Final Words

Final words: Just as no two people have the same personality, no two individuals leave the world the same way. For some, the moment of departure is silent, and happens after the individual has lost consciousness. For others, they may be talking rationally and reasonably to the end. For others, they are speaking, but what they say, at first glance, appears to be disconnected from reality, or almost sounding like nonsense.

At the time of death, if we are well-cared for and on hospice, usually, death is not an uncomfortable or frightening experience. And those who have returned from near-death experiences that were sudden and unexpected consistently relay that the moment of death was not full of pain or unbearable. In fact, near-death experiencers consistently report feelings of bliss, love, harmony, and comfort. Some families report having experienced a great deal of confusion listening to their loved ones' final words in circumstances where those words do not appear to make much sense.

Lisa Smartt has documented the variety of categories of speech that loved ones may hear as an individual passes into death. She details these categories on her website exploring the common themes that appear. For example, did you know that individuals may repeat the same words over and over? Think about Steve Jobs' last words: "Oh wow, oh wow, oh wow!". According to Smartt, repetition is one common category of speech we see at the end. Others may speak in metaphor. For example, Smartt documents the final words of choreographer Jeffrey Holder: "Arms, 2, 3, 4...Swing, 2, 3, 4...". Others may also refer to modes of travel or voyage, discussing packing bags and getting tickets, or preparing for a big event, like going to a dance or a ball. When taken out of context, these words may sound like nonsense, but for individuals who have known and loved the dying person, they may be able to sleuth out the meaning of these utterances, and find a way to connect them with meaning to this individual.

Unusual language can be frightening at first: talk of windows to different dimensions or glimpses into new realities may be startling for those witnessing final words. As humans, we express a desire for control and to understand our surroundings. This helps us feel a sense of safety, predictability, and meaning in life. During the dying process, an individual's brain may not feel the need to make meaning in the same way they have over the course of life. Preparing to depart the physical body can be exhausting, interesting, and overwhelming. It's unclear how much control individuals have over what they say: as the brain dies, speech may be challenging to control. However, I do believe that the individual remains present in some way. Therefore, it's imperative for us to focus on providing soothing touch (if the person consents to it and is not in pain), speak loving and encouraging words, and try to enter into that individual's new reality as much as possible. Write down those final words and explore their meaning. You may just find a new way to maintain a bond with your loved one that has died.

Sometimes, we may feel ourselves become anxious when we think about the final moments of our loved ones. It is not uncommon to experience flashbacks or intrusive memories about the deaths of people we care about, whether we were present or not. It also isn't uncommon to have questions about the things they said, or to be confused trying to interpret those final words. Working with a therapist to process your feelings about that loved one's death, as well as death itself, is important. When people we care about die, it can trigger reminders of our own mortality, and it is important to explore these and associated thoughts and feelings in a safe and secure environment. Talking and thinking about death won't hasten it, but it's like carrying an umbrella in case of rain: the umbrella won't make it rain, but you will be prepared if it does.

This is important when you think about how you want to die and prepare for death. Consider filling out a healthcare advance directive or living will to record the types of medical interventions and assistance you might want if you are unable to speak for yourself. Talk to your loved ones and let them know how you want to leave this world, and things they can do to help you. Consider the following questions:

If I experience cardiac arrest (my heart stops beating), do I want CPR to restart it?
If I am diagnosed with a terminal illness, what is more important to me: aggressive treatment that might have many side effects but will potentially add longevity to my life, or symptom-based approaches that do not slow the course of the disease but give me a better quality of life?
How do I feel about the afterlife? What are my beliefs surrounding cremation or burial?
Do I want my loved ones to record my final words? Would I like to begin a journal or story about my life to pass down to the next generations?

None of the above questions are easy to answer, and it can take time to think through even one of them. Your answers may change depending on your prior experiences with death and illness, as well as your age or other factors unique to you. But it's never too early to begin to brainstorm and even discuss with close friends, family, or a therapist some of your thoughts on the above. You'd be surprised to know that talking about death and your final moments will actually result in your feeling less anxious and more in control about the process.

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