Go in peace: rituals for the dying.

JOYCE RUPP, O.S.M. is a spiritual director, retreat and conference speaker, and author of many books, including Praying Our Goodbyes (Ave Maria, 1988), Your Sorrow Is My Sorrow (Crossroad, 1999), and Walk in a Relaxed Manner (Orbis, 2005).

Much has been written about death and dying, particularly the stages of the process, including the physical, mental, and emotional responses accompanying end-of-life issues. There is much less information about how to attend spiritually to those entering the last days and hours of earthly life. How can we pray with the dying in a way that is supportive, caring, and respectful? How can we temporarily forgo the ache in our hearts as we focus on being a loving presence for them? Rituals can be a valuable source of support for the dying, but traditional church rituals are limited and those we do have often lack sufficient help for this significant transition.

I discovered the meagerness of these rituals on the day a dear friend died. That morning the nearness of impending death whispered in every corner of her house. Friends and family came and went in the crowded living room. They stood by the hospital bed, attempting to say farewell to the beloved woman in a semi-coma. As they did so, my heart felt the heaviness of each one's sorrow.

In that grief-laden atmosphere, my friend's sister-in-law approached me and whispered, "We ought to gather tonight and do some sort of ritual for Joan." I readily agreed, knowing how inept we all felt about telling her "goodbye." I agreed to plan a prayer service for that evening.

A combination of panic and dread collided in me as I drove home. My mind briefly reviewed the traditional rituals of the Roman Catholic Church. There was the Sacrament of the Anointing of the Sick, but this is usually given weeks or months preceding death. Even when the anointing is near the time of death, the sacrament is only allowed to be administered by a priest. Besides the fact I am not ordained, this ritual allows only minimal participation for those present (mainly observation and some brief responses to the prayers).

Non-ordained chaplains sometimes bless the dying with holy water, making the sign of the cross on the head, the mouth, the heart, the hands, and the feet. Other chaplains pray the litany of the saints. One hospital chaplain encourages those at the bedside of the dying to create their own litany by naming deceased family members and friends. In doing so, they are reminded that the one dying will soon be welcomed home by those who have gone before him or her. The rosary was another option that I knew to be of comfort to the dying.

Each of these Catholic rituals has value but none of them seemed to be what Joan and her family needed. Her loved ones needed a prayerful experience that would provide support and strength to Joan as she slowly slipped away, while also encouraging their own ability to peacefully let go of her.

To each his own
Knowing how to pray with others when death nears is difficult because what gives comfort and ease to one dying person can cause anxiety and unease for another. Such was the case when a beloved pastor of mine was dying. Although he was conscious, he could neither see nor speak. One of his priest friends and I stayed the night with him. At a moment when it appeared he was close to his last breath, his friend and I began singing church songs such as "Be Not Afraid" and "On Eagle's Wings."

As I gazed upon the pastor's face, I sensed the need for quiet, remembering what he had once told me about wanting silence in his house for his morning prayer. So I leaned down close to his ear and asked, "Would you like us to stop singing? If yes, squeeze my hand." His response, even in his weakened state, was to nearly squash my fingers!

Another time I was with a young man dying of AIDS who wanted the opposite of silence. He asked that classical music be played continually in his room during his final days. Because each person has his or her own needs when approaching death, we cannot presume that one or two church rituals will best assist every dying person.

Certainly what we do not want to do when we are at the bedside of the dying is to foist our own needs and beliefs onto the one who is departing. How unfair if we encroach on dying people's last moments, focusing on our own desires for consolation instead of centering on what will bring peace and serenity to them.

It helps greatly if those around the bedside know what the dying person appreciates about personal prayer. One family told me their father was completely inert and unresponsive as he lay dying. They decided to pray the Our Father because he always prayed it at home. As they began, he turned his head toward their voices and a faint smile appeared on his ashen face. The Our Father was obviously what resonated with him and brought consolation. They had chosen well.

Many times we do not know the patient's spirituality and can only guess at what he or she might need. No situation is ever the same. We learn as we observe and tend to the dying. We do the best we can, trusting our deepest intuition and our Spirit-connection to lead the way. I had been Joan's spiritual director for five years so I was familiar with how she prayed and what she valued but I knew of no satisfactory rituals I could use.

Silent presence
To calm my searching and clear my vision, I went for a walk in the woods. My feet plodded along while I struggled to think of something appropriate. I prayed intensely for guidance. Above me an owl with wide wings silently glided through the trees.

Then four deer stood not far from me, gazing with what seemed to be compassion in their eyes. Joan was passionate about nature and often found her comfort there. The sight of those creatures assured me I would find a ritual that would encourage her journey onward.

Memories of my time as a hospice volunteer surfaced. It was during my bedside times with the very ill that I discovered a new way to pray with them, a personal ritual allowing me to be present in a spiritual manner that was respectful of their own religion and way of praying.

As I sat in the presence of a hospice patient whose body was weakening, I sensed the soul expanding in freedom. It was as though the soul was "ripening," being readied for its journey onward, like an apple maturing toward its moment of departure from the tree. I saw myself as a privileged witness to this awesome event. Although I spoke very little, I did offer encouraging words, affirming the dying one's spiritual strength and ability to release the body's hold on life. Always I assured them they were not alone.

