Expected Death at Hospital

'REV. ELI JENKINS' EVENING PRAYER'

by Dylan Thomas

... every evening at sun-down

I ask a blessing on the town,

For whether we last the night or no

I’m sure is always touch and go.

We are not wholly bad or good

Who live our lives under Milk Wood,

And Thou, I know, wilt be the first

To see our best side, not our worst.

O let us see another day!

Bless us all this night, I pray,

And to the sun we all will bow

And say, good-bye – but just for now!

When someone dies in hospital and their death was expected - WHAT TO DO

When someone dies in hospital following an illness or condition where their death was expected, the hospital team will take care of the immediate medical and practical procedures.

If you are with the person when they die, there is usually no need for you to immediately start making telephone calls or thinking about funeral arrangements.

For now, you can simply be with them.

IN THE FIRST MOMENTS AFTER SOMEONE DIES

A member of the hospital's clinical team will need to formally verify that the person has died. The nurses will explain what is happening and what needs to happen next. There may be some necessary clinical procedures, particularly if the person had medical equipment, lines or medication in place, but you can ask staff to explain what they are doing and whether anything can wait until you have had some time together. If there are particular religious, cultural or personal practices that are important to you or the person who has died, tell the nursing team as soon as you can.

YOU CAN USUALLY SPEND SOME TIME TOGETHER

You do not ordinarily need to leave the moment someone dies. Ask the nurses how long you can remain with the person. What is possible will depend upon the ward, other patients, hospital procedures and the circumstances at the time, but staff will usually do what they can to give you some privacy and time together. You may want to: - sit beside them; - hold their hand; - talk to them; - play some favourite music; - say prayers or a blessing; - read something meaningful; - invite close family to come; - place flowers, a photograph or another meaningful item nearby, where permitted; - or simply sit quietly together. You may also be able to be involved in their care Families are often surprised to discover that caring for someone does not necessarily have to stop at the moment of death. With some advance notice, and subject to the hospital's own policies and what is practically possible on the ward, staff are often open to families undertaking a small ceremonial washing or act of care before the person is transferred to the hospital mortuary. You may wish to do this privately as a family, or you can ask whether the hospital would be comfortable with one of our specialist Ceremonial Care practitioners coming to support and guide you. This does not need to involve a lengthy or elaborate ceremony. It might simply mean washing someone's face and hands, brushing their hair, anointing them, dressing them in something meaningful, saying a prayer or blessing, playing a piece of music, or taking a few quiet moments to tend to them together. For some families, being able to perform even one small act of care can be enormously meaningful. If this is something you think you may want, tell the nursing team as early as possible. Ideally, if someone is approaching the end of their life, you can have the conversation before they die. This gives the hospital time to consider what can be accommodated and, if you would like our support, gives us time to liaise with the ward and make arrangements subject to our availability. There is never an expectation that you should do this. You may want to participate fully. You may prefer us to guide you. You might want to perform one small act and leave the rest to others. Or you may not want to be involved in physical care at all. There is no fundamental right or wrong. The important thing is knowing that, where circumstances allow, you can ask. Some people want to remain for quite a while after someone has died. Others find that when the person dies, they are ready to leave. Neither is more loving than the other.

If you were not there when they died

You can ask whether you are able to come to the hospital and spend some time with them before they are transferred to the hospital mortuary. If you would like to do this, tell the staff. There may be occasions when it is not possible, or when the person has already been transferred, but that does not necessarily mean you have lost your opportunity to spend time with them. There can usually be further opportunities once they have been released from the hospital and brought into the care of your chosen funeral director.

What happens to the person afterwards?

When the necessary ward procedures have been completed, the person will normally be transferred into the hospital mortuary. This is different from a funeral director taking someone into their care. They remain in the care of the hospital until the necessary medical and administrative processes have been completed and arrangements can be made for their release. You do not need to follow them or organise their transfer yourself. The hospital will take care of this.

What happens with the medical paperwork?

Following a death in England and Wales, the circumstances and proposed cause of death are considered through the medical certification and Medical Examiner process. The Medical Examiner is an independent senior doctor who was not responsible for the person's care. As part of this process, the Medical Examiner's Office may contact you and give you an opportunity to ask questions or raise any concerns you have about the person's care or the proposed cause of death. Once the necessary processes have been completed, the relevant information is sent to the Register Office so that arrangements can be made to register the death. The hospital's bereavement or mortuary team will explain the local process and what you need to do.

