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| Illustrations by Rod Clement |
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It is when words matter less than just being there and listening.
Although we know that death is inevitable, our societal norms promote denial and avoidance. It is no wonder then that, if we are honest with ourselves, most of us are afraid to talk to someone who is dying. We think we will say something awful, stupid, or think of nothing to say at all. However, helping someone who is dying is one of the most wonderful things one human being can do for another. And simply being there and listening is more important than words.
Dr. Robert Buckman, a medical oncologist in the Department of Medicine at the University of Toronto, is the author of I DON’T KNOW WHAT TO SAY: HOW TO HELP SUPPORT SOMEONE WHO IS DYING (Little, Brown, 1990). Dr. Buckman, along with most other experts on the subject, makes the following suggestions.
Allowing the patient to talk helps relieve their distress. Not talking about, or even worse, overtly avoiding talking about fears only serves to magnify them. Thus, one must be a good listener.
Learn about the patient's condition in advance. This will enable you to help constructively. It will also help protect you from also being frightened by the unknown.
When you talk with a dying person, get the setting right. Choose as private a location as possible, preferably a private room. Show that you intend to spend some time with the patient. Take off your coat, put down your bags, and so on. Sit only at a close distance and with no physical obstacles between you (table, lamp, flowers, etc.).
Remember the importance of non-verbal communication. Try to maintain eye contact to show that you are genuinely interested. Facilitate this by keeping your eyes on the same level as the patient's. This may mean sitting on the bed or in an uncomfortable position. If, during a painful moment, you just cannot bear to look directly into their eyes, stay close and maintain physical contact--touch their hand, arm, or shoulder, for instance.
Be sure the patient wants to talk during your visit. The patient may be tired or not able to concentrate properly due to medication. If so, tell them you will come back soon.
If they are able to do so, encourage the patient to talk. And allow the conversation to be one-sided. Offer comments such as "Yes, I see", "Tell me more", or just nod. Repeat a few words to show you are listening and that you understand. Try not to interrupt. But if they interrupt, let them.
Focus on the patient and not on yourself. Listen to what is being said, not what you expect to hear--as upsetting or shocking as this might be.
Encourage reminiscence. Often, a patient will think they cannot cope--even momentary panic will occasionally set in. Reminiscing with someone allows them to draw on their past coping abilities to help them cope now.
Respond to humour. Humour allows the patient to express feelings and fears. Let the patient make their own jokes rather than trying to set the mood with yours. Too much cheerfulness from you will possibly be perceived as phoney.
Refrain from giving advice unless it is asked. If you must offer advice, do so only late in the conversation. Use phrases such as "Have you thought about doing..." or "An idea might be to..." Avoid the phrase "If I were you..." You are not them. And unless you are dying too, you only highlight a barrier between you and them which inhibits communication.
Acknowledge the patient's feelings. Allow them to complain. If you cannot think of a response, do not be afraid to say "I don't know what to say". Sometimes allo that they wish is to simply stay near to someone who is dying, even in silence.
Respond to dying requests where possible. Perhaps the best response is to consider what you would do if the patient were not dying. If the request is one that you would otherwise try to honour, then make the promise. But you need not agree to something that violates your principles or is out of character. And false promises later broken will only produce guilt afterwards. If you think you cannot honour a request, suggest an alternative that you can.
Reassure the patient that they will not be forgotten. Avoid long arguments where you try to convince them that life has meaning. Instead, reassure them that, even if they think their life has no meaning to them, it has had meaning to you. Tell them that they have had an effect upon you and that they will always be loved. Tell them now. You may not have the chance later.
In her pioneering 1969 book, ON DEATH AND DYING (revised edition, Scribner’s, 1997), Elisabeth Kubler-Ross described the stages of death and dying that people normally go through. However, Mary E. Johnson, a chaplain at the Mayo Clinic in Rochester, Minnesota writes in 'Terminal Illness: Interacting With A Terminally Ill Loved One' on the Mayo Clinic website (6 April 2006) that 'She [Kubler-Ross] discussed dying as a process, making us think we had a scientific way to understand and talk about a very existential experience. But dying is not a science. Don’t assume that your loved one with a terminal illness is going to go through a methodical process of coming to terms with death, such as denial, anger, and so on. It may not happen that way. Sometimes well-meaning people try to push the one with a terminal illness through these stages of death and dying. That’s not helpful.'
After they have died, try not to let the last painful negative memories of the person block the earlier positive ones. For example, memories of years of friendship together are not wiped out by the image of the last few days of their dying. Avoid letting guilt poison memories as well. Neither their death nor your survival is your fault.
Life is short and we move on.
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