Nearing death awareness is a term that the authors have used to describe the special processes in those slowly dying. (Callanan & Kelley, 1992, p. 21) The authors have spent many years providing hospice care and have noted various themes in dying. These reflective or metaphysical themes can arise alongside the physical process of dying. (Callanan & Kelley, 1992, p. 39) The dying person and their loved ones and support care team may experience peace by finding meaning through their final gifts. These gifts can assist in grief because they can provide comfort, enlightening information, and peace if not overlooked. (Callanan & Kelley, 1992, p. 21) The final gifts can help the dying person feel heard, less lonely, and have a sense of trust with their loved ones. The overall dying experience may be seen as a less challenging experience. (Callanan & Kelley, 1992, p. 22) They may feel heard in their end-of-life requests which will help them achieve a peaceful death. Loved ones will feel peace for the dying but also gain valuable insight into the process of nearing death. (Callanan & Kelley, 1992, p. 22) This peace can be helpful in the grief trajectory and provide insight to feel a sense of control or less fear towards dying. The support care team can also benefit by understanding nearing death awareness because it can help them provide satisfactory care for the dying and their loved ones. (Callanan & Kelley, 1992, p. 22)

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         The authors describe the final gifts as the dying person's way of describing what it is like to be near death and what is needed for a peaceful death. (Callanan & Kelley, 1992, p. 22) They offer a glimpse into what and who is waiting for them and describe what may be needed to make peace with dying. (Callanan & Kelley, 1992, pp. 22-23) The messages may be missed, but they provide insight into the dying process, bringing peace to the dying and their loved ones. (Callanan & Kelley, 1992, p. 21) Sometimes the dying will say something symbolic or mention a long-forgotten memory that may be dismissed for confusion and a wandering mind. (Callanan & Kelley, 1992, p. 21) These acts or statements may have meaning for the dying, and they may be seen as the dying person's way of letting their loved ones know it is time, even though it may seem obscure, unexpected, or missed. (Callanan & Kelley, 1992, p. 21) Understandably, a loved one or even a member of the support care team may see these gifts as confusions or hallucinations and may respond inappropriately, like prescribing a drug or responding with annoyance. (Callanan & Kelley, 1992, p. 22) The dying may have a hard time finding the words, and it may seem as if they are confused, disoriented, or even recalling a distant memory. (Callanan & Kelley, 1992, p. 25)

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         Nearing death awareness does not have a definitive timeline as it can happen in the final weeks, days, or hours. (Callanan & Kelley, 1992, p. 21) The gifts usually need to be deciphered as some statements or symbolism may not be apparent. The dying person may seem distracted, preoccupied, and puzzled and may ask questions or seem to be focused on something beyond. (Callanan & Kelley, 1992, p. 67)The author describes common universal themes exhibited by a dying process. The first set of themes describes what a person is experiencing in nearing death. They center around preparing for a journey, being around a presence and not feeling alone, seeing a place that is not ordinary, and knowing when their death will happen. (Callanan & Kelley, 1992, p. 36) The second set of themes centers around what is needed to achieve a peaceful death, like removing barriers or reconciling spiritual, moral, or personal relationships. (Callanan & Kelley, 1992, p. 36)      

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         The first theme in nearing death may seem as if the dying need permission to die or are preparing to travel, even though they physically cannot travel and know they are dying. They may look for special items to take on their journey, like a passport or a map and may even ask how the conditions are for travel. Loved ones and support workers may even fetch these items, thinking they will help improve the dying person's state of well-being. However, they may not appear to be at ease because they are still looking for the items needed to make their journey. Preparing for a journey may be the dying person's way of asking for permission to die and asking their loved ones if they will be okay. (Callanan & Kelley, 1992, p. 74) Loved ones and support staff may need to reassure the dying by giving them relief by letting them know it is okay to leave for the journey, they will not be alone, they will find what they are looking for, and everyone will be okay. (Callanan & Kelley, 1992, p. 74) It may seem cruel to tell a dying person they are dying when in actuality, they are not afraid and know death is coming. (Callanan & Kelley, 1992, p. 81) Rather, the dying may need to know that their loved ones and support staff are prepared and have accepted that death is near. (Callanan & Kelley, 1992, p. 81) The gift of preparing to travel is the dying person's way of letting them know death is approaching and asking if it is okay to go.

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         The second theme in nearing death is described as the dying person seeing or interacting with people who are otherwise not alive or not present in the room. (Callanan & Kelley, 1992, p. 85) Some may see people they know, people who have died, or religious figures like angels. (Callanan & Kelley, 1992, p. 85) They may seem like they are having a conversation with the presence or as if they are trying to understand what the presence is saying. The interaction is not scary as it can often help the dying person know they are not alone in dying because the presence can bring a sense of joy, pleasure, or reassurance. (Callanan & Kelley, 1992, p. 85) The dying person may feel a sense of support and companionship in dying and feel reassured that they will be physically fine regardless of their physical condition while dying. (Callanan & Kelley, 1992, pp. 87, 94) Loved ones may feel comforted in their grief by knowing the dying person is not alone and will meet one day again. (Callanan & Kelley, 1992, p. 97) In these instances, it is best to respond positively by accepting the message as a gift rather than finding an explanation or a cure. (Callanan & Kelley, 1992, p. 97) Avoid condescending statements, like the person is next door and speak the truth by reminding the dying person that the person they see has died. (Callanan & Kelley, 1992, p. 97) The gift of seeing a presence is the dying person's way of letting their loved ones know they will not be alone in death.

