Jill Smolowe wrote a compelling article in Next Avenue, a health awareness online resource in its June 21, 2016, edition, with this tantalizing title: What to Say When Someone is Dying. Read the complete article.
Smolowe recounts the experience of advising a friend whose father was dying. The friend wanted guidance about how to approach some of the sticky, unresolved issues between the father and daughter which might haunt her even after his death.
The article references a popular writing by Kate Roiphe, The Violet Hour: Great Writers at the End. Roiphe reinforces a popular myth about end-of-life conversations stating that “Nearly everyone has a fantasy of a ‘last conversation’ with someone they love. It is the fantasy of resolving all conflicts; of setting the record straight.”
Nearly everyone has a fantasy of a ‘last conversation’ with someone they love. It is the fantasy of resolving all conflicts; of setting the record straight.
Approaching loved ones
As a licensed clinical social worker in a community palliative care organization, it has been my experience that seldom will the pattern and history of relationships dramatically change simply because someone we are close with is preparing to die. Those who hastily rush to the bedside in order to finally hear a word of forgiveness or acceptance are generally deeply disappointed. On the same hand, a patient who is “hanging on” in order to embrace an estranged son or daughter or sibling or parent with a celebration of reconciling love is likewise set up for a lost opportunity.
Rather, Smolowe offers an alternative to the often disruptive exercise of “baring one’s heart to each other” by highlighting and affirming shared memories with the dying loved one that bring joy, contentment and a sense of accomplishment. She reflects on the last days of the death of her spouse with these words:
Later, when the fog of early grief lifted, I would think how fortunate I was — dumb luck, really — that my last words to this man I loved so much had been words of praise. Words that conveyed appreciation. Words that left no room for regret.
Dr. Atul Gawande, author of the much-acclaimed book on the end of life, Being Mortal: Medicine and What Matters in the End, reinforces this focus on the words that matter. He wrote, “What is turning out to be the powerful way of actually having this conversation is, you put the pills down, and you talk to the patient and you say: ‘What’s really important in your life?’”. What is important to the dying patient is to feel that their life has been worthwhile, that they have made a difference in the lives of those around them. When we can focus on appreciation and affirmation, the dying process takes on a transformative quality of embracing death with peace and serenity.
Tips for guiding conversations
Can health care professionals have an influence on the conversations we witness and often initiate within the circle of people around our dying patient? Yes, indeed, with a few of these simple steps:
- Model conversation with the dying patient and their loved ones by speaking honestly, directly and empathically. Others around the patient will take their cue from how we engage the patient in conversation (when their symptoms allow them to converse).
- Allow the patient to be reflective about their life but encourage them to focus on those events and experiences which bring a sense of closure and accomplishment.
- When the patient or loved ones bring up more difficult or challenging issues that are not resolved, assist the conversation to find the positive and those aspects that can be addressed in these last moments together.
Together, health care professionals, patients and loved ones will discover the truth that each of us end our life much in the same way we have lived our life.
What to say when someone is dying? Simple words filled with graciousness, appreciation and gratitude. In these words, there will be no regrets.