Occasionally I held a hand, touched an arm, swabbed dry lips with moisture, or placed a wet washcloth on a fevered head, but mostly my physical actions were few. It was my "inner action" that I consistently gave to the patient. I tried to be a peace-filled presence of compassionate love as I imagined Mary of Nazareth was with when he was dying on the cross. Very intently I continuously gathered the love of God in my heart and sent it to the dying person, surrounding him or her with as much compassionate courage and peace as possible.

While "sending love" may not seem like a ritual, it does have its elements of gesture (inward attentiveness) and repetition (intentional sending of love over and over). I never knew whether or not this inner ritual was of value until two days before a beloved cousin of mine died. On Saturday morning I sat in her hospital room as she lay sleeping and "sent love" to her. I left before she awoke and on Sunday when I returned she appeared more peaceful than usual. As I drew near her bed, she turned to me and said, "You were praying for me while I rested yesterday, weren't you?"

Blessing the body
For Joan, I trusted the benefits of my personal inner ritual but realized we needed a communal one, something external that everyone could participate in and that Joan could hear. Then I realized I had missed something essential:

I had discounted the body with so much focus on the soul.

The soul was ripening but so was her body as it weakened and prepared for its separation from the soul. Through Joan's 55 years of life her physical body had been her faithful companion and instrument for spiritual growth. Whatever ritual we prayed, her body would need to be included. Out of this realization, I created a prayer service with the central component being that of the blessing of loan's body.

That evening when family and friends gathered around the hospital bed we knew we were standing at the threshold of a powerful moment for our loved one. Joan barely moved. Her breathing was shallow and her body calm. As we began the ritual, I invited everyone to remember the presence of the Holy One in our midst. We needed this to give us hope and strength. We listened as some of Joan's favorite poems by Mary Oliver were read. Next I explained how we were going to bless and thank Joan's body for what it had done for her and for us.

We spoke directly to Joan as we blessed the various parts of her body (head, eyes, ears, hands, etc.). We recalled what her body had done for her and thanked her for how she had used that part of her body in some way as a gift to us.

For example, when I prayed a blessing for her head (the dwelling place of her brain and mind), several persons standing nearby placed their hands on her head. I mentioned how she influenced our lives by her beliefs, attitudes, and values, and thanked her for sharing her dreams and hopes with us. Then those around the bedside added personal ways her head had helped them. After each part of her body was blessed, the group spoke together to Joan: "You will always be a part of our hearts. Go in peace." We continued in a similar manner for the rest of her body.

Throughout the ritual, Joan's 80-year-old mother gently held her daughter's bare feet in her hands while loan's husband bent close by her side. When it came time to bless her womb in gratitude for the wonderful life it had carried within it, her two young-adult sons knelt down and put their heads on her stomach and cried, "Thank you, Mom! Thank you!"

During the entire blessing I stood at the back of the bed. We completed the farewell ritual by listening to a musical rendition of the Our Father that Joan had included in her funeral plans.

I'll never forget what happened after the music stopped. Throughout the blessing she had been silent and seemingly unaware of our presence. To our amazement, after the closing song she slowly raised her right arm and extended it backward toward me for a brief moment. Then the arm flopped down limply on the bed. Joan had heard everything and was trying to express her gratitude!

Healing at the end
Since that time, I have used the blessing in similar situations and have shared it with others who have waited with the dying. People continually assure me that it provides both their loved one and themselves with the surrender and peace they need.

A chaplain recently told me of a woman who clung to her husband's body after he died and could not bear to leave him. As she tried to console her, the chaplain remembered the blessing of the body. When the ritual was completed, the widow turned and whispered, "Now I can leave."

Another chaplain recently described how she was in the intensive care unit ministering to a family with hostile emotions toward one another. Some had not spoken to each other for years. They stood or sat silently in far corners from one another as they waited to hear the surgeon's prognosis. Eventually they learned their loved one was not going to live.

When the family was able to enter the ICU room to say their goodbyes, the chaplain invited them to join her in the same ritual I used with Joan. The chaplain said it was like a miracle. By the time the ritual was completed, the family began to speak to one another, then to hug each other and to cry. The ritual helped them release their old wounds. In expressing gratitude to their family member and encouraging him to go in peace, they rediscovered a center of love that united them again.

Death is a momentous journey that each of us will one day take. I hope we will have what we need spiritually in our final days and hours. Let us urge those in pastoral ministry and chaplaincy to create meaningful rituals for end-of-life situations. Let us search for prayerful ways to assist patients, and those who are with them, to say goodbye in a comforting way. What a magnificent gift for the dying if our church could be a catalyst of compassion and consolation for the great transition from this life to the Beyond.

Monthly Aspirin Use Linked to Lower Pancreatic Cancer Risk

MONDAY, April 4 (HealthDay News) -- Taking aspirin even once per month, whether low-dose or full strength, appears to be associated with a marked drop in the risk of developing pancreatic cancer, new research reveals.

