Nina de Cocq, EOLD, RMT

When I tell people what I do, the response is almost always the same: “How can you do that, it must be so hard.” I understand why they say it, because what I do is hard.

Working in end-of-life care means bearing witness to death. I have been present for about thousand last breaths, and for just as many last goodbyes. Many people reading this know that experience; and many others cannot imagine it. But just like any calling, any profession, any skill, we are each shaped for something unique. We all carry gifts that allow us to stand in places others may not be able to. I am not the only one.

What I want people to understand, though, is that I don’t just see death or grief. I witness culture, ritual, and faith that often leaves me in awe. I see the kind of strength people draw from belief systems I am still trying to fully understand. I see complicated family dynamics too, some tender, some painful, and I remind myself that my role is not to fix, but to honor what is present. And sometimes I see relationships so full of love that a part of me aches, because I never had that. Yet even in that ache, I am comforted by knowing such love exists.

What I see, over and over again, is love, every shade, every expression, every way a human being shows up in the face of the inevitable. I see how people react, how they lean in, how they prepare themselves for the mystery of what comes next. I am not just invited to be present for the most fragile, most intimate, and most personal part of life, I am trusted to be there, and that means everything to me.

Death opens the door to the deepest parts of who we are, our traditions, our faith, our sorrow, our tenderness, our love, and in witnessing it all, I am shown life.

So no, I don’t just see death, I see life, and I am grateful every day that I get to witness this.

xo
Gabby
Hospice/palliative care nurse, end-of-life doula

www.thehospiceheart.net

Some of the most common fears I hear from those at the bedside after a death are these:
"I didn’t do enough."
"I should have been there more."
"I should have stayed longer."
"I should have known what to say, what to do, how to make it better."

When we read or hear things afterward about end-of-life care, it is almost impossible not to think, "why didn’t I do that?"

Learning after the fact does not mean you failed before it. It simply means you are human, doing the best you could with the tools, knowledge, and strength you had at the time.

Sitting at the bedside, especially for the first time, comes with uncertainty, fear, and impossible decisions.
You gave medications even when it scared you.
You didn't give medications because they scared you.
You fed them because you thought it was right.
You stopped feeding and carried the weight of that choice.
You stepped out of the room, and they took their last breath.

You showed up when you could, advocated when you knew how, trusted others when you needed help, and loved in the ways available to you. None of this is a flaw. These doubts and second-guessing yourself are not signs that you did something wrong; they are signs that you cared deeply.

You don’t have to have all the answers to get this right. Even those of us with experience still question ourselves at certain bedsides. What matters most is that you showed up with your heart, that you tried, and that you loved. That was enough.

Remember this: you did everything you possibly could. You did the best that you could with what you knew, what you had, and who you were in that moment, and you showed up, that is the gift.

Do not compare your story to someone else’s or second-guess what you gave. This was never a competition or a test of self-worth. It isn’t about what others might have done or how you think you should have done it. It is about what you did, and that you were there, and to the person in that bed, that was everything.

And if this was your first time caring for someone at the end of their life, and you learned something that may help you show up differently for someone else someday, or allows you to offer wisdom to a friend walking this path, then what you did here mattered in another way too. You grew. You evolved. We continue to do better, and that is what matters.

xo
Gabby
www.thehospiceheart.net

Exactly

I often joke that no one asks me how my day is because they are afraid I might actually tell them.

The truth is, most people don't want to talk about what I do every day because what I do requires us to acknowledge something many of us spend our lives trying to avoid: death. It remains the elephant in the room, not because it is rare, but because it is universal.

Yet I have always believed that if we talked about death more openly, it would lose some of its power to frighten us.

Imagine having these conversations long before a diagnosis, a medical crisis, or an unexpected loss. Imagine knowing what matters most to the people you love because you took the time to ask. Imagine them knowing what matters most to you because you had the courage to share it.

These conversations are not about giving up. They are about showing up.

Talking about death does not make it happen sooner, just as avoiding the conversation does not keep it away. Death is not waiting for an invitation, nor is it discouraged by our silence.

What talking does provide is clarity. It gives us the opportunity to share how we want to be cared for, what brings us comfort, what music we want playing, who we want nearby, and how we hope to be remembered.

Most importantly, it gives the people who love us a gift. When difficult decisions arise, they are not left guessing. They are able to honor our wishes with confidence instead of carrying the burden of uncertainty.

