Procession

The patient had been much-loved. Family and friends were in the room with the body; I went down to ask some quick questions and get the form filled out that would permit us to release the body to the family's chosen mortuary. They let me know that they would remain with the body until the mortuary transport arrived. It was clearly hard for them to let go. Some tried to remain calm (as if we needed them to) and then wept in sadness for their loss. A strong Christian faith told them their loved one was now free of pain and with God, but there is nothing, nor should there be, that removes the pain of loss. I told them that, when the transport came, their loved one's body would be placed on the cot, and they could follow it to the exit, if they liked. They liked. When the mortuary attendant arrived, I took him aside and asked that he leave the face uncovered until the body was loaded, to which he agreed. We walked to the room, I introduced him, and stood back. When the family was ready, the CNA and I and the attendant wrapped the body in sheets and transferred it to the cot and tightened the straps around it. Then the attendant draped the cover over the body, leaving the face uncovered, as we'd agreed. We rejoined the family in the hall. They had given me permission to walk with them, so we set off, slowly, down the hall, turning the corner to the utility hall, slowly down that long, bright, barren hallway, on the gleaming tile floor, a ragged but heartfelt procession, down to the ambulance entrance. The attendant stopped as someone hit the switch for the double doors to swing open. I started to pray, aloud: "May the angels, dear M., receive you into paradise; may they bear your spirit upon their wings to the presence of God..." The doors opened, the family and friends gathered around me. We watched, in silence, while the attendant slid the cot onto the rails in the back of the transport vehicle and closed the door. The double doors swung closed. A family member touched my arm. "Thank you," she said. "I didn't know we would be allowed to do that."

Most families leave before we call the mortuary. Most times, a CNA then goes in to prepare the body for transport by removing peripheral IV lines and subcutaneous sites and foley catheters and placing a toe tag. Mostly we place bodies in body bags, though the majority of hospice facilities do not. And then we close the room door and leave a sign on it that directs any visitors to the nurse's station. When the transport attendant comes, we do paperwork, escort them to the room, and they load the body and take off. Sometimes that feels just right, but sometimes it seems as if the body, dead, becomes a piece of scut work, our interest no longer focused in that direction, just manual tasks left to do. Sometimes we can discount the impact on a CNA when we ask him to handle the body of someone for whom she has provided the most intimate of personal care and companionship, place that body in a bag, and zip up the bag over the face. It is a tough thing to do, and I think that once in awhile that's why the task is so easy to assign to CNAs. So, being an irreverent sort of chaplain at times where "scope of work" is concerned, I have made myself available to help if needed. Some of the best nurses do so as well. I notice that we all, CNAs, nurses, and I, "talk to" the person as we prepare the body. And we comb the hair, wash the face a last time, carefully arrange the hands. I think that last preparation can be a sacred moment, because even if you do believe that body and spirit are utterly separate and spirit is always better, the body has been loved and cherished, lived in, and in its unique pattern of strengths and weaknesses has played a huge part in who the deceased was and how he or she lived and died. And the body is the medium through which the family and friends have encountered the deceased, and the loss of its familiar presence, its appearance, texture, substance, is a huge piece of their grieving. So, to me, that body deserves tender care in the preparation for transport as much as in its living state. Providing that care honors the person who was and those who grieve--and also allows us to feel the loss and say a last goodbye. I think it has meant something to the CNAs that the chaplain will come and help, and sometimes it has meant something to the families waiting outside the room as well.