The first time I saw a butterfly on a door, I had no idea what it meant.
It was not until many years later that I would learn that butterflies are universal symbol in palliative care, and that a butterfly on the door meant that the person inside the room was dying.
The symbolism of butterflies is based on metamorphasis and the process of transformation through the life stages. From the egg comes a caterpillar, the caterpillar becomes a chrysalis, and in the last stage of rebirth the butterfly emerges and flies away ‘reborn’.
Each of these stages signify life, death and resurrection – concepts familiar to christians but which in fact have meaning in many cultures and religions.
In Michoacán, Mexico, the annual migration and return of Monarch butterflies coincides with the celebration of The Day of the Dead (Día de los Muertos) on 2nd November. The Mazahuas indigenous community believe that the butterflies are the souls of their ancestors coming home for their annual visit.
Aristotle gave the butterfly the name psyche, meaning “breathe, breath of life, soul”. Greek people believe that when someone dies, their spirit leaves the body in the form of a butterfly.
The Aztecs believed that the happy dead in the form of beautiful butterflies would visit their relatives to assure them that all was well.
Elizabeth Kubler-Ross, the swiss born psychiatrist who is well known for her theory of the stages of grief, gave the example of a cocoon and butterfly as an analogy for the body and soul.
“Death is simply a shedding of the physical body like the butterfly shedding its cocoon. It is a transition to a higher state of consciousness where you continue to perceive, to understand, to laugh, and to be able to grow.”
Elizabeth kubler-ross
The concept of the death of a loved one is painful and brings with it feelings of grief, loss and finality. Even for those who work in palliative care, death does not always sit comfortably.
We sometimes struggle – not only with bearing witness to suffering, but with finding meaning in the work that we do and ways of coping with our thoughts and feelings. The situations we find ourselves in day in, day out, can lead to vicarious trauma, compassion fatigue and burnout.
Dr Naheed Dosani spoke at the OCEANIC palliative care conference this year about his work providing palliative care to the homeless in Canada. When a homeless person dies, his team shares the experience of grieving in a group by forming a healing circle and using the ‘4Rs’ to remember, reflect, recover and plan to reinvest.
A week later, I heard renal supportive care rural nurses from Broken Hill talking about a wall of butterflies in their office, symbolising the people that their team had cared for who had died.
Both of these resonated deeply for me. I wondered if combining the two concepts could provide a way of helping our team to cope with the sometimes overwhelming nature of our work, and to honour the people we have the privilege of caring for.
We have a large whiteboard in the office, which we use to keep track of patients who are receiving end of life care, and schedule visits or reviews. We now have a number of butterflies fluttering across the whiteboard towards the window. Each represents a person who has died in the past month under the care of the PEACE team.
On the last day of each month, our team will come together in a ‘grief circle’, with the butterflies in the centre. We will take time out of our busy schedules to pause, to remember the person, their story and their family.
We will reflect on their death, share our experiences and what we have learned from them. We will take a deep breath, recover, and prepare to reinvest and continue our work.
Butterfly photo @GettyImages