Death is a part of life. It always has been. And perhaps when we stop treating it as something forbidden to discuss, we discover something unexpected: talking about death often teaches us how to live.

When we acknowledge that our time is finite, we tend to waste less of it. We love a little harder, forgive a little faster, worry a little less, and savor a little more.

And I am absolutely in favor of savoring a little more.

xo
Gabby

From my blog “Talk About It,” which you can find here:
https://www.thehospiceheart.net/post/talk-about-it

You might find my book, “The Conversation,” a great resource to help you get the conversation started:
https://www.amazon.com/Conversation-guide-talking-about-people/dp/B0CZXD4BT4

I wrote this blog in 2020 during the height of Covid. Last night I received an email from her son. It was his mom's birthday and they were all together celebrating. He wanted me to know that they talked about their mom and their last day together, and they mentioned me... and wanted to thank me again. As you might imagine, this touched my heart in so many ways... I wanted to share the blog and that day with each of you.

The Very Best Last Goodbye
Written by Gabby Jimenez

I walked into the apartment having absolutely no idea what I was going to find or what my role would be. There was clear disconnect among the family members. Each was trying to navigate her rapid decline, feeling unheard and unsupported by the people closest to them. It was emotional, complicated, and heartbreaking to witness.

I went upstairs to her room and knew immediately that she had very little time left. When I turned to look at the family, they were all staring at me with hope in their eyes, and I knew the conversation ahead would be difficult.

We gathered in the small living room downstairs. The room was unbearably hot, and I was wearing a mask, gown, gloves, and booties. I felt uncomfortable and claustrophobic, wishing desperately that I could peel away the layers and be more present for these beautiful people who were counting on me for answers and support.

I gently told them that I did not believe she had much time left, hours, possibly days, but likely hours. They were not on the same page. Each was processing the situation differently, and as emotions intensified, voices grew sharper and tears fell harder.

I put on my momma bear hat and reminded them that what she needed most right now was for them to support one another. I explained that no two people experience death the same way, and that they had to find a way to respect their differences and listen to one another. This moment was not about them; it was about her. I worried I was being a little harsh, but I didn’t want them to lose any of the precious time they had left together.

I encouraged each of them to spend time with her privately, to say the things that needed to be said and to say goodbye. I shared something I often tell families: assume this is the last day and make it the very best last day. Say what needs to be said. Leave no room for regret.

I told them that, as a mother, one of her greatest concerns would likely be whether her children would take care of one another after she was gone. I suggested they tell her they would. That despite how much they would miss her, she did not need to worry about them.

In the same breath, I acknowledged the truth, that they would not be okay, at least not for a very long time. This would be incredibly hard. But sometimes those we love need permission to rest, and they need reassurance that the people they leave behind will find their way forward.

Several grandchildren, ranging in age from two to twelve, shared a close bond with her. The question I struggled with most was: “Do we tell them the truth, or do we keep it from them that she is dying?”

As both a mother and grandmother, I answered from my heart. I suggested they tell the truth. Be honest that her time was short and allow each child to decide whether they wanted to sit with her, visit with her, or stay away.

Taking that choice away from them could become something they carried forever. If their bond was strong, they deserved the opportunity to say, “I love you,” “I’ll miss you,” and “goodbye.”

I suggested the six-year-old draw her a picture or read her a story. More than anything, I emphasized the importance of giving them the chance to make that decision for themselves.

Before I left, we reviewed medications and other ways to keep her comfortable. I reminded them to call with any questions or concerns.

Knowing they probably wouldn’t, I called about an hour later.

Hearing her moaning in the background, I suggested they give the medications we had discussed. An hour after that, I called again. The medications had not been effective, so I suggested another dose. Twenty minutes later, I called once more, and she was finally comfortable.

I could hear her son’s voice relax.

He was able to comfort her and quiet her moans, and that was huge. I told him so. I wanted him to know that he had brought her peace. In many ways, I think it brought him peace as well. He needed to know, deep in his heart, that he had eased her suffering and done everything he could for her.

About two hours later, her son called to tell me she had stopped breathing and asked if I could come.

I arrived roughly thirty minutes later, walking into the same apartment I had left only hours before. Yet everything felt different.

The family was calm. They were comforting one another and speaking with kindness. They had found their way back to each other.

I went upstairs and confirmed that she had taken her last breaths.

She looked peaceful.
She looked beautiful.

I turned toward the family and nodded. Their eyes filled with tears, and I felt my own do the same.

