The Use of Flower Essences in Hospice Care


I find that patients who have severe pain refractory to high doses of narcotics are often dealing with underlying emotional and/or spiritual issues that are manifesting as intense physical pain. Receiving the essences seems to bring those issues to the surface so that they can be dealt with more effectively and completely. This allows me, as a physician, to get to the source of the discomfort, rather than simply over-medicating my patients in a futile attempt to make their pain go away.

— Dr. Kelly Warshel

Case summaries from Dr. Kelly Warshel,
Windber Hospice and Palliative Care Unit,
Windber, PA

Listen to an interview with Dr. Warshell (23,962 kb)

The following information is based on an oral interview between flower essence practitioner Jane Ellen and Dr. Kelly Warshel. It was transcribed, edited and condensed by Jann Garitty for publication.

Jane Ellen
Dr. Kelly Warshel

Read about the introduction of flower essences into the Windber Hospice care program here.  

Facilitating transition: Walnut flower essence

“I just want to be free”
Honoring the patient’s choice
Awareness of other realms
A gift from the use of essences: faith
A relative speaks of the experience

“Angels, they’re everywhere
The quality of life and death improves

Breaking through family denial and moving toward acceptance

Receptive to the flower essences and acceptance by family

Facilitating transition: Walnut flower essence

The most profound initial experience for me with the essences was a patient, a gentleman who was relatively young, who had lung cancer. His wife was in absolute denial in regard to his condition. He was very contracted with his arms positioned in his chest and his knees pulled up. He was extremely weak, so weak that he couldn’t really change positions, but he was coherent. He was not eating anything and he would not lift his head off the pillow for me; he was basically laying there waiting to die.

There were always seven or eight family members sitting around the periphery of the room surrounding his bed. His wife would ask me, “When do you think he’s going to get out of here? When do you think he’s going to be better?” She was in so much denial despite me telling her, “He’s dying, I don’t know if he’ll make it out of here.” He never spoke, but he was there, he was awake, and you could tell he could hear you and would nod to my questions. It was very sad.

I was just starting to use the essences and I only had Walnut at that point. I went into the room and explained what essences are and said, “This helps you when you are dealing with a transition, as you are dealing with a transition from this world to the next.” He looked me right in the eye at that time—he had not made eye contact prior to that—and I said, “I can use this with your family as well because they’re facing a difficult transition, too.” He literally reached his arm up to me, which he had not even moved prior to this, and put his wrist in front of me to put it on him. This was so profound to me, because this man had not moved for days. Then, he turned his arm over to his wife who was in the corner crying and motioned to her. So I offered it to her; though crying, she accepted it. I went around the room and offered it to each of the family members. It was an amazing experience. For the nurses, that was their first experience with any of the essences and they felt that this was profound too, because he actually asked for Walnut every four hours; just like patients ask for morphine, he asked for Walnut.

“I just want to be free”

B. was only 48 years old, with two teenage children, who initially came to hospice with a very rare malignancy. While at the hospital for aggressive treatment, she did very poorly and so they sent her to Windber Hospice—basically, for no further treatment. Within 24 hours after being in hospice, she felt much better than she had felt the whole previous three or four weeks at the hospital. So at that point, just within 24 hours, she decided that she was going to pursue chemotherapy and try working with a new oncologist. I lost her for about a month but I kept tabs on her because a mutual friend works at my hospital.

After about a week of being out of hospice, she ended up in the hospital with an infection and it just kept getting worse and worse; bad things kept happening to her, they found new tumors, and then she developed an infection around her heart. All these fairly rare things occurred to her and she was deteriorating.

At one point, she was starting to get more and more lethargic and was in a lot of pain at the hospital. She had no quality of life left and so finally after much persistence from the friend who works at Windber, her husband took her home. B. kept saying “I just want to be free.” That’s all she would say, she wasn’t coherent most of the time, but she would say to her husband, “I just want to be free.”

B.’s husband called me and asked for my advice. I said that B.’s statement most likely had really deep meaning and she probably didn’t want medical procedures done to her any more. I wanted him to consider that if she really wanted to be home, then he should try to honor that and that we absolutely would be there if he or she would need us.

B. was on IV feeding and they brought her home. Unfortunately, by hospice criteria (i.e., IV feeding is a life-sustaining treatment) she couldn’t come into the hospice facility. But that was fine, because she wanted to be home anyway. However, B.’s husband called within 24 hours of her being home, just frantic, because she was in excruciating pain and he was inconsolable. He called hospice in the middle of the night and they told him to take her to the ER. Subsequently, I was able to arrange for him to bring her to hospice and we could deal with the feeding issue later after getting her comfortable.

