Travel Metaphors at the End-of-Life
As your loved one gets closer to dying, they might start using travel metaphors. They may talk about packing for a trip, waiting in lines, or boarding a ship. It makes sense — they’re preparing for their next journey. In “Final Gifts,” Maggie Callanan and Patricia Kelley describe this state as “Nearing Death Awareness” and provide many beautiful patient stories about symbolic language at the end-of-life.
If you are a family member or friend of someone who has started speaking like this, listen for the underlying messages. Are they distressed about this trip? Do they have everything they need? Do they need reassurance that you will be OK when they’re gone? Ask open-ended questions, be open, and listen.
One of my home hospice patients, Jack* was lying in his hospital bed in the middle of his living room. His wife Sophia and I wanted to place an egg crate on top of his mattress to soften the firm hospital bed. We gently helped him out of the bed and onto the couch. He moved slowly and thoughtfully — all 120 pounds of him. As he stood up, a flashlight fell to the floor. He must have been lying on it. It was a small, sturdy MAG light. I picked it up and wondered aloud why it was in bed with him. His wife said, ”He always sleeps with one when he travels. He never sleeps with it at home, but for some reason, he wanted it under his pillow today.”
“Dying people know they are dying. They attempt to share this information by using symbolic language to indicate preparation for a journey. Travel is a clear metaphor often used to describe this need to go forth—to die.”
Maggie Callanan and Patricia Kelley in Final Gifts.
Jack was a Peace Corps volunteer in Ghana long ago, and he and his wife traveled extensively over their 47-year marriage. He was a planner, organizer, and was always prepared. When we got him back into his bed on his soft, fluffy egg crate, his wife gently tucked the flashlight under his pillow: “Here you go, Jack. Your flashlight is right here.”
The next morning he became restless and started moaning. I gave him his morning dose of oxycodone. His wife and sister-in-law were sitting on the couch nearby. Jack was glassy-eyed and vacant but attempted feeble replies to Sophia’s questions. I thought perhaps he had somewhere between hours and days to live. His wife noticed his flashlight on the floor and picked it up. She placed it under his pillow again: “Don’t worry Jack, your flashlight is under your pillow.”
We were quietly watching him when his breathing pattern shifted suddenly. Hospice nurses call this “mandibular breathing,” the lower jaw moves but the patient isn’t really taking in any breaths. This is an end-of-life breathing pattern that often means the patient is minutes away from dying. I tell the ladies I think Jack is close. His wife walks to the kitchen to get me a chair, and we all sit around him in silence. His wife gently rubs his chest and says, “Goodbye, Jack. I love you. Have a safe journey.” He breathed his last breath right then and there.
“Dying people need the company of those who will listen, those willing to understand their situations, those who continue to offer love and friendship in the face of death.”
Maggie Callanan and Patricia Kelley in Final Gifts
Callanan and Kelley share that if we listen closely to the symbolic language of dying patients they have much to teach us. Jack’s simple request could easily have been denied or chalked up to confusion which may have added distress or agitation to his circumstance. I love this story because Sophia listened to her husband's strange request for his travel flashlight and knew that it was significant if it would provide him some comfort. This sturdy MAG light under Jack’s soft pillow gave him some peace and control as he prepared for another one of his epic journeys.
Blessings.
Writer’s note: Names and circumstances have been changed to protect privacy.