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         The third theme in nearing death is described as the dying person briefly seeing a place that is not visible to anyone else. (Callanan & Kelley, 1992, p. 98) The place may not be familiar or visited and may be described with little to great detail. (Callanan & Kelley, 1992, p. 106) It may be hard for the dying person to describe this place that brings them comfort and peace, but it provides them with a feeling of warmth and light. (Callanan & Kelley, 1992, pp. 98, 106) Some of these places may be based on afterlife beliefs or that life carries on after death, regardless of religious beliefs. (Callanan & Kelley, 1992, pp. 101-102) It may be an indescribable place only for the dying person to know or experience. (Callanan & Kelley, 1992, p. 109) It may be easy to misinterpret the gift, but loved ones and support staff are encouraged to ask the dying person if they are ready to go to this place or ask if this is where they are going. (Callanan & Kelley, 1992, p. 109) The gift of seeing other places is the dying person's way of letting their loved ones know that there is a peaceful existence and continuation of life after death. (Callanan & Kelley, 1992, p. 110)

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         The fourth theme in nearing death is described as the dying person knowing when their death will occur. (Callanan & Kelley, 1992, p. 111) They will not feel panic or fear and may or may not directly share the message. (Callanan & Kelley, 1992, p. 111) It may seem as if they are confused or referencing something unique by using language or symbols. (Callanan & Kelley, 1992, p. 114) Loved ones and support staff may look past the message and not think much of its possible meaning. (Callanan & Kelley, 1992, p. 114) Loved ones may find comfort by paying attention, listening, believing, and noticing the messages from the dying person. (Callanan & Kelley, 1992, p. 116) It may give the dying person and their loved ones time to prepare for death or say or do something that otherwise may be regretted later on. (Callanan & Kelley, 1992, pp. 117, 122) The gift of knowing when death will take place is the dying person's way of knowing that death will happen and they are not distressed by the information. (Callanan & Kelley, 1992, p. 124)

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         Nearing death awareness can be described in various ways and are unique for the person dying and is open to interpretation by loved ones and support staff. Being aware of what nearing death is like can provide comfort to the grieving family, prepare them for death, and allow them to say or do things to provide peace. Often, these messages may be overlooked if there is too much anticipatory grief or busy taking care of other things. The first set of gifts describes the themes around what dying is like and can occur over a varied time. The second set of themes centers around what is needed to achieve a peaceful death, like removing barriers or reconciling spiritual, moral, or personal relationships. (Callanan & Kelley, 1992, p. 36) The dying person may be direct or vague, anxious, agitated, or prolong the dying process. (Callanan & Kelley, 1992, p. 127)

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         The fifth theme in nearing death is described as the dying person needing to make peace, complete, or reconcile unfinished business. (Callanan & Kelley, 1992, p. 137) Sometimes the requests are made with enough time to fulfill them, and sometimes there is less time. The dying person may be clear and direct or less clear, leaving them to be missed, unimportant, or labelled as confusion. (Callanan & Kelley, 1992, p. 137) The dying person knows that they must reconcile to feel peace in dying and less spiritual or emotional pain. (Callanan & Kelley, 1992, p. 137) Most of the messages are related to finding peace or reconciliation with people, supreme beings, or themselves. (Callanan & Kelley, 1992, p. 138) Some may need to speak with someone they have not spoken to in a long time, ask for support from their religious community, or reconnect with their religious beliefs and faith. (Callanan & Kelley, 1992, pp. 141, 143) Some people may regret their past behaviours and actions and feel guilty, sad, or troubled when nearing death. (Callanan & Kelley, 1992, p. 148) Some may describe this feeling as seeing their life pass before their eyes because they become aware of their need to find peace. (Callanan & Kelley, 1992, p. 153) In these instances, it would be helpful for the dying person to reflect on what has gone right and what has gone wrong. They may need to think about broken relationships, lost faith, opportunities missed, and tasks not completed while finding meaning in their existence. (Callanan & Kelley, 1992, p. 153) The gift of reconciliation or finding peace is the dying person's way of showing us what they need to achieve a peaceful death. It also helps those left behind to see the value of finding peace and purpose while living.  

