‘The Bright Hour’ Review

Two weeks ago on the blog, we shared a review of Paul Kalanithi’s “When Breath Becomes Air” with the mention that coming soon would be the review of Nina Riggs’ memoir, “The Bright Hour,” which chronicles her thoughts about living and dying. Although Nora Krug in her Washington Post review compares “The Bright Hour” to “When Breath Becomes Air,” the two books handle the end-of-life journey differently.

Nina’s Bright Hour

Nina Riggs was a typical mom with two sons: helping them with homework, arranging playdates and taking last-minute trips to the grocery store. And then her life took a dramatic turn in 2015.

Due to a strong family history of breast cancer, Nina knew the importance of mammograms. Her paternal grandfather died of the disease along with other family members, including her mother. A routine mammogram uncovered a small breast cancer lesion, and Nina opted for a single mastectomy followed by chemotherapy and radiation treatment.

Her mother used to joke; “Dying isn’t the end of the world.” It wasn’t until Nina learned that her breast cancer treatment had not prevented the disease from becoming metastatic and incurable did she understand what her mom meant. She shares; “There are so many things that are worse than death: old grudges, a lack of self-awareness, severe constipation, no sense of humor, the grimace on your husband’s face as he empties your surgical drain into a measuring cup.”

Her Mother’s Journey

Nina’s mother battled breast cancer for eight years. This struggle helped Nina cope with the stress of her own disease. End-of-life care was a frequent topic of conversation. In fact, the mother and daughter read Atul Gawande’s “Being Mortal” together. The discussion within the pages of this bestseller prompted both of them to think about what mattered most to them in their respective lives on a personal level. It helped them navigate their way toward the edge of life “in a meaningful and satisfying way.”

Both women struggled with the fear of the unknown. “When it comes to illness, dying, death—those darknesses—it seems we are still so very much Plymouth Pilgrims—all fear and fretting and fortifications, and a strong sense of our own alienness in a hostile land,” writes Nina, who is the great-great-great-granddaughter of Ralph Waldo Emerson.

For both women, hospice helped them along with the loved ones they left behind. Nina thought it strange that the word “hospice” makes people’s faces fall. However, the more she thought about it, the more Nina was struck by the beauty of the word. “It’s comfortable and competent sounding.”

Fitting Ending

Obviously, anyone reading Nina’s memoir knows how it ends—the spread of cancer took her life. In the afterward by her husband, John Duberstein, we learn a number of additional and poignant details:

• Nina finished the manuscript for “The Bright Hour” in late January 2017.
• Morning was Nina’s favorite time of day. John describes, “Before she got sick, she used to bounce out of bed at first light, and she insisted on open blinds when we went to bed, even if we were in a hotel with an eastern exposure in the desert.”
• It was only fitting that Nina died at 6 a.m. on February 26, 2017, just before the sun came up.

At Chapters Health System and its affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Preparing for a Peaceful Passage

Chapters Health System and its affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice—are dedicated to providing guidance and education for people facing death. Sometimes the greatest fear is that of the unknown. Though each of us will experience the end of life in our own way, understanding the final phases can help prepare both the dying person and those who love them—for one of life’s most personal journeys.

Physical Signs of Approaching Death

Like other stages in life, there are physical changes that are expected in the dying process. Just as pregnancy prepares a woman’s body for the birth of a child, the body transitions in preparation for death. These changes are normal. Knowing what to expect and how to care for a dying person eases the transition for both the patient and caregiver.

Possibility of pain: Many people die without having pain. However, if pain occurs, the hospice team will show you how to give the patient medicine that can relieve the pain. How do you know if your loved one is in pain? Ask the question. When the person can’t communicate, look for other signs of pain, i.e., tension in the face, frowning, restlessness or difficulty calming your loved one.

Decreasing activity: As the body approaches death, a patient’s activity level decreases. Your loved one will spend more time sleeping. This is the transition time between life and death so try to create a calm, peaceful environment and don’t attempt to keep them awake. Keep in mind that hearing is the last sense to be lost so it’s important to be reassuring and stay close by.

Skin temperature, color and breathing pattern changes: As death draws near, it becomes more difficult for the body to regulate temperature. Hands, feet and legs may be cooler than the rest of the body. It isn’t necessary to place extra blankets or turn on the heat for your loved one. On the other hand, you may also notice that your loved one is hot or appears to have a fever. In this instance, keep the room temperature cool.

Depending on the illness, a person’s skin can take on a yellowish appearance. Sometimes a grayish tone to the face is noticeable. Closer to the end of life, the patient’s skin has a spotty pattern of blue or purple discoloration and can appear on fingernails, hands, feet and legs.

Additionally, your loved one will begin to have changes in breathing. Rapid, slow or shallow breathing can occur. At times, breathing may even stop for 10 or more seconds.

Refusing food and drink: In the natural process of dying, an individual needs little or no food or fluids. To keep the mouth moist, you may wet a toothette (oral swab) and gently apply to the inside of his or her mouth.

Saying Goodbye

As you begin to see physical changes in your loved one, there might also be emotional changes. The person may tell you they are ready to die. He or she may want reassurance that you or other family members will be all right. They may need you to say that it’s okay to let go.

Try to understand that your loved one is doing the work that needs to be done to let go. There are many different ways to say goodbye, and no one way is best. There’s no magic answer. Just follow your heart.