Chapter 3: Conversations as the disease progresses
Talking to the person who is dying
She began to sleep more and more; and when awake, she was often confused and irritable. I felt I was losing her slowly, day by day. Over and over, I was saying goodbye.
Knowing what to say to someone who is dying and when to say it can be difficult. The ideas on the next two pages may be useful at any point during a serious illness, but especially when the person is not expected to live more than a few weeks or days. Click on each suggestion for more information.
Feeling anxious is normal when talking about dying with someone who is nearing end of life, especially if the person is someone you love. Some people handle this anxiety by being clear and blunt. Others say little or nothing for fear they may appear to be giving up hope. One way or another, we tend to try to protect each other at this difficult time.
If you feel it is urgent to talk about end of life with the person who is dying, you may be impatient with conversation about ordinary things. Humour and laughter may be distracting. On the other hand, if you find talking about dying embarrassing or awkward, you may be relieved that the topic doesn’t come up. In either case, what is most important is what the dying person needs. Ultimately, they will choose if, when, and with whom to discuss dying. Listen for cues that the person is ready to talk about dying – for example, a passing comment about new symptoms, not being around for an upcoming event, being tired of being sick, or wanting to go home. When you think you hear such a cue, you might ask, “Do you want to say more about that?” or say, “I’m not sure I know what you mean.” Then listen and ask more questions to make sure you understand.
Some people who know they are dying avoid talking about it right up until the moments before death. It’s important to recognize that this is a valid choice and to respect it. More often, however, people who are dying feel respected and supported by openness and honesty in conversations. They may talk about symptoms such as pain, shortness of breath, or nausea. They may wonder what to expect when death is near. Rather than avoiding these concerns, acknowledge that they must be worrisome. You might say, “Tell me more about what you are experiencing,” or ask, “What do you think is happening?” You could add, “This would be important to discuss with your doctor. Can I help you make a list of questions for the doctor?”
Inviting the person to share information from the healthcare team can lead to open conversations about the progress of the illness and an opportunity to ask, “What do you need most from me (or from other friends and family members, or from the healthcare team) now?” If the person has difficulty answering this question, offer examples of the support you could provide – perhaps being present and listening, running errands for the family, or helping with housework.
Ask the person if there is anyone they would like to talk to by phone, via internet, or in person. This may include a visit from a religious leader in the person’s faith community, or the spiritual care provider in the hospital or hospice.