A man I know, a veteran of some of the fiercest fighting of World War II, once described the job of taking care of his wife during her final illness as "tougher than combat."
Terminal illnesses can be grueling for family members and friends. Watching a loved one waste away is hard enough; the relentless routine of around-the-clock care can be exhausting.
But the final phases of a deadly disease don't have to be a nightmare. A terminal illness in which a person approaches death gradually can hold special moments for dying people as well as for those around them.
From their long experience with dying people, two hospice nurses, Maggie Callanan and Patricia Kelley, have come to describe these moments as a gift from the dying to those they leave behind, gifts of insights or reconciliation that can bring solace to their survivors.
But the gifts go two ways. By recognizing these moments and paying attention to the messages dying people are trying to send, the people caring for them can help fulfill their last requests, relieving their anxieties and allowing them to die more peacefully.
In their new book, "Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying" (Poseidon Press), Callanan and Kelley have given a name to this phenomenon: Nearing Death Awareness, "a special knowledge about -- and sometimes a control over -- the process of dying."
The symptoms of this special awareness can begin to appear hours, days or even weeks before death actually occurs. However, those around the dying person can easily miss the signals because they often come in unexpected ways.
Sometimes dying people will seem to be confused or to be hallucinating. They may talk about taking trips or carrying on conversations with people or beings no one else can see.
These kinds of experiences are frequently reported by people caring for the dying, and too often they are explained away as confusion or a wandering mind.
But Callanan and Kelley have found that these seemingly random messages are not random at all. They generally fall into two categories: attempts to describe the experiences a person encounters while approaching death; and requests for something the dying person needs in order to face death peacefully.
By paying attention to these messages, families, friends and caretakers can glean valuable information about the dying person's needs.
Sometimes these messages can even give clues about when death will occur.
One example they cite involves Doug, a young football coach in his late 20s who was dying of lymphoma.
One Saturday, although his condition did not appear to have changed, he drew a diagram of a football play. A circle with his initials on it had an arrow pointing out of bounds and a scribbled note saying, "Out of the game by noon on Sunday."
As it turned out, Doug died shortly before noon the next day. Because the nurse had pointed out this message, each member of his family had a chance to spend a few final minutes with him.
Stories like this may sound strange, but hospice workers and others with long experience with dying people can report many instances where people seem to sense when death will occur, or to control the timing of their death so that they have a final meeting with people who are important to them.
And in many cases, dying people seem to sense what death is like. Thanks to the careful listening of people like Maggie Callanan and Patricia Kelley, maybe the rest of us can learn to help their attempts at communication succeed.