Vol. 4 Issue 15
Grief and Culture
From each culture, we can learn something new about dying and grieving
I admit that, like most people, I prefer to dwell on life as opposed to death. The closest I come to thinking about death is when I obtain a new investment and I'm asked to identify a beneficiary in the event of my death. However, my recent conversation with Phyllis B. Taylor, BA, RN, an end-of-life nurse, now working in the Phila.delphia Prison System, taught me what most nurses in this capacity already know, that observing death teaches us a lot about how to live.
Taylor has observed death and the grieving process among many cultures and religions in the 30 years she's been a nurse. And with each culture, she's learned something new about dying and grieving.
"I've always been concerned about the intersection of justice and health care," said Taylor, a long-time civil rights worker and community organizer. "My calling has al.ways been to work with people who have been marginalized."
She said that the most important question a nurse can ask a dying patient is, 'what they need?' Never assume that each culture grieves the same way or requires the same medical treatment.
Taylor recalls a Jewish physician on his deathbed. His bone marrow was failing and he told Taylor he knew he was not going to make it. "What do you need?" she responded. Taylor always uses what she calls "guiding" questions that will help reveal the appropriate action for the patent.
He said he needed to live 3 1Ú2 more months for his grandson's bar mitzvah, the celebration of a Jewish boy's 13th birthday. Taylor, who is also Jewish, understood his request. She asked him to consider having the bar mitzvah earlier than the scheduled date. After discussing it with his family, he agreed. They had the bar mitzvah 2 days later in his hospi.tal room, and the patient died a few days later.
Taylor recalls a similar case with a young Muslim woman who had a stillborn child. Taylor said that family didn't have money to bury the baby, so she recommended they use services from Humanity's Gift Registry, which would pick up the baby's body for cremation, then bury the ashes.
"Because I knew little about Islam É I did a little research and found out that cremation was forbidden," she said. Because of her quick thinking, she was able to prevent the cremation. An imam, a Muslim leader, was called to ritually wash the baby. Taylor was able to obtain permission to retrieve the body from the morgue and set aside a room for the ritual washing.
"It was very moving to watch," said Taylor.
As evident by these examples, water is an important ritual for many cultures and religions dealing with death, and is used differently in each culture..
Take for instance the African-American patient she cared for a patient dying of metastatic cancer. She makes it a habit to do a dual assessment by making inquiries of one's physical health and spiritual health. This patient was no different.
The patient revealed he was doing poorly both physically and spiritually. Although she was limited treating the fatigue he was experiencing as a result of the cancer's progression, she asked how she could help him spiritually. The patient, a 77-year-old Southern Baptist, asked to be baptized, which requires full-body immersion.
"This was not going to be possible," said Taylor. "But at this particular hospital we had a wonderful group of people called the Comforters."
The Comforters, a group of spiritually based health care workers at the facility, gathered at the patient's bedside for his baptism. Unfortunately, they could not find a Southern Baptist minister who could do a partial-body immersion, but she did find the pastor of one nurse, a Mennonite, who was available. Untraditional by nature, Taylor even gathered her nursing orientation class to participate in the ceremony. Between her class and the Comforters, they supported the patient by acting as the congregation.
"It was glorious," said Taylor. "When I went back to do the assessment the next day he said he was doing better in his spirit." A couple of days later, the patient died.
Taylor has learned many things from the cultures she works with. In fact, she said she learned one of her best tricks from an African-American grandmother, who taught her how to keep the eyes of the dead closed by placing a piece of cotton or toilet paper under the eyelid. "She taught me the trick and I've since taught a lot of nursing students," said Taylor.
On another occasion she nursed a Korean mother and baby who were badly burned. She worked with the Korean pastor of their church to act as her guide and translator. He told her that culturally it was very important for the family to stay with the dying baby in the ICU as part of the death vigil while they administered treatment. Instead of asking them to leave, they simply asked them to move away from the bed so that they could give the family members the proper care.
Taylor had a similar experience with a Vietnamese family and contacted the Nationalities Service Center in Philadelphia for guidance. Assuming the patient speaks English, she said that all nurses have to do is ask the patient whom she should contact.
Taylor learned there was a prayer service in session for a terminally ill Puerto Rican woman she was visiting at home. The pastor's wife told her that the service wouldn't be over for another 2 hours.
"What you're giving her is more important than anything I might give her," she said to the pastor's wife. Acknowledging the respectful way she communicated with the pastor's wife, the family and patient gladly agreed to let her do a quick examination.
On another occasion, a dying Pentecostal woman asked to be bathed in the blood of Christ as an anointing. The process would involve repeated washing of her body with prayers.
"I had to explain that to the administration so that the security would allow more than the two visitors to her room, and I also explained it to the nurses," Taylor said.
While Taylor's 30 years of nursing has provided an extensive knowledge base for dealing with various cultures, she recommends Religious Values of the Terminally Ill: A Handbook for Health Professionals (Uni.versity of Scranton Press, 1997) by Delfi Mondragon for further guidance. However, references like these are just one way to learn.
"We're always learning if we are open to learn and it doesn't take much time to say to a person's family, 'Help me understand what I can do to make this time easier,'" said Taylor.
"It [end-of-life care] has also taught me how important it is to be aware of all of the things I have every day," acknowledged Taylor. "My son, who is ironically now a pediatrician, used to say that I was 'disgustingly mushy, and I wish you would stop telling me every day that you love me.' Well, I told him that I couldn't because I've been with too many families where there is unexpected dying and death.'"
I couldn't agree with Taylor more. I hope that we all have enough sense to live life "disgustingly mushy" too.
Sylvia Coleman is editorial assistant at ADVANCE.