THE LAST OFFICES: WHEN SAYING GOODBYE…

The past several days have subjected the Kenyan public to the unimaginable horror of coming face to face with the ugly side of death. These are the things which, as a community, we do not stop to think about because our minds would rather not wander into that dark spot.

The public exposure of the bodies of the tiny little babies at the Pumwani Maternity Hospital during the Governor’s visit to the hospital left a bitter taste in our mouths. The pictures circulating in social media were heartbreaking.

As if dealing with the loss of life at such a tender innocent age wasn’t bad enough, the real devastation was in coming to terms with how these little ones were handled after death. Putting these little souls in carton boxes and disposal bags is certainly no way to see them off!

As we ponder the inefficiencies of a health system that left us all feeling so very vulnerable, the reality is that we shall exit this world. For this reason, though we never want to think about this, a small part of us is constantly nagged by our exit.

Death takes away everything from a person with such finality. It equalizes all of us. We immediately stop being referred to as person X and become a ‘body’. We cease to occupy a space in the midst of others and immediately becomes past tense.

The one thing we may fail to recognize is that, our outrage at the situation in Pumwani is driven by the innate need as human beings, to maintain some level of dignity even in death. Death strips us of everything. For that reason, the only thing we want to at least exit with, is dignity.

It is on this premise that the very important process of care given to a body after death, otherwise known as the “Last Offices”, is based on. The process is performed with the aim of demonstrating respect for the deceased and is focused on respecting their religious and cultural beliefs, as well as health and safety and legal requirements (Dougherty and Lister, 2004). This important process is intended to be carried out by the nurse before the deceased is released from the clinical setting to the mortuary.

Once the patient is gone, the first step is to preserve privacy by drawing the curtains around the bed. Thereafter, the doctor then goes ahead to confirm death by checking for cardiac activity (presence of a heartbeat), respiratory function (breathing movements) and state of the pupils (yes, the pupils of the eyes get really wide and do not react to light after death). These are then documented in the patient’s file, along with the cause of death. The time that death was verified is usually documented against the signature and name of the ascertaining doctor.

Once death has been ascertained, the patient’s next of kin are informed of the news. Where the family is within the hospital, they are informed by the health provider immediately. In the event that they are away, they will be summoned to the hospital and informed upon arrival.

This is one of the most challenging duties for any health care provider. To be able to pass on the difficult news with empathy irrespective of one’s own feelings. Many times, the nurse is deeply heartbroken to lose a life so young, or a doctor so distraught to lose the head of a home to a tragic accident, leaving behind a young family. Yet as care providers, it is not our place to out-mourn the family.

After breaking the news, the body should be identified correctly with identity bands that are properly labelled, to ensure their identity is well documented even upon transfer to the mortuary.

Thereafter, the body is prepared before moving. The body is aligned by straightening the limbs and keeping the head to face straight ahead. The eyes and mouth are closed and the bladder is emptied. In case of any open wounds that are oozing, they are dressed up to prevent soaking the whole body. All medical intervention accessories that were in place are removed. The body orifices (mouth, nose and anus) are sealed with cotton to absorb secretions. Afterwards, the body is then dressed.

All the above procedures are performed to enable the patient look presentable to the family to ease their discomfort and pain. It provides for a dignified manner in which to remember the departed hence bringing some peace of mind.

In the event the manner of death requires a post-mortem, then there is minimal intervention. All medical intervention accessories are left in place for further evaluation by the pathologist. These should never be tampered with.

After the family has viewed the body, it is then wrapped in a bed sheet ready for transportation. Across the world, all patients who die in the hospitals are wrapped in hospital linen for transportation to the mortuary. However, in the event the patient is suspected of having had a contagious disease, them the body will be put in a body bag.

Meanwhile, the notification of death form is filled by the doctor, stating the identity of the patient, the immediate cause of death and all other factors that may have contributed to the death. The notification slip is given to the family while the copy accompanies the body to the mortuary.

The importance of the last offices is a special task that is designed to help families and friends handle the difficult moment of letting go of their loved one. There is need for a lot of compassion and capacity to accommodate everyone. The mother who lost her baby during labour should be accorded a secluded area to hold her baby and bid him farewell. Special arrangements should be made to allow the Muslim and Jewish families to perform their religious cleansing rites on the body in preparation for immediate burial as they do this within 24 hours.

What has been happening in Pumwani Maternity hospital is by no means unique in this country. It happens across the country in resource-starved public and private institutions. We must purpose to change this narrative going forward. We cannot drop the ball on dignity immediately after death, only to pick it up after the departed is in a coffin!