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Chris Miske has a sculpture that no one will ever be able to recreate.
It's a plaster mold of her late son's hand. Chris' son, James, died just two months short of his 22nd birthday in 2016.
A sculpture of his hand, created by the team in the Medical Surgical Intensive Care Unit (MSICU) at Toronto General Hospital before he died, has allowed her to keep a physical memento of him.
"It's comforting. I am so privileged to have this," says Chris. "I can hang on to his hand for comfort, just like he hung on to mine."
Chris is one of many family members who have expressed comfort and gratitude for this physical reminder of a loved one's life. For more than eight years now, the team in the MSICU has offered this unique service to families whose loved ones are dying.
An artistic approach to grief
The hand casting initiative started with a staff member on the unit who knew of a similar program at The Hospital for Sick Children. With their expertise, some supplies and the dedication of staff on the unit, the project has kept going, with about eight casts created every year.
"For staff, we often struggle with whether we're providing enough emotional support for families and I think this is another way to not only support them but also indicate to them that we care," says Denise Morris, Nurse Manager of the MSICU. "We care and we're trying to understand their pain.
"This shows families that in a small way, we are trying to make it better."
Most often, it's families with small children who participate in the casting. It's not uncommon to have three or more hands featured in the sculpture, all holding the hand of the loved one who is dying.
"It is really a relational piece," says Derek Strachan, Spiritual Care Professional in the MSICU. "It portrays the family's relationship to one another and the fact that the relationship still exists after a loved dies.
"It just becomes a relationship of absence as opposed to a relationship of presence."
Not every family whose loved one is dying is interested in the idea, or ready to have their family member's hand eternalized in sculpture form.
Some medical criteria also help determine whether the project is appropriate for the family at that time.
The plaster used is cold, and it's important for the process to be dignifying for the dying patient. For instance, the patient needs to be in an unconscious state, but still alive, so that the process would not be jarring to them if they were to regain consciousness.
Derek, along Gail Fairley from Social Work, and their teams always assess the family and the patient before moving forward.
"I want the family to understand the whole process," says Derek. "And it is important that it is respectful to the patient."
Healing through art
James had been diagnosed with a heart condition as a child. Though doctors predicted he wouldn't live past age seven, James was in his first year of college when his aorta tore, leading him to the TGH MSICU.
"I knew the end was near," Chris remembers.
Chris asked to have James' hand cast with the original idea to have it translated into a tattoo. Now she's looking at having it 3D-printed for display.
"I am overwhelmed with the detail of the hand," she says. "The art shows the beauty in something that was bad."
Derek has found that this art form offers a different starting point to examine death and dying.
"It's an abstract way to engage families in a grief process that they will carry from here," Derek says. He offers support for patients, families and staff in the MSICU.
"Spiritual Care provides therapeutic intervention, which then develops into a relationship with those in need of support," he explains. "The hand molding process fits in to how I understand my role completely.
"There is always someone here for those in need."
The significance of hands
To Denise, the sculptures are also special because of the important symbolism of hands in healthcare.
"For those who provide direct patient care, our hands are so meaningful because our care flows through our hands," she says. "We touch with our hands, we comfort with our hands, we love with our hands, we try to ease someone's pain with our hands.
"It's such an intimate connection."
The unit sometimes even holds ceremonies during which healthcare workers' hands are blessed with water to pay tribute to the work they do.
"Unfortunately we've had a few staff members who have died in the last few years and this is a way for us to honour them, and the work they did," Denise says, "And a way to honour us and the work we continue to do as well."
For families, hands represent an intimacy with loved ones that no one else could know.
"The last thing I held was his hand," Chris remembers from her goodbye with James.
Through her grieving, Chris says she has found comfort in the sculpture.
"It's as though a piece of him is always with me," she says. "I will treasure it forever."
It is just one of the many gifts she has from James. Another came in the form of a call on Mother's Day in 2016, when she found out he had been able to save two people's lives through the donation of his organs.
After the one-year anniversary of his death, she plans to travel to Iceland and take something of James' with her.
"I want to start fresh. He would have loved to come with me – he was studying Environmental Education.
"It will be like I am taking him with me."