Category Archives: Breathing

At Dying Beds

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At dying beds I’ve experienced a lot of silence – which felt at times good, at times disturbing. Dying people will be almost always be in coma in their last hours (and, mostly, days). What hinders us from speaking with the dying?

  • As family members, we may be in a shock state, frozen or confused.
  • We may be insecure if they hear and understand us.
  • We may be insecure what is relevant and helpful for them.
  • We may feel insecure what the staff thinks of us if we behave unconventional.
But surely, if we find out what hinders us from speaking and acting, this can free us and widen the range of our possibilities, to the benefit of both ourselves and the patient.

Sometimes it’s extremely difficult to notice and interpret any nonverbal reactions of coma patients. In other cases we need to sharpen our senses. With no other body reactions left, often there are still reactions on our words, or on caressing, in the patients’ changing his of breath style and rhythm (unless on a breathing machine).
If we do find tiny nonverbal reactions or changes of the way of breathing, the questions are:

  • Does the patient show this behavior repeatedly (every time) when we bring up a certain topic or do something particular (or when a certain person is arriving or leaving or being mentioned)?
  • Do we rather see the reaction as one of stress or relief?

I would like to summarize a few things that I have learned from the Encounters I had with dying people.
1. Treat dying people as living people.                                                                              2. At a dying bed, get aware of what hinders you from acting and speaking free. Free yourself to get flexible.
3. Observe which tiny reactions (movements, mimics, breath) the dying person shows repeatedly on certain key words, persons, behavior. Are they reacions of stress, relief or interest? Which are the triggers?
4. Dying patients may be in coma, but they’re usually not deaf. Choose your words well. No catastrophic medical descriptions or burial talk.
5. Create rapport. Introduce yourself and tell your aim shortly. Use body contact, use your voice and breath pacing.
6. See a coma patient as someone who is already in trance. Create rapport. Interventions can start right away, without induction
7. The subconscious responds strongly to imagery. Speak in a dream language. Use metaphors, avoid abstract words.
8. Breath pacing and leading can regulate pain or breath problems (and can regulate breath down till it almost stops).
9. Breath, blood pressure and heart rate can also be regulated by metaphors (f. e. of a flying eagle, a pulsating jellyfish or a manta ray).
10. Speak about emotional content rather than about facts.
11. Express in metaphors or more directly that it is possible and good to let go – of live, of psychological problems of body problems.
12. Use metaphoric terms to speak about the good future.
13. Introduce thoughts like “You can love them from the other side”, “things will change, relations go on”.
14. Use negative terms only with a good reason. Except for pacing strong pain, don’t mention “pain” but “body sensations”. Teach this to the relatives.
15. People will rather die when they’re ready to go. What may help: Rituals, a bye-bye from family members, messages of “letting go”.

The Good Shepherd

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I would like to say something about breath pacing, and about texts that we can recite to a dying Person.
I knew Mrs. Seiberth, and we had liked each other. I knew that she was a religious woman and that she wished that her son would come and see her. Asked why he doesn’t come she said: “He’s living far away. – But also, he is afraid of seeing me so sick.” When I was visiting her now she was in coma. She looked into an empty space. With every breath she made a coughing sound. I put my hands on her arm. Calm and slowly, with long pauses in the pace of her breath I recited the psalm of the good shepherd. Her breath went calmer and the coughing noise went silent. But at the words “thy rod and staff they comfort me” the coughing came back. Maybe they reminded her of something that made her sad? The concept of systematic desensitation of fears came to my mind. So I repeated these very words so often in a very calm and friendly tone till the coughing disappeared again. Then I continued. At the words “in the presence of my enemies” the coughing came back. I did the same procedure of repeating the words in a friendly tone till the coughing was gone and she was breathing calmly. At the words “Goodness and mercy will follow me all my life” her breath got even calmer. So I repeated these words many times till it got even calmer. I finished the Psalm and said “I would like to say bye-bye now.” Immediately the coughing noise came back and continued with every breath. “I will come back, I will come back, I will come back…” I said, and the noise disappeared. The next day I visited her I read the same psalm to her. Her breath was calm and silent all the time. Only when I said that now I would leave the coughing noise came back. “I come again, I come again, I come again…” I said till it was calm again. The next day I was about ninety minutes later than on the previous days. Entering her room I saw a man who introduced himself as her son. “She’s died an hour ago.” He said. „Was she still alive when you came?“ „Yes“, he said. (Stefan Hammel, Handbook of Therapeutic Storytelling, Karnac, London 2017/18)

La respiration agréable

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Une amie m’a appelée. Elle respirait extrêmement vite et de manière agitée et ne pouvait prononcer que quelques mots à la fois. Sa voix avait un drôle de son. Elle raconta que sa fille venait d’avoir un accident de voiture avec son bébé sur le siège arrière. Le bébé n’avait rien eu mais le SAMU avait transporté sa fille à l’hôpital car ils craignaient une fracture de la base du crâne. Elle-même avait dû rester où elle était ; elle devait garder le bébé et n’arrivait pas à savoir ce qui se passait avec sa fille. J’ai alors commencé à respirer et à parler de la même façon qu’elle et au bout d’un certain temps j’ai changé de rythme et ai ralenti peu à peu ma respiration et ma façon de parler. J’ai remarqué qu’elle me suivait instinctivement dans mon comportement et qu’elle se calmait. Sa voix sonnait claire et forte et ce qu’elle racontait maintenant sonnait plus positif qu’au début de la conversation. « Je te remercie de la façon dont tu m’as parlé », ont été ses mots quand elle termina la conversation.