Honoring the patient’s choice

When she arrived, she was somnolent and somewhat lethargic. Her children were there and I didn’t know what to expect, except that I knew she had said that she just wanted “to be free;” that’s all that I knew. When I went in to talk to her, I told her that I understood that she wanted to be free, that’s why she was there and we would honor that but we wanted to get her pain under control first. I asked if it would be okay if we stopped giving her the IV and the IV antibiotics, because at this point I didn’t think they were really helping her or honoring her request. Amazingly enough, her two children who were there, aged 19 and 17, said, “Whatever you think.” I was really pleased that they were okay with this suggestion. B. was not quite coherent enough to really respond to that suggestion herself, so I just let them know I was thinking about it as a possibility.

I then introduced B. to the flower essences and told her about Walnut, how it would help her with this transition. I didn’t say “transition from this world to the next” like I usually say, because I didn’t know where she stood at that point. She had always wanted to do everything possible for her recovery, as did her husband. So I said to her, “…this transition from being healthy and walking around to being in bed and being in the hospital.” I also said, “Your children can use it too, because it is a transition for them as well.” I knew as a mother she would feel good about that. Probably her primary and sole concern was really about them. Then, I explained the use of Angelica, to be surrounded by her angels, and Angel’s Trumpet to help her focus from the physical realm which caused her so much pain and discomfort and to help her visit more of the spiritual realm (which I’m sure she’d been to many times).

B. became much more intent and listened; I could see she was coherently listening; I remember that really vividly; it was as though she was thinking, “Wow, somebody can verbalize what’s in my head.”

It wasn’t even five minutes later that the daughter, who was 19 years old and who was also the caregiver along with her dad, said “We agree with you, we don’t want mom to have any more IVs or the food or anything, we just want her to be comfortable.”

Awareness of other realms

We then got her comfortable with her pain medication, she completely woke up and just had these beautiful days with her children and her family who were there all the time. Probably the second or third day I came in, and every time I came, they had the three bottles of flower essences beside her bed. When I would arrive, I sat beside her, held her hand, put the essences on her wrists and told her what they were for. B. LOVED Angel’s Trumpet. The second or third day, her family told me that she said that she had seen a little baby with wings in the room. I said to B., “Wow, what did that look like?” And she said, “Well, you know, like a cherub.” Her children were standing right there and that was their first exposure to her saying anything about being in that realm. I said, “What was it doing?” And she said, “Oh, it’s just in the room with all of us.” And as the days went on – she was actually there for three weeks, which is longer than anybody – every day she saw angels. She wouldn’t openly talk about it unless people asked what she was looking at, which I encouraged them to do, but she’d say things like, “Oh, angels, they’re everywhere.” Real matter of fact. It was amazing for her children.

For about ten days, she was very coherent and able to tell us her experiences. Her husband and children stayed 24 hours a day; they just lived in the hospice unit. The family became interested in the spiritual realm being shown to them by B., and in fact, they started writing about it. I put a hospice journal out in the front so they could write about their experiences. The husband came out of his wife’s room one time and said, “You’re not going to believe what just happened. My wife is in there talking to my father about being a carpenter, about a table he made for my grandmother and about the houses that he used to fix up and rent out.“ The husband is a volunteer fireman and she was talking to his father about that as well. And he said, “The thing is, my father died when I was ten, so my wife never met my father. Sure, I talked about him a little bit, but my father was not a nice man and I haven’t talked about him a whole lot.” He was totally amazed. He said, “You tell me how that can happen—I have no doubt, she’s in there talking to my dad.”

A gift from the use of essences: faith

The children were receiving Five-Flower Formula, and Walnut during this time. Typically, I would offer it to them and they were very open about receiving it, but they were still somewhat hesitant about the whole thing. The daughter was a little disturbed about even going alone into her mother’s room because of all the things her mother was seeing, even though it was loving and it made her mother very peaceful. However, one thing was really beautiful: when B. was dying, perhaps the last five days, she slipped into a coma and could no longer talk. The family continued to be near her around the clock. One day the children were on both sides of their mother and I kept telling B. that it was okay to let go and that they were going to be okay. The daughter said to her mom, “You gave us something that we could never get from anybody else, you gave us faith.” She said, “I had so many doubts until what you’ve given me at the end of your life—it’s more than I could ever ask for.” She was fearful of what she was experiencing with her mother, but it gave her what she called “faith.”

A relative speaks of the experience

Letter from B.’s sister:

Please accept this donation in honor and remembrance of my sister, B.. Your hospice program is wonderful. I was there almost every day (for three weeks) to spend some time with my sister and her young family. Your staff is wonderful and caring. I knew B. was “Home” when I was there, when Dr. Warshel gave her the Angel’s Trumpet and read the paper that described how it would help her. Her face glowed and she was relaxed and peaceful – for the first time in a very, very long time. Thank you for that.

