A Cup of Coffee – I Don’t Know What To Say

Welcome back! Last week, we talked about gaslighting. If you missed this blog and would like to catch up, click HERE.

This week, we are going to talk about the inevitable. A friend, a loved one, or a co-worker gets a terminal diagnosis and you’re rendered speechless. It’s really hard to know what to say, isn’t it?

I had a special request for this week’s topic, and while I’ve done blogs on death and dying, or working through grief, I’ve never actually written on this topic before, and I thought it was really worth exploring because it will happen to all of us. You can’t escape it.

In the beginning

At some point in your life, you will be faced with talking to someone that you know who doesn’t have long to live. The information will make you feel sad, angry, scared, and helpless. Sure, at first, you will have some words like, “I’m so sorry” or “you didn’t deserve this”, but later on in their dying process, you will eventually run out of platitudes. Then what do you say? Do you simply avoid them? Stop answering the phone? I hope not. Let’s chat…

Nobody cares about the weather

The small talk will suddenly seem crass and pointless as you struggle to find some meaning in what is happening to this person that you care about. They aren’t the only ones who will be traveling through the stages of grief. You will travel that road with them, yet separately and for different reasons.

The stages of grief apply

There are several stages of grief. Denial, anger, bargaining, depression, and acceptance are the five stages that most experts subscribe to, however, there are some that believe those stages are not just five, but six.

The sixth stage

David Kessler—an expert on grief and the coauthor with Elisabeth Kübler-Ross of the iconic On Grief and Grieving—journeys beyond the classic five stages to discover a sixth stage: meaning.

What do I say?

This particular blog isn’t going to speak to the process of grief, but will instead address how to find the “right” words to speak when addressing the person that you love who is losing their life in front of your eyes.

As you visit them, call them, or send them a supportive text, what do you say? “How are you doing” seems trite when you know full well they aren’t doing well. Some folks just stop communicating with their loved ones because it’s too awkward to find the right words. I’m hoping this blog will help take some of that uncomfortable feeling out of the equation for you so that both you and the patient can find some meaning in their last days with you.

Stay in your lane

Please realize that you don’t have to make them feel better. That’s not your job. Allow the professionals to work on that end of things. Many folks who are terminally ill, don’t want to burden their loved ones with the gory details, so if you ask them how they’re doing, you will get “oh, I’m fine…” or “I’m hanging in there”. It’s ok to simply say, “I know you probably aren’t feeling well, so I won’t keep you on the phone. I just wanted you to know I love you and I’m thinking about you“.

Acknowledging their discomfort relieves them of having to deny it.

Some things just aren’t funny

Try not to do things to “make them laugh” or “cheer them up” unless they tell you that it helps to be cheerful. One of the stages of grief is depression, and when we feel depressed, we “cheer up” to make others feel better, not to make ourselves feel better. It’s another burden to expect the patient to smile so that we feel better. It’s not their job to make us feel better.

The ostrich had it right

Denial is a powerful tool that our brains use to protect us. If they have been told they’re terminal and they say, “heck, I’m not going anywhere” then please don’t lecture them to “accept reality“. Just saying, “I believe you” will give them the space they need to process what is happening. You don’t have to be right all the time.

Anger is to be expected

Please don’t take it personally if they display anger. Remember, it’s not about you. They are the star in their dying process and they get to call the shots. Anger is another stage in the grieving process that is underrated. It often stems from a place of fear. Fear of the unknown. Fear of pain. Fear of spiritual consequences. Fear of hospitals and most of all, a fear of losing control. Something that’s easy to remember that you can say is, “I know you’re angry. I would be angry too“. Empathy will take you a long way and help diffuse the situation. Whatever you do, don’t strike back with your own angry feelings.

Don’t get angry in return

Acknowledge their anger, relate to that anger, and then try to find out if they want to talk about it. “Is there anything you want to talk about?” or “What’s your greatest concern right now at this moment?” are ways of breaking the ice, but be ready for them to shut you down and stop the conversation. Be ok with that as an outcome.

Find the answers to “why”?

As a volunteer End of Life Doula, I believe that the kindest thing one can do is help someone find meaning as they leave this world. Many times, people struggle with the question, “why was I even born?“. The end of life came sooner than they expected it to, even if they are in their 90s. There is never enough time, and people forget all the things they’ve accomplished in their lifetime, or they minimize their impact on this world.

Remind them of what they’ve done

Telling your mother that she carried you for 9 months, painfully brought you into this world, changed your pants, felt your forehead for fever at 2 am, and taught you everything you know about being a human from how to hold a spoon to how to interview for a job, gives her the realization that she made an impact on you. Her life had meaning, simply because you exist.

When my dad lay on his deathbed, he knew he had a matter of hours left. He asked me if I thought his life had mattered. I was shocked. A WWII combat vet, loving son, faithful husband, great dad, self-made successful businessman, and yet, on his death bed, he wasn’t sure. As he took his last breath, I reminded him, “You served your family, you served your community, you served your country, and you served the God you believed in. Job well done“.

Meaning. It’s so vital to the dying process.