We talked about bathing her and changing her clothes. I suggested flowers in her hands and her favorite music playing softly in the background. They planned to do it all together later that evening.

As we sat downstairs, they told me that after I left, they had reached out to every grandchild and told them the truth.

Each one chose to say goodbye.

Every family member had a private moment at her bedside. Her six-year-old grandchild drew her a picture and read her a story. Her children promised they would take care of one another.

And when all of that was done, she took a few final breaths and passed peacefully with them by her side.

It was the very best last goodbye.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/the-very-best-last-goodbye

All of this

When a friend recently received difficult news about her health, I found myself saying something I never expected to say.
"It's going to be okay."

The words came out before I could stop them.
She looked at me and asked, "how do you know that?"

The truth is, I don't.
No one does.

After I apologized, I asked her what she would rather hear.
Her answer was simple.
"The truth."
Not predictions. Not guarantees. Not sugar-coated reassurances.
Just honesty.

As our conversation continued, I found myself wondering what I would want if I were the one receiving difficult news.

What would comfort me?
What would help?
What would make me feel seen?

The answer surprised me…
I wouldn't want people to assume what I needed.
I would want them to ask.
I would want permission to need space without people taking it personally.
I would want permission to change my mind.
I would want people to check in without hovering.

I don't need fifteen boxes of soup delivered to my doorstep, but I would appreciate someone asking, "is there anything you are craving today?"

I think more than anything, I would want patience.
Patience with my moods.
Patience with my fears.
Patience with my tears.
Patience with my uncertainty.

Because if I am being honest, I would probably send a lot of mixed messages.
Come over.
Please leave.
Stay a little longer.
I need some time alone.
I need help.
I'm fine.
I'm okay.
I'm not okay.
I might cry.
A lot.
I might laugh at inappropriate things.
I might talk about my fears one day and avoid the subject completely the next.

And most of all, I wouldn't want people to be afraid to talk to me about it, to ask questions, or to say the words no one wants to hear, terminal, decline, end-of-life, dying, death...

None of those things would mean I am difficult.
They would simply mean I am human.

Receiving difficult news doesn't suddenly make someone wise, graceful, or emotionally consistent. It makes them a person trying to find their footing in a reality they never asked for.

What I think I would want most is for people to meet me where I am, not where they want me to be.

And when I shared those thoughts with my friend, her response was immediate.
"Yes, please. All of that."

So maybe this is what I want people to know…
If you are the one receiving difficult news, you have permission...
To ask for company.
To ask for solitude.
To change your mind.
To not know what you need until you need it.
To be brave one moment and terrified the next.

You do not owe anyone consistency while your world is being rearranged.

And if you are someone who loves a person receiving difficult news, you have permission too.
Permission to not always know the right thing to say.
Permission to stop trying to fix what cannot be fixed.
Permission to ask instead of assume.
Permission to be honest.
Permission to say, "I don't know what to do, but I want to support you. Tell me what helps."

Maybe that is where the best care lives...
Not in having the perfect words.
Not in having all the answers.
But in creating enough room for someone to be exactly who they are, exactly where they are, on any given day.

Sometimes they will need you to stay.
Sometimes they will need you to go.
The gift is being willing to do either... with love.

xo
Gabby
www.thehospiceheart.net

One of the hardest lessons in palliative care and hospice is learning that our role is not always to do, but often to be. Families will come to us in moments of deep fear, uncertainty, and heartbreak, and the instinct to “fix” things is strong, after all, most of us entered this field because we wanted to help, to ease pain, to solve problems. But there are times in this work when there is nothing to fix, and trying to do so can leave families feeling unseen in their grief.

Silence can feel uncomfortable, can’t it? We are trained to explain, to comfort, to try and ease the pain with words. And when a family is hurting, our first instinct is often to fill the space with something, anything, that might help. But the truth is, in palliative care and hospice, silence can be one of the most healing gifts we offer. It’s not emptiness. It’s not absence. It’s a space where care, compassion, and presence quietly live. And sometimes, it is exactly what is needed.

We don’t always have to have the right words. We are not here to fix anyone or solve every problem. What matters most, what families need most, is us being fully, quietly, present. There’s incredible power in sitting still, in taking a pause, in simply breathing together. Silence says, I am here with you. You don’t need to respond, to explain, or to perform. You are safe to just be. That alone is enough. And sometimes, when we remind ourselves of that, we realize that we are enough too.