“Angels, they’re everywhere

Across the hall from B. was J., who was 87, and who also had a very rough time before coming to hospice. She had previously been very healthy and had never gone to a doctor and had taken no medications. However, she had had a stroke three months prior to coming in, and had been in and out of the hospital constantly. Her daughter very reluctantly decided to withdraw all treatments and put her in hospice. She had a horrible experience at the hospital with multiple surgeries due to misplaced feeding tubes that, unfortunately, went into her abdominal wall. The result was that she had multiple open wounds; her abdomen, in fact, had three gaping open wounds from the three surgeries she had. That was her primary reason for coming to hospice; she was so malnourished, there was no way that these wounds were going to heal. The surgeons just left the sutures in because they said they would not heal and eventually most likely she would die from an infection. There was one area that was about a half-dollar size, shaped perfectly round, on the side of her abdomen that was open so deep – at least three inches – that you could see her intestines.

Of course right away, I offered her the flower essences; her daughter was in the room, the one who felt guilty about putting her in hospice. I explained to J. that Angelica surrounded her by her angels and explained about Angel’s Trumpet and Walnut, and put them on her wrist. She started staring intently, just past me. She really hadn’t made any eye contact or anything until I offered her the essences and then she was listening to me and looking right at me. When my patients do that, I always ask them, “What do you see?” Because they’re often, I feel, seeing things that are in different realms. I always encourage family members to ask as well so that they can experience it with them. So I asked J., who barely could communicate because of her stroke, “What do you see, J.?” And she said “Angels, they’re everywhere.”

The quality of life and death improves

For her wounds, we used an aromatherapy spray with Rose and Tea Tree essential oils and Self-Heal Crème. Basically, we covered the wounds on the outside and then, not thick, inside the wounds as well. After she was with us for about three weeks, her wounds healed well, we removed the staples and we had to discharge her from hospice, even though she had come in with “impending death” because of the stroke and the abdominal wounds.

About a month later, J. came back, after having been in a nursing home. She did eventually die. The family members who were there all the time felt that angels were pouring out of one room and into the other. Even the nurses would come to me and say, “Did you hear her? She’s talking about seeing angels.” I had already known that. Sometimes she would – and this isn’t really uncommon, but this was a woman who could barely talk – be talking to her mother. Once when I asked her, “Who do you see?” she said she saw her mother, her father, her brothers and her sisters. They were all together – they were all deceased – but they were all together with angels around them.

It was beautiful to see that with B. and J., both of whom had had such trauma in their lives prior to coming to hospice, had such beautiful deaths.

Breaking through family denial and moving toward acceptance

In one of our weekly hospice staff meetings which include the pastor, counselor, and everyone involved with the patients – I heard about a patient and her large Italian family that I had not yet met. The people at that meeting said, “Oh, they’re so challenging…we’re never going to get through to them…they’re in so much denial…we need to have family meetings…” From then on, every week I heard about this particular family.

Later, the patient came into the unit for “respite care.” One of the nurses called me and said that the family wanted a doctor to see their mother. I was going out of town and I said, “Please explain to the family that I’ll be in tomorrow instead of today.” (I wasn’t really supposed to see her anyway.) The next day I went in and there were two daughters in the room and the mother who was basically unresponsive. I introduced myself and they let me know that they were not happy that I did not see their mother the day before; they were very irate and angry.

They wanted me to evaluate their mother and tell them if she really needed to be in the hospice unit. I went to examine H. and she was unresponsive. The daughters repeatedly tried to arouse her. I said, “It’s very difficult for me to know—just meeting her, plus her not being able to respond to me at all—what’s going on.” I then explained that our bodies metabolize substances differently when we get older and suggested we could start taking her off some of her medications. However, as with all my recommendations, it took them very long to accept and approve the idea, and it was a couple of days before they gave their approval to wean her off the medications.

Receptive to the flower essences and acceptance by family

To make a long story short, I introduced essences gingerly with this family, a very strong Catholic family who so loved and cared for this woman, and were not able to accept her impending death; they continued to ask for medical intervention when it was not appropriate. I explained the essences to them as gently as I could and they looked at me suspiciously but with an attitude of “whatever.” And so, every time I came in the room I would talk to H. and I would explain to her what the essences were for, and that they would help her with this difficult transition. After about four or five days, the younger daughter again asked for a series of medical tests and I said, “Your mother is dying.” The daughter looked at me angrily, turned around and left the room. I went to her and put Walnut and Five-Flower on her wrist and said, “I know this is very difficult.”

Flowers of the Five-Flower Formula—

A formula for calmness and stability in any emergency or time of high stress, and for extreme pain or shock in situations of death and dying, helping the soul to register consciousness.