What if the Coroner becomes involved?

A death being expected does not completely rule out a referral to the Coroner. There are circumstances in which a hospital must refer a death — for example, where the cause of death is uncertain or there are other circumstances that require investigation. If this happens, the hospital will explain that the death has been referred. A referral to the Coroner does not necessarily mean that anybody believes something suspicious has happened. The Coroner will consider the information available and decide whether any further investigation is necessary. [Read more: What happens when the Coroner is involved ]

When should I contact a funeral director?

You can contact Gentle Endings Funerals whenever you feel ready. You do not have to wait until all of the hospital paperwork has been completed before speaking to us. In fact, there can be something reassuring about making contact sooner. While the person remains safely in the hospital's care, we can begin getting to know you, talk through what happens next and start exploring the funeral without requiring you to make every decision at once. We can discuss: - burial or cremation; - the type of funeral you might want; - where it could take place; - coffins and natural alternatives; - flowers; - music and readings; - ceremony; - who might be involved; - spending time with the person afterwards; - and anything that feels particularly important to you. Or we can simply begin with a conversation. You don't have to know what you want before you call us.

Choosing your funeral director

You are free to choose the funeral director who feels right for you. You do not have to use a particular funeral director because they have previously worked with the hospital, because somebody has given you their details or because you feel that arrangements need to be made immediately. Take the time you need. At Gentle Endings, we understand how important it is to choose the right funeral directors. The care, guidance and support you receive can make a meaningful difference to your experience - and to the memories you carry with you from this time. When you have chosen your funeral director and the hospital is able to release the person, the funeral director will arrange everything directly with the hospital mortuary. You do not need to organise this yourself.

Bringing the person into our care

If you choose Gentle Endings, we will liaise with the hospital and arrange to bring the person into our care once the hospital has completed everything required for their release. You do not need to coordinate between us. We will do that for you. Once they are in our care, we will talk with you about what happens next and anything you would like us to do for them.

CAN WE SPEND TIME WITH THEM AGAIN?

What about Ceremonial Care of the Body?

If you would have liked to be involved in caring for the person after their death, please talk to us. Our Ceremonial Care service at the place of death is straightforward when somebody has died at home and may sometimes be possible within a hospice or care setting, subject to the agreement and practical requirements of that setting. Hospitals operate differently. Hospital wards and mortuaries have their own clinical procedures, facilities and policies, and it may not be possible for an external practitioner to undertake Ceremonial Care within the hospital itself. That does not mean the opportunity has necessarily been lost. Once the person has been released by the hospital and brought into our care, we can talk with you about what may still be possible. You may wish to be involved in: washing and tending to them; anointing them; brushing or arranging their hair; dressing or wrapping them; taking locks of hair; taking fingerprints; creating hand casts or other keepsakes; arranging flowers; playing music; saying prayers or blessings; incorporating personal, cultural or spiritual traditions; or simply spending some quiet time together. You can participate as much or as little as feels right. You can also ask us to undertake their Ceremonial Care on your behalf, without you being present or participating yourself. There is no fundamental right or wrong. [Discover Ceremonial Care of the Body]

If you know someone is approaching
the end of their life in hospital

You don't have to wait until someone has died before contacting us.

If someone you love is approaching the end of their life and you know that you would like Gentle Endings to support you afterwards, you are very welcome to call us beforehand.

We can begin getting to know you and understanding what matters to the person

and your family.

You might want to talk about the funeral.

You might want to understand what happens immediately after death.

You might be wondering whether you can spend time with them afterwards or be

involved in their care.

Or you may simply want to know that, when the time comes, you already

have someone to call.

Nothing needs to be decided simply because you have contacted us.

Sometimes knowing what is possible - and knowing who will be there - is enough.

You don't need to do everything today

When somebody dies, particularly after a long illness, there can be an enormous sense that practical things must suddenly begin. There will be things to do. But they do not all need to happen at once. The hospital will take responsibility for the immediate clinical procedures. The Medical Examiner and registration processes will follow. Your funeral director can take responsibility for bringing the person into their care and helping you arrange what happens afterwards. Your job does not have to be managing a process. For now, you can simply be someone who has lost someone they love. And when you are ready for us, we are here. Gentle Endings Funerals 0800 77 202 44