Silence gives families the room to find their own words, or to find none at all, and that is a gift. It gives permission to rest without the weight of questions or expectations. It gives us, as caregivers, the chance to witness, to honor, to hold space for life’s most fragile moments without rushing in to “fix” what cannot be fixed. And in those moments, we may notice something subtle but profound: just by being there, we are giving something irreplaceable. Our presence is a gift, and it matters.

Being fully present in silence requires courage. It asks us to trust ourselves, our instincts, and our humanity. Sometimes we worry that we are not enough, that our gifts are too small, or that we should be doing more. But the truth is, what we offer is not measured in words or actions, it is measured in our willingness to be there, fully and without apology. It is in the steady hand, the quiet breath, the unhurried willingness to simply remain. That is enough. Always enough.

Families may not remember every word we say. They may not notice the perfect sentence, the clever explanation, or the reassurance we offered. What they remember, what they carry long after, is the sense of being deeply accompanied, of being seen and held. And that, our presence, is one of the most profound gifts we can give. Sometimes, the most compassionate thing we can “say” is nothing at all.

xo
Gabby

This was written for my book, "When Words Have New Meaning," which you can find here:
https://www.amazon.com/When-Words-Have-New-Meaning/dp/B0GDFT9WL3

A poem I wrote, “Presence” can be found here: https://www.thehospiceheart.net/post/presence

"The reality is that you will grieve forever. You will not "get over" the loss of a loved one; you will learn to live with it. You will heal, and you will rebuild yourself around the loss you have suffered. You will be whole again, but you will never be the same. Nor should you be the same, nor would you want to.

The time we take following a loss is important in grief and grieving as well as in healing. This gift of grief represents a completion of a connection we will never forget. A time of reflection, pain, despair, tragedy, hope, readjustment, reinvolvement, and healing.

The time after a significant loss is full of the feelings that we usually have spent a lifetime trying not to feel. Sadness, anger, and emotional pain sit on our doorstep with a deeper range than we have ever felt. Their intensity is beyond our normal range of human emotions. Our defenses are no match for the power of the loss. We stand alone with no precedent or emotional repertoire for this kind of loss. We have never lost a mother, father, spouse, or child before. To know these feelings and meet them for the first time brings up responses from draining to terrifying and everything in between. We don't know that these foreign, unwelcome feeling are part of the healing process. How can anything that feels so bad ever help to heal us?

With the power of grief comes much of the fruits of our grief and grieving. We may still be in the beginning of our grief, and yet, it winds its way from the feelings of anticipating a loss to the beginnings of reinvolvement. It completes an intense cycle of emotional upheaval. It doesn't mean we forget; it doesn't mean we are not revisited by the pain of loss. It does mean we have experienced life to its fullest, complete with the cycle of birth and death. We have survived loss. We are allowing the power of grief and grieving to help us to heal and to live with the one we lost.

That is the Grace of Grief.
That is the Miracle of Grief.
That is the Gift of Grief." -

Dr. Elisabeth Kubler-Ross and David Kessler (Authors of the book: On Grief and Grieving- Finding the Meaning of Grief Through the Five Stages of Loss)

I know I talk about this often, but it is because I believe so deeply in the importance of having conversations about death and dying before we are sitting at the bedside.

Talking about death and dying will not make it happen sooner, and silence will not slow it down.

What these conversations do is help the people we love know what matters most to us if a time comes when we can no longer speak for ourselves.

About a week ago, I received a call from a woman I had never met. She had been given my name by someone I had supported before. Her mother had a sudden change in condition and was in the hospital, no longer responsive. She was about to board a flight to come see her mother who she hadn’t seen in a few years.

I could hear the helplessness in her voice. She felt lost and kept asking, “What can I do for her? How can I support her? What does she need?”

I asked what she knew about her mother. She told me her mother had a strong faith, so I said, “Then the first thing you can do is pray with her.”

So when she arrived at the hospital, she sat beside her mother and prayed.

Later, when we met in person, we went together to her mother’s apartment and looked for the things that might feel familiar and comforting. We found her pajamas, a quilt from her bed, a few photos, her hairbrush, a small mirror, Chapstick, and her Bible.

We brought those things back to the hospital. Together, we changed her mother into her pajamas, laid the quilt over her, and placed her personal belongings beside her bed.

Her daughter read prayers to her for three days.

And then her mother woke up.

One of the first things she said was, “You prayed for me.”