The next day, H. was sitting up in bed, probably because her medications were finally out of her system, and her daughters said, “Mother really likes those flowers you’re giving her. When we give them to her, she smiles at us.” It was so great because they had, fortunately, seen that their mother was really receptive to them, and so they had embraced them as well. The family then very much pulled away; the woman eventually had a beautiful death – with her huge Italian family all around her – there must have been 15 or 20 people there. They were very accepting, except for her husband, whom I had not seen at all because he was having such a difficult time. The daughters asked if they could use Walnut for their father, and they actually took all the essences with them when their mother died. They have come back twice to buy more Walnut.

The counselors were amazed, they just couldn’t believe it; they think I’m a miracle worker because I got this family to be accepting of their mother’s death—but it wasn’t me at all. They keep saying that it’s absolutely amazing, the turn around with this family.

This patient is an example of how difficult it is for people when they’re not able to speak; they can be extremely depleted and weak. Sometimes they only speak with their eyes. But, even that eye contact tells you so much. Sometimes, the first eye contact I have with a patient is the acceptance when I’m offering the essences.

Close up of a tiny Angelica flower

Introduction of flower essences into the Windber Hospice care program

I first contacted Jane for a flower essence consultation for myself as I was leaving my Internal Medicine practice to become the Medical Director of our local hospice. After several weeks of receiving the flower essences, I realized that the surprisingly easy transition that I experienced in my job change was, in a large part, due to the essences. I also recognized that my patients, who themselves were facing a much more difficult transition than me, would benefit substantially from the beautiful support of flower essences. When I asked Jane about this, she immediately embraced the idea and made herself available to me twenty-four hours a day as a consultant. In fact, Jane did this free of charge.

In May 2006, Jane came to Windber Hospice and did a presentation on flower essences for the hospice staff and for over fifty hospice volunteers. She explained that the essences could be used not only for our patients, but also for the families and the nurses who give so much of themselves every day while caring for their loved ones and patients. Jane introduced us specifically to the flower essences of Walnut, Angelica, and Angel’s Trumpet, which assist the soul in transition and aid in the ability to shift one’s focus from the physical realm to the spiritual, as well as feeling the support of the Angelic realm. This is exceedingly important in hospice work. I find that patients who are not relieved with high doses of pain narcotics are often dealing with underlying emotional and/or spiritual issues that are manifesting as intense physical pain. Receiving the essences seems to bring those issues to the surface so that they can be dealt with more effectively and completely. This allows me, as a physician, to get to the source of the discomfort, rather than simply over-medicating my patients in a futile attempt to make their pain go away. The flower essences gently and powerfully assist in addressing the spiritual, emotional, and psychological needs of patients.

Walnut, Angelica, and Angel’s Trumpet have become my personal allies in hospice, and I am continually amazed at their subtle yet profound influence on my patients and their families. I have numerous examples of patients and families whose minds were somehow put “at ease” once they began receiving the essences. I became a believer, as I mentioned above, with my own personal experience with the essences; but my patients continually reaffirm the need to receive them in the transition from life to death. Occasionally, patients who have been nonverbal will reach out a hand and ask specifically for Walnut, Angelica, or Angel’s Trumpet. It has been my policy when patients are admitted into the hospice unit to write an order for all three of these essences to be placed on my patients’ wrists and gently rubbed in every 6 hours. They appreciate the gentle touch that is involved, and family members often offer to administer them. Sometimes I will place the drops over my patient’s heart, always explaining what they are for.

Jane has been exceptional in her support of offering the flower essences in hospice. I can honestly say that I don’t think I could have pursued it to the extent that I have without her undeniable enthusiasm and persistence. Jane has had to endure many roadblocks in dealing with my hectic schedule and unfamiliar hospital policies; but she has tirelessly persevered, simply for the love of the essences and the firm knowing of how much they would benefit the dying. I am forever indebted to Jane for introducing me to the flower essences at such a critical time in my life. She has unknowingly been the catalyst for something that has touched the lives of hundreds of people who experienced either their own death, or the loss of a loved one.

I should mention that the nurses and hospice staff have become more and more accepting of this nontraditional therapy for our patients. They are seeing for themselves how the patients somehow change once they begin receiving the essences. They are often sleeping better, taking less of their anti-anxiety or pain medications, and family members are requesting the essences. The nurses themselves frequently tell me that they “need” more Five-Flower Formula, which I leave at the nurses’ station for anyone who feels the need to receive it.

Last month, Jane created beautiful handouts with pictures and affirmations of each of the flower essences we are currently using. She made laminated copies bound by a ring for each of our hospice rooms and one for the nurses’ station. This is just one of many examples of what an invaluable resource Jane has been for me. Now, the family members can read the affirmations, and patients who are not under my care can be exposed to the essences. She has also recently introduced me to Grief Relief, and Benediction Oil, which I plan on offering to patients and their families.


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