Everything Else

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In a land in our time there lived a man, who read a book and found lots of wonderful stories therein. There were true and invented stories, experienced and pensive, enjoyable and painful stories. There were stories which contained stories, and such which were actually not stories. For every story he read, there occurred to him nearly five which he had either experienced or thought up himself. So the thought came to him, that a lot in the world was a story which could be healing for himself and others; he only needed to absorb the healing stories well and to forget the terrible ones immediately. Then he would learn which story he had used when and for what. So he organised his own stories which he knew, and which had become a help to himself and others, or could become so. Sometimes he noted it down when a new story came to his ears and sometimes when a helpful story occurred to him, he memorised it.

Then he saw before him in a picture the storystories of this life arranged in long shelves, as in a large pharmacy. And behind the counter there sat a man who had learnt to listen to himself and others. He was a master of his subjectspecialty. His talent was that he understood how to tell the right thing at the right time to himself and to those who visited him.

Valves

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Some engineers are specialized in constructing valves. They do nothing else; they just construct valves, all day long. Now someone might ask: Isn’t thisit boring, to occupy your mind with nothing but valves all day long? But actually it is a very interesting field. There are valves for air and valves for steam, and then there are some for water and some for oil. There are high- pressure valves and thermostat valves. There are regulators for monitoring the temperature of a liquid, for instance in the shower. There are valves, which activate themselves and others, which can be operated only by hand, and there are some which work both automatically and manually.

One could think that valves are a human invention, but nature also knows valves and regulators of many different kinds. We find natural valves at the entrance of the gullet and of the air tube, at the exits of the stomach and of the bladder, and at the end of the intestines. Many glands are using some kind of valve. There are the heart valves, and in the veins, there are valves to ensure that the blood flows in the right direction.

We are used to turning the heat on when we are cold, and to turning it off when we are warm. We use a control for the central heating, if we want to change the temperature of the oven. We know that we can turn off the water in the house if a pipe bursts in the winter. We are used to regulating the amount and temperature of the water in the bath tub, and to accelerating and slowing down our car. We are used to our bicycle tyres being filled with air, a kettle whistling, and a steamer cooking our meals. For all this we use valves. They serve our purposes without us having to think about them. But there is one important difference between the valves of our body and the technical ones invented by humans. If a technical valve is set in the wrong position someone must come and readjust it. The natural valves of our body and soul adjust and get set all by themselves, and they can – if necessary – independently readjust themselves at any time.

Civil War and Civil Peace

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Once there was a civil war in Pampelonia. This is what happened: one evening, the guards on the tower of the royal castle heard gunshots from far away. Somewhere on the western horizon they saw a column of smoke ascending. “A revolution!” they shouted. “Our country is in danger!” A unit of the royal army took their weapons, saddled their horses, and rode away. They followed the direction of the smoke column. Their path went through a deep dark forest. It was already dark when they arrived in the area from where the gunshots had been fired. At some distance, on a forest glade, they saw a fire burning. What had at first appeared to be a burning house turned out to be a very large bonfire. Around the fire, a large crowd of armed citizens had gathered. “Rebels!” the commander whispered. Silently, they surrounded the clearing. Then they stepped forward. “Surrender!” the commander shouted. “We are superior in number!” The men on the clearing were startled. “Robbers!” one of them exclaimed. “Poachers!” shouted another. They jumped up and opened fire. Too late did they recognize the uniforms of the royal army. Slowly the soldiers realized that they had encountered a gathering of hunters, who had come together for a good roast and a drop of wine after a hunt. But they already found themselves engaged in combat, and very soon the inhabitants of a nearby village came with scythes and pitchforks to defend the hunters against the alleged robbers. What should the commander do? “Cease fire!” he shouted. He had the trumpeter sound the retreat, and his soldiers drew back. He decided upon a phased withdrawal of his troops, pulling out half of his soldiers and letting the other half secure the field. He waited until his opponents had understood that they wanted to withdraw and ceased their fire as well. Again he ordered half of the remaining soldiers to retreat while the other half secured the territory. He waited again until the sound of gunshots died down, and repeated the procedure a few more times until he was the only one left. Last of all, he left the battlefield. Back at the royal castle he gave a report to the king about the incident. The king, who was a good monarch, ordered them to go there again, but by daytime and unarmed. He himself accompanied the unit. They arrived at the place of the nightly encounter. The king had the villagers and the hunters of the area gather before him and explained how friends had erroneously mistaken each other for enemies. He pointed out that he saw their very good intention, although initially in misjudgement of the actual situation. A misunderstanding like this was there for being clarified. Whoever wanted to support the common good could contribute to reconciliation here and now. Now the king praised the villagers for having defended the hunters against their assaulters. He praised the hunters for having defended the forest against robbers and poachers. He praised the army for having defended his country against rebels. Most of all he praised the commander of his army for having defended the villagers, the hunters and the army by his cautious withdrawal. After the king’s speech, the hunters, villagers and soldiers asked each other for forgiveness. They pledged to support each other anytime, and to stand for justice and peace in the kingdom as long as they lived. They confirmed this pledge by putting out the fire together.