Final Gifts – Maggie Callanan and Patricia Kelley
Bantam Books 1997 240pp
ISBN 0-553-37876-7

As I read this book it gradually dawned upon me that the authors, two hospice nurses, were revealing hard won secrets from over 40 years of clinical experience and compassionate work with the dying. Their insights alone make this unassuming little book worth its weight in gold. It is truly indispensable. How can I express this strongly enough? I wish that I had read it years ago. I hope that everyone who is around me when I die has read it. It should be a primer in every medical field of study (MD, Nursing, Health Sciences) and could change the way that working with the dying is envisioned for many years to come.
Final Gifts posits and (in my opinion proves), that we need to pay attention to the words, gestures, comments, utterances and indications of those who are close to death. Any and all of these forms of communication serve to inform caregivers as to what the dying person is experiencing or what he or she needs for a peaceful death. The language is often symbolic and may even appear nonsensical, but if listened to and gently examined it usually holds the clue to some element that is important in the persons passing.
This is a rather revolutionary concept. It hints that we have some knowledge and control of the time and circumstances of our passing and will strive to let others know about it. The authors call this Nearing Death Awareness. We know when our death is near and have things to say about it! The communication is often in another language and requires a compassionate listener. Professionals should be tuned in to NDA and more importantly they should help family and friends to become aware of it as well.
The book has an organized and interesting structure, presenting concepts and principles and then backing them up as well as illustrating them with well written case studies. It starts by presenting the challenge of finding some meaning or opportunities for growth at the time of death.According to the authors’ experience, growth is possible at the time of passage when the wishes of the dying are held paramount and attended to.
It introduces Nearing Death Awareness, (a patient’s attempt to describe what he or she is experiencing and/or what he needs for a peaceful death) and describes the similarities and differences to Near Death Experience (NDE). It is important not to get the two concepts confused…I found no significant similarities.
The authors go on in the next chapters to show the similarities between the birth and death processes, tell a bit about the history of hospice, share how NDA was developed, and give a variety of useful practical information about symptoms and circumstances surrounding the time of death. I found this last section to be particularly helpful because due to their experience the authors are able to present the things that are truly useful – in a well organized format- disregarding those that are too clinically complicated for the layperson.
One important caveat that the nurses warn us about is to know what our own beliefs are and to be careful not to project them onto the passage of those who are dying. This comes up several times in the book. It becomes clearer as the authors examine Kubler-Ross’s five stages. The simple process of being a good listener is very important in dealing with denial and anger. A good listener, a compassionate guide, is free of preconceptions and ideology, and will not strive to lead the dying anywhere but will accompany him, providing encouragement and support on his or her own unique path to awareness.
The book goes on to present 5 chapters describing death experiences from the authors’ work. This is the “What I am experiencing” part of NDA.
The final section of 6 more chapters deals with What I Need for a Peaceful Death. I found the presentation of a short case study illustrating an underlying principle to be most effective. The chapter headings organize the material nicely. It covers, among other things; urgency, reconciliation, being held back, symbolic dreams, choosing a time, choosing location, right conditions, verbal permission and particular dates.
The authors end with a list of specific reminders for keeping NDA in mind when working with the dying. Quickly paraphrasing some of these:

* Pay attention to everything a dying person says. A pen and notebook might come in handy to write everything no matter how seemingly insignificant which at a later time might make sense.
* Important meanings in any message are possible
* Watch for key signs and gestures
* Respond to things that you don’t understand with gentle inquiries
* Pose questions in open ended encouraging terms
* Accept and validate what the dying say.
* Don’t argue or challenge.
* The dying may employ images and terms from work or hobbies to convey valuable information. (p225)

This listing doesn’t do justice to the final section. It is well presented and thorough, an excellent summary. In fact, looking back I have hardly done justice to the entire book through this review. I can only urge you to go out and pick it up or visit your local library. If on your way to buy this book you go through Amazon.com you will see that this book has 92 reviews…with all but a few rating 5 stars. You won’t find anyone including the present reviewer who can’t speak highly enough about it.