         The sixth theme in nearing death is described as the dying person feeling as if they are being held back or prevented in some way to have a peaceful death. (Callanan & Kelley, 1992, p. 155) These messages relate closely to feeling held back because of something that has either been missed or not completed. (Callanan & Kelley, 1992, p. 155) Sometimes the messages may be direct as to what needs to be done or vague and rooted in a metaphor. Not everyone will have someone available to decipher the message and help complete the task. Support workers may recognize the message that something needs to be reconciled either through their frustrations or agitations. Some may need reassurance to help them through their feelings of being held back, especially when reconciliation is not possible. (Callanan & Kelley, 1992, p. 161)  Some people may need to make sure financial affairs are in order or that others will be okay by doing something. (Callanan & Kelley, 1992, p. 165) In these instances, the dying person needs reassurance in knowing that whatever they are being held back by will be fixed, or they will get what they need to achieve a peaceful death. (Callanan & Kelley, 1992, p. 165) The gift of the dying person knowing they are held back in some way allows loved ones to help them find a peaceful death. (Callanan & Kelley, 1992, p. 165)

         The seventh theme in nearing death is described as the dying person expressing their time to die through non-verbal actions. (Callanan & Kelley, 1992, p. 169) These actions may be limited to small hand movements or eye movements because of the debilitating nature of nearing death. In some ways, the dying person expresses their readiness to die through their actions, which helps their family members know that it is time or to give their permission. Loved ones or support workers may notice these expressions and confirm with their loved ones to see if there are any meanings. In some instances, the dying person may appear to be reaching for something or trying to go somewhere but end up falling onto the floor. (Callanan & Kelley, 1992, p. 175) The messages or meanings behind the non-verbal communication might be interpreted or apparent to the loved ones or support workers. In one example, a son may interpret his mother reaching her hands as if she was holding a baby and interpret that she is being reunited with the baby in her final moments before death. (Callanan & Kelley, 1992, p. 171) In these times, loved ones and support workers may consider the hidden meanings behind these movements rather than seeing them as something negative. (Callanan & Kelley, 1992, p. 176) It may seem as if the dying person died because of falling on the floor, or it can be seen as the dying person having a final burst of energy to meet the people who are waiting for them on the other side. (Callanan & Kelley, 1992, p. 176) The gift of the dying person moving or expressing themselves non-verbally demonstrates that there may be meaning connecting to something relevant from their lives. This gift can help loved ones know that the dying person has found peace or answers in their death.

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         The eighth theme in nearing death is described as the dying person learning about their important needs through their dreams, especially if they are recurring, vivid, or a series of progressive dreams. (Callanan & Kelley, 1992, pp. 177, 187) Their dreams help them connect with their unconscious minds and explore what they need to achieve a peaceful death. Some dying people may have fears about dying or questions about what it is like or what will happen to them. They may have fears or anxieties about death because they do not know the answer or cannot talk with living people. These dreams may or may not have direct and clear meanings, and it is best to ask the dreamer to interpret them. (Callanan & Kelley, 1992, p. 187) Once uncovering their meanings or addressing the questions and fears, a dying person may feel a sense of calmness surrounding their death. It may be hard to find and identify the meaning and needs from the dying person's dream, especially if they create feelings of fear. (Callanan & Kelley, 1992, pp. 183, 184) In these instances, it is best to listen and encourage the dying person to explain the dream's details while leaving the interpretation up to them. (Callanan & Kelley, 1992, p. 187) Fearful dreams may relate to the illness and death. Dreams that create a sense of anxiety may demonstrate worry, and puzzling dreams may demonstrate a need for information. (Callanan & Kelley, 1992, p. 187) The most beneficial action from loved ones and support workers is to help the dying person identify the feelings or needs hidden in the dream. (Callanan & Kelley, 1992, p. 187) The gift of the dying person's dream is their unconscious way of revealing what they need to achieve a peaceful death.

 

         The ninth theme in nearing death is described as the dying person waiting for certain conditions to be met so that they can have a peaceful death. (Callanan & Kelley, 1992, p. 188) The condition may be clear, like waiting for a family member to arrive from out of town, leaving the hospital to return home, waiting for a specific date like a birthday or anniversary, or even receiving permission. (Callanan & Kelley, 1992, pp. 195, 203, 205, 207) Other times, the message may not make sense at the moment and may seem like confusion or disorientation. It may not even be certain that the dying person is waiting for something specific. Dying people may wait until a person arrives, but they also may wait for the person to leave. (Callanan & Kelley, 1992, p. 195) In these instances, the dying person's message is that a peaceful death means sparing loved ones and support workers from the anguish or memory of being present for the death. (Callanan & Kelley, 1992, p. 197) Loved ones and support workers may feel guilt or sorrow for not being there at the time of death, but waiting for the perfect condition, is the gift from the dying person to ensure their loved ones are supported or spared from the pain. (Callanan & Kelley, 1992, p. 199) They may wait until a specific date passes before they die because they do not want to spoil the dates for their loved ones, or they may need reassurance that it is okay for them to go. (Callanan & Kelley, 1992, pp. 205, 207) The gift of the dying person waiting for the perfect condition is their way of feeling a sense of control and power in their death. It can help the dying person achieve a peaceful death and help their loved ones with their grief.  

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References

Callanan, M., & Kelley, P. (1992). Final Gifts. New York: Simon & Schuster Paperbacks.