     Specifically, taking full-strength aspirin once monthly was linked to a 26% reduction in the risk of pancreatic cancer. Taking low-dose aspirin, to reduce the risk of heart disease, was associated with an even greater drop (35% lower) in pancreatic cancer risk.

     The findings, from a team led by Dr. Xiang-Lin Tan, a research fellow at the Mayo Clinic in Rochester, Minn., are slated for presentation Monday at the annual meeting of the American Association for Cancer Research, in Orlando, Fla.
     "This provides additional evidence that aspirin may have chemoprevention activity against pancreatic cancer," Tan said in a news release from the association.
But, he cautioned, "the results are not meant to suggest everyone should start taking aspirin once monthly to reduce their risk of pancreatic cancer. Individuals should discuss use of aspirin with their physicians because the drug carries some side effects."
     To explore the protective potential of aspirin, the investigators focused on 904 pancreatic cancer patients and just over 1,220 healthy individuals, all of whom were seen at the Mayo Clinic between 2004 and 2010.
     All of the study participants were at least 55. Questionnaires were completed to assess aspirin use between the ages of 41 and 60, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.
     Using aspirin at least once per month was linked to a significant drop in pancreatic cancer risk, the research team concluded, even after accounting for other factors that might affect the finding, such as body-mass index and smoking history.
     Those who had once smoked but kicked the habit seemed to experience an even stronger protective effect with respect to aspirin use than those who had never smoked or those who continued to smoke, the study authors noted.
     NSAID and acetaminophen use did not, however, have any noticeable impact on pancreatic cancer risk, the authors added.
     Dr. Michael Choti, a professor of surgery and oncology with the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, expressed little surprise with the findings.
"There have been other preclinical findings suggesting that there may be some role for aspirin in inhibiting carcinogenesis, including pancreatic carcinogenesis," Choti noted. "And in other cancers, such as colon cancer, aspirin use has been associated with a reduction in cancer risk."
     However, "studies that are not randomized trials are fraught with biases," he cautioned. "Those taking aspirin for a variety of reasons, say for cardiac or other cancer-protective effects, may generally have a better lifestyle, smoke less, eat better, exercise more. So one cannot purely conclude from this kind of study as to whether they are finding a general association between people who take aspirin, or in fact a true causative effect," Choti pointed out.
     "But it's very interesting," he added. "And certainly the cost and risk of aspirin use is quite low. And this is compelling evidence to suggest there is some benefit, and it's perhaps another reason to advocate the use of aspirin."
     Because the study was presented at a medical meeting, the findings should be viewed as preliminary until they are published in a peer-reviewed journal.
-- Alan Mozes

Copyright © 2011 HealthDay. All rights reserved.

Pancreatic Cancer Drugs Sutent And Afinitor Recommended By FDA Advisory Committee

Sutent (sunitinib malate) and Afinitor (everolimus) were recommended for approval for the treatment of unresectable pancreatic neuroendocrine tumors, a rare type of pancreatic cancer - by the FDA Oncologic Drugs Advisory Committee. Patients with advanced pancreatic neuroendocrine tumors (pNET) have limited treatment options; no new drug has been approved in three decades. Unresectable means that it cannot be removed by surgery.

Pancreatic neuroendocrine tumors affect approximately 0.32 in every 100,000 people, a very rare type of cancer. Unlike other pancreatic cancers, which result in death within a few months, pNET generally grows more slowly. Approximately 95% of all pancreatic cancers are pancreatic adenocarcinomas.

Dr. Mace Rothenberg, senior vice president of Clinical Development and Medical Affairs, Pfizer Oncology Business Unit, said:

"We are encouraged by the panel's favorable review of sunitinib for the treatment of unresectable pancreatic NET. Following today's discussion, we will work closely with the FDA to ensure that it has all of the information that it needs to finalize its review. If approved in the United States, sunitinib would be a major advancement in the treatment of patients with pancreatic NET, a disease for which there remains a significant unmet medical need."

Although the FDA Advisory Committee's recommendations are not binding, the Agency tends to go along with what their members advise. Earlier on in the day the Committee recommended that another drug, Afinitor (everolimus) also be approved for the same type of cancer.

The Committee appeared to be more impressed with Novartis' everolimus (Afinitor), which received a unanimously favorable vote, compared to 8-2 in favor of Pfizer's sunitibib (Sutent), a tyrosine kinase inhibitor.

Everolimus, which already was approved for kidney cancer treatment by the FDA on March 30, 2009, will probably exceed sales of $1.3 billion in 2015, experts estimate. Sunitinib is also an existing kidney-cancer drug - it was approved for the treatment of renal cell carcinoma and imatinib-resistant gastrointestinal stromal tumor (GIST) on January 26, 2006. Everolimus is currently used as an immunosuppressant to prevent the body from rejecting transplanted organs.

The Data Monitoring Committee for the SUN 111 trial (for Sutent) recommended the halting of randomization for the study in interest of patient safety and also on data indicating a high probability the study would meet its primary endpoint - progression-free survival - if it were to carry on to the end date of the study. A final analysis showed that Sutent more than doubled progression-free survival.

Written by Christian Nordqvist
Copyright: Medical News Today