“The thought of taking our final breath is something we consciously ignore and for many of us, it is nothing short of morbid.” – International Journal of Palliative Medicine.
Doctor T (my supervisor) had asked us about the Islamic Palliative Care. He asked for a source of information about how to care for the dying Muslims because all these while he has been caring for predominantly patients of Christian or Western background.
I know the practical stuff of caring for the dying in Islam, I suppose. I mean, it would be roughly similar to caring for the rest of the world population. The clinical aspects would be the same…make sure their pain is well-managed, treat the nausea and vomiting, treat all the distressing symptoms so that their final days in this world would be as comfortable as possible. And the nursing aspect would be similar to, like making sure that they take their pills at the right time, make sure that they are clean after they’ve had some explosive diarrhoea, make sure they are eating well and all that. It would all be similar with some important additions; the five daily prayers.
We have to make sure that our patients know how to modify their prayer movements while praying in bed. We should provide them with a jug for ablution (if we are caring for the Muslim patients in the Western setting), maintaining their dignity in the hospital (the aurat), reminding them about the making of the will or any unresolved financial debts and obligations, settling the matter of the will or inheritance, reconciliation and forgiveness among relatives and friends.
To enable them to pray and perform their spiritual obligation in this very critical time of their lives, we need to make sure that the dose of morphine are just enough not to cause them to be too drowsy or too sedating.
I provide here, a link to a journal article talking about Palliative Care for the Muslims, which I googled especially for my supervisor who had asked Suhaila (and she passed the job to me) to provide him with some background information about Islamic Palliative Care.
How Does The Patient Feel?
Palliative Care in Islam is the easy bit. All Suhaila and I had to do was googling some Islamic website talking about all the practical stuff in caring for a pious, Muslim patient who is dying. But when Dr. T asked about how we could calm the patient’s anxiety regarding death and the life after death in an Islamic way….
Now, that’s hard!!
I know how to calm the family members of the dying. All we usually say would be “May Allah bless his soul and may he be among the pious in the hereafter. Innalillah hi wa innalillah hi rojiun.” Or we can always say “Be patient in facing this great calamity. There’s reward for those who are patient.”
But how do we calm the dying patient?
I have never talked to a dying patient to ask about how they feel?
Are they scared? They must be!!
Are they sad? Maybe a great deal sad, having to leave their children and their friends. But if they TRULY believe about life after death and about a better place, wouldn’t they be happy too?
How about regrets and remorse for their past sin? All their past deeds would come flashing back in their minds.
And what can WE, the professional doctors do about it? Really!! How can we calm someone’s fear of dying? I am, Alhamdulillah, still well and healthy, though that is no guarantee of my future lifespan. But even I am scared of death!
Imagine the cancer patients who knew that they got an incurable disease and is just WAITING for the final breath. How MUCH MORE scared they would become. Every time they close their eyes, they would fear that they might never open them up again. That fear could lead to insomnia because they are never calm enough to sleep properly.
All we can do is give them some Diazepam or midazolam; something for their anxiety. Or maybe some sleeping pills to sedate them. But when they wake up, the fear is still there!! It will always be there from the time they receive their diagnosis to the time they come to terms with their prognosis until their final breath!
Coupled with the fear, in some patients, would be regrets of how they have lived in the past. At times like this, they would wish to trade all their wealth for another life of living indefinitely.Or maybe they wish they could die a sudden tragic death in a traffic accident…because the suspense of waiting is too painful, too fearful and too depressing.
ONLY THOSE WITH STRONG FAITH….
I have heard stories of the pious saints…how they welcome death in their embrace because they could not wait to meet their Creator. Because they just knew that they have been assured a place in heaven. They have strong faith and death is a welcome treat in their minds.
I guess, the majority of people does not have such strong faiths then, to fear death beyond anything. That means, I am among them. Most of us, in this time and age, have the same disease that our prophet had mentioned; the disease is called Al-Wahn which is translated as ‘love of the world, and dislike of death’. PENYAKIT CINTAKAN DUNIA DAN TAKUTKAN MATI.
This disease is eating me alive. It’s eating all of us alive, to the extent that we think it’s natural to fear death. To the extent that we just couldn’t help it.
Maybe back in the glorified days of Islam, what was natural was not to fear death. But NOW, because we are all plagued with this Al- Wahn disease, we feel that death is a natural anxiety-provoking issue. Because we are all mentally and spiritually diseased in some ways.
THE ATHEIST AND THE THEIST
Some doctors actually even argue that the atheists do better in dealing with death than the religious people. Because the atheists just do not think about heaven and hell, so naturally they feel no fear about what is going to happen to them. They just think that once they have taken their final breath, they just become nothing. Even though the concept of feeling nothing, is actually feeling something, if you know what I mean.
However, we can even see some atheist who deal very badly with fear of death too. They could not grasp how being nothing would feel. Or sometimes they are beginning to have an attack of self-doubt. Some even find religion after a diagnosis of terminal illness!!
So, I guess, what I am trying to say is….either you are an Atheist or a Theist of whatever religion, there is no guarantee that you would not fear death. Because only those with strong conviction in their life’s philosophy (a strong Atheist or a strong Theist) would be good at dealing with death. A strong atheist would just say “There is nothing to fear because I am going to NOTHING.” And the strong Theist would draw comfort by saying “I have been a pious person, a true believer of God and I have been good all my life and I trust the promise of my Lord so absolutely that I have nothing to fear.”
It’s those of us who are in the middle….or among the weak-hearted (the agnostic, the sometimes-nice-sometimes-naughty Muslims), we are the ones who would be assailed with anxiety and fear! Because there would be so many calculations going on in our minds:
-Ok, I did wear some provocative clothes, but that was during my younger days. Been ten years now since I wear jubah all the time. Surely, that compensates a bit.
-Ok, I did flirt with some guys back in my teenage years, but I have never cheated on my husband since I found out that I got breast cancer.
-Well, I missed a few prayers but I have given lots of charity.
You know, what I mean? The anxiety comes from knowing that we may not be good enough! Or when we are good enough, the intention was never sincere enough.
For those who even until their last moment still haven’t recovered from the disease of Al-Wahn, the only thing that can help them is having a good, fulfilling life. The fear will be there, of course, but it is less painful if you’ve at least sincerely attempted to be good (even if the result of the attempt is quite disappointing) or if you can at least say I have never committed the big sins (even though you have committed the small ones quite A LOT!!).
That would help!
Reconsiling with enemies and asking for forgiveness and looking for closure…..that would help!
Making sure you have all your debts paid and all your worldly affairs neat and tidy…that would ease your mind a little.
But if we are still plagued with Al-Wahn…the fear will always be there! It will go away with Midazolam and sleeping pills, but when the effects wear off, the fear would come back with a vengeance and can reduce the strongest of man to tears of shameful cowardice!
So, I am calling for you and me, to be prepared! You should not fear the cancer….you should fear the fear. Because that is the worst experience when you are facing your end of life! Morphine could take care of the pain but the waiting and the knowing that this is the end and you are not prepared but you could not stop it happening…it’s the worst feeling of all. Trust me…I have seen it in others and I have experienced the anxiety in the past! And until you have felt it, you can never understand it. When it hit you…
…you will wish you were never born.
All the pleasures in life become nil! People often ask you, what would you do if today is the last day of your life. And their answers are fantastics fantasy of travelling to somewhere they have never been to cuddling up with loved ones etc etc. I often laugh at that! Because the truth is, if you could somehow know that today is the last day of your life, you will be too scared to do anything much!!
I leave you with this video from Khalid Yassin: From The Womb To The Tomb.
Enjoy and Reflect!