Don’t shy away from the experience

Don’t be afraid to talk about it. They know they’re dying. They might even feel bad about it. When I asked my mama if there was anything she was worried about, my mama said, “I don’t want to leave your father in the lurch“. I couldn’t believe what I was hearing. She felt guilty that she was dying! If I hadn’t asked the question, I never would have known what she was worried about. I was able to assure her and give her my word that I would personally take care of him, and he’d be sad, but he’d be ok.

Hospice gives us some great ways to talk to those who are dying, and I’d like to share several with you.

Say thank you

  • Thank you for all the days you’ve made brighter just by being you. There have been more of them than I can count.”
  • Thinking of the good life you’ve lived, the great times we’ve shared, and feeling so grateful for you.
  • You’ve been such an important part of my life, and for that, I’ll always be grateful.”
  • I so admire the warm, funny, genuine person you are. My life will forever be better because you’ve been part of it.”
  • I wish we could have more time together, but I want you to know I cherish the times we have had and the time we still have.
  • Thanks for being the one and only you and for being a blessing to so many people—especially me.
  • I’ve been beyond lucky to know you. Thank you.”
  • You’ve been the best dad. Thank you.”

Say I love you

  • I love you so much, Mom.”
  • Hoping you’re having a good day and sending you my love…
  • I love you. Thank you for loving me, too.”
  • It hurts to let you go, but I wouldn’t trade one moment of all we’ve shared. I love you with all my heart.”

Note: When I would tell my mama I loved her, I would also add, “and I know you love me too” because she was too weak to speak at the very end. I could see the relief in her eyes when I said I knew she loved me.

We will be ok

  • You’ve taken such good care of all of us for so long. We’ll miss that, and we’ll miss you, but we’ll be all right. We’ll find ways to take care of each other.”
  • One thing I want to make sure you know is that I will honor you in taking care of the kids and doing the same things for them that you would have done.
  • I hope it eases your mind a little to know Spot is going to make his new forever home with Kathy and Tom. They’re happy to have him, and they promise to love him just like you do.”
  • Of course, I’m going to miss you like crazy, but you don’t need to worry about me. I’ll be okay.”
  • Maybe we’re not exactly okay right now, but in time, we will be. Luckily, we’ve got a lot of caring people around us to help us through after you’ve gone.”
  • I hope you’re not worried about anyone or anything right now. I hope you simply feel surrounded by love.

Note: My daughter told my mama, “we’ll be ok gram, because you raised three strong women and one of them raised me“.

What we leave behind…

  • I hope you’re proud of the amazing family you’ve raised. Thanks for putting some good humans into the world.”
  • You’re someone who has used your life to touch so many others. I’ll always feel incredibly lucky that mine was one of them.”
  • You’ve shaped our community in ways that will live on beyond you, so thank you.”
  • You’ve done so many good things in life—for your family, for your church, in your career, and for all of us who care about you. I hope you feel great about the difference you’ve made.
  • Just so you know, we’ll be pouring an extra glass for you at wine book club. You’ve been the heart and soul of our crew, and we plan to keep it going in your honor.”
  • I wish my kids were old enough to know you better, but don’t worry. They’re going to know all your funny stories and weird traditions. They’ll know their Papa Frank is a huge part of what makes our family so great.”
  • A friend like you doesn’t come along very often. You made so many tough times easier and the best times even better. I hold every memory we’ve made together close to my heart.

What to avoid saying

  • “I’m still hoping/praying for a miracle.” Of course, you can keep praying on your own. But when you’re communicating with someone in hospice, be accepting of the fact that they’ve moved past this point.
  • Keep fighting.” Be respectful of their decision to stop fighting.
  • Everything happens for a reason.” This unintentionally implies that the person must have done something wrong to deserve to die.
  • This is God’s plan/will.” Even people of faith are sometimes angry at the end of life, and likely to struggle with this idea. Telling them that you’re praying for peace and comfort would be a better way to go.
  • You look great!” Unless they do, but they probably don’t, and they probably know it. Just be real with them.

Last thought

Don’t avoid talking about their last wishes. We recently had to put a family member on hospice, and I asked her if there was anything she was concerned or worried about. She wanted to know what we were going to do with her body. That is a very typical question that won’t get asked unless you open the door for the conversation.

Give them back control of their process

It’s at this point, that you hand the control back to the patient and say, “well, what would you like us to do with your body?” If they say they don’t know, talk about their options, such as leaving their body to science, cremation, formal burial, or natural burial using a shroud instead of a casket. She made her choice: cremation, and even told us where to put her ashes.

Reminder

If you remember nothing else, remember this: it’s not about you. Keep the conversation patient-centered and ask questions as opposed to making statements. Follow their lead, wherever they take the conversation, and rest assured that you are helping them to find meaning in an otherwise meaningless experience.

And as for yourself, be sure and take good care. Dying is an extremely stressful business and you can’t give what you don’t have. If you get good support, then you can in turn offer good support. Having folks to talk to outside of the immediate family is so important.

I hope this blog helps. If you have any questions that I didn’t cover, be sure and leave me a comment and I’ll do my best to answer them.

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As always, this blog is not a replacement for sound medical advice. I am not a doctor. Please make an appointment to see your healthcare provider and put a good plan in place that works for you and the needs of your body.

That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.

Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!

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