s

Honor Guard – eulogy, rifle salute, taps, flag)4. VA Grave marker5. Cemetery vault (if full casket burial)

12 | P a g e

6. Cost of casket or cremation is borne by family with VA assistance described below

IF THE VETERAN DIES AT A VA HOSPITAL1. The family receives $745 or cremation allowance2. The family gets a $745 plot allowance IF burial is NOT

in a National Cemetery. Receipt required.3. The family is reimbursed by VA (“removal fee”) for

transport of body from a VA Hospital4. Free burial (vault, plot, headstone, military graveside

service) in a National Cemetery is permitted for veteran and spouse ($14,645 value)

5. IF NOT buried in a national cemetery, the family pays for body transport to place of burial or services

IF THE VETERAN DIES OUTSIDE A VA HOSPITAL

SCENARIO #1If the veteran received a monthly VA service connected disability pension:

1. The family gets $300 burial/cremation allowance2. The family gets a $745 plot allowance IF burial is

NOT in a National Cemetery. Receipt required3. Paid transportation will be given ONLY for burial

in a National Cemetery.4. Free burial (vault, plot, headstone, military

graveside service) in a National Cemetery for veteran and spouse

SCENARIO #2If the veteran received a monthly VA support pension:

1. The family gets $300 burial/cremation allowance2. The family gets a $745 plot allowance IF burial is

NOT in a National Cemetery. Receipt required3. NO TRANSPORT MONEY IS ALLOWED, EVER.4. Free burial (vault, plot, headstone, military

graveside service) in a National Cemetery for veteran and spouse

13 | P a g e

SCENARIO #3If the veteran received a 100% service connected disability pension:

1. The veteran MUST have died from service connection. IF SO, up to $2000 reimbursed to family for funeral or cremation costs.

2. Free burial (vault, plot, headstone, military graveside service) in a National Cemetery for veteran and spouse

IF THE veteran is buried in a national cemetery

All honorably discharged veterans are entitled to free grave space for the veteran, spouse and dependent children IF THE FOLLOWING CONDITIONS ARE MET:

1. The honorably discharged veteran served prior to 9/7/1980.

2. The honorably discharged veteran served 24 months of continuous duty after 9/7/1980, OR for the entire time for which the person was called to active duty.

3. IF THE VETERAN DIED INDIGENT:a. The VA will disburse $1967 (casket) or $172

(urn) in 2015 to individual or business.b. It must be certified to VA that veteran’s

next of kin could not be found OR is unwilling OR unable to assume financial responsibility for burial costs.

c. VA FORM 40-10088 must be filed with the VA.

BURIAL AT SEAVeterans of ALL branches of military are eligible for

burial at sea as follows:CASKET – Veteran of 20+ years of service. Spouse included.CREMATION SCATTERING – Any honorably discharged veteran and spouse.

14 | P a g e

v.1: 6/18/2015

15 | P a g e