That moment meant everything.

It told her daughter that her mother had heard her. That she knew she was there. That even in the silence, something between them had connected.

Her mother pulled the quilt up close to her, almost as if she were being held by it. And her daughter knew she had brought her something that mattered.

Her mother lived three more days, but in those three days, they connected in a way they may not have otherwise. There had been distance between them, but at the bedside, something softened.

Her daughter called me this morning to tell me her mother had died.

The voice I heard was not the same voice I heard during that first call. There was grief, of course, but there was also peace.

Peace because she knew her mother had heard her.
Peace because she knew her mother knew she was there.
Peace because she had done what she believed would bring her mother comfort.

This is why the conversation matters.

Not just the big conversations about medical decisions, but the tender ones too.

What brings you comfort?
What prayers, songs, or words would matter to you?
What blanket would feel like home?
What small things would you want near you?
What would help the people who love you know how to show up?

Because if the time comes when we no longer have a voice, the people we love can become our voice.

And sometimes, knowing what brings someone peace is one of the most beautiful ways we can honor them.

xo
Gabby
www.thehospiceheart.net

One of the questions I am asked more than almost any other is this: “Why do we stop food and water at the end of life?”

It is a question filled with tenderness, and often, with fear. Families struggle. Clinicians and caregivers struggle. Anyone who has ever cared for someone who is dying knows how deep the instinct is to nurture, to comfort, to give. We equate food and water with love, with survival, with doing right by someone we care about.

And so, when we are asked to stop, or when a patient begins refusing food and water, it can feel like we are participating in something harmful… or abandoning something essential. Some worry they are contributing to suffering or hastening death. Others feel a conflict with their faith, their values, or the core human urge to sustain life. All of these feelings are valid. All of them deserve to be seen.

But there is another truth, one rooted in the wisdom of the body itself. At the end of life, the body does not want food and water. As the systems begin to shut down, appetite and thirst naturally fade. The digestive system slows. The cues in the brain that tell us “I’m hungry” or “I’m thirsty,” grow quiet. The body needs less energy, less input. It begins turning inward, conserving what little is left for the final work of letting go.

When we try to give food or fluids during this time, no matter how well-intentioned, we create discomfort. The body can no longer process what we are offering. Liquids can pool in the hands, feet, and limbs. Food can sit in the mouth or throat without the strength to swallow. These are not signs of neglect. They are signs of a body transitioning, doing exactly what it is designed to do at the end of life.

This is why stopping food and water is not an act of harm. It is an act of honoring the body’s own wisdom.
It is allowing the natural process to unfold without introducing distress.
It is trusting that they are not dying because we are withholding anything, they are dying because the illness has reached its end. And when we stop giving food and fluid at this stage, we are not causing death, we are helping create the conditions for it to be more peaceful, gentler, and filled with far more grace.

The body will actually let go with a little more peace and grace when food and water is not given at the end of life. The body responds well to this. It prefers this. And when we honor the body in this way we can remove or avoid physical suffering which is inevitable when we push or force food and water.

There are ways to offer care, comfort, and presence:

• Offer, don’t force. If someone shows interest, small sips or favorite tastes like ice cream, Jell-O, or a spoonful of something familiar can be soothing. But refusal is communication, and it must be respected.

• Provide mouth care. Moist lips, a clean mouth, and gentle swabs can bring comfort without asking the body to process what it cannot.

• Watch for cues. Holding food in the cheeks, coughing, spitting out food, or drooling are signs the body is not tolerating intake.

• Honor their choices. If they have an Advance Care Directive, their decision about artificial hydration or nutrition must guide us.

• Above all, prioritize comfort. Hospice and end-of-life teams are here to help families and caregivers understand these changes, to hold space for the grief they bring, and to create care plans centered entirely on comfort and dignity.

Stopping food and water at the end of life is one of the hardest things we ask of families and care teams. It challenges our instincts. It touches our fears. It asks us to redefine what care looks like.

But the truth is simple and profound:
Their body prefers it this way.
We are not hurting them. We are easing their way.
We are meeting them with compassion, not deprivation.

This work is tender. It asks so much of our hearts. But when we allow the body to guide us, when we stop forcing what it can no longer use, we give our patients what they deserve: a death held with gentleness, respect, and deep humanity.

And that is the essence of the care we all strive to provide for the people in our care, and for the people we love.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/a-gentle-truth-about-food-water-and-the-end-of-life