3 tools to start the end of life conversation

Most people wish that they knew what to say and do, and how to be when approaching dying, death and grief.

Because we’re uncomfortable and unprepared for end-of-life encounters, we either stay away, say and do things that don’t help; or act in ways that are neither becoming nor helpful to the people about whom we care.

What if you did know what to say, what to do and how to be in end-of-life encounters?

Use these three tools to start a conversation with someone, to learn what to do and how to be when approaching death.

The first tool is easy to use. All you need to do is ask question,“What is most important to you right now?”

If you want to add something to that, then say, “I’m sorry.”

After those few words you need only to listen quietly. Listen for their answer because it will tell you what to do, or how to help. Frankly, simply listening will help.

Answers about what is most important may vary from needing sleep or a walk to needing someone to weed the garden, needing relief from pain and symptoms or needing to say something to someone.

The second tool is also easy to use. While we seem to be specialists at getting busy doing something, doing anything; that is often an avoiding response, and it may miss entirely what the person or family actually needs us to help them do.

A time ago there was a hospice volunteer coordinator in Beloit, Wisconsin, who taught her volunteers to “Do what needs doing.”

She wrote a poem about it.

You can find out what needs doing by asking, “If there was something you needed done, what would it be?”

Then either do it or get someone to do it, if it’s not something you can do.

Before my husband died, I stayed in the hospital with him for almost a week and then we were at home 7 days before he breathed his last. During all of those two weeks, our lower-level carpet was saturating with water as the summer rains fell long and hard, streaming down the hill to our valley home. There was no way that I could deal with that. But it had to be managed. So, I mentioned it on the care pages that we had running to update friends and family on Josh’s condition. Someone read that and before I knew it, Harry was down stairs, vacuuming up water, placing dehumidifiers and what ever else needed doing. He did it. To this day, I cannot say my gratitude in words for that and the other things our friend, Harry did.

Do what needs doing. Ask and do.

The third tool is about being. Be quiet and open-minded. Be present. Be available. Be willing to ask and hear and do.

Don’t anticipate what someone’s answer may be to the questions you pose. Just ask and listen and plan on doing if you can.

The best thing that happened to me after Josh died was the arrival of my lifelong friend Mary. She came over every day after her work. I don’t remember that we said at all. She was being-for me, completely for me. Those first days after his death, I waited the whole day alone in my empty house, anticipating Mary’s visit. She was my lifeline. Mary had other things to do with family, kids and a full time job. But she came to be-with me.

It’s really not difficult to ask someone what’s important to them, to ask them what needs doing or to be present for them with a quiet mind, a smile and a gentle touch. Try any one of those things or all three. You won’t begin to gauge the difference it will make in someone’s living and dying.

Virginia L. Seno is founder of the Esse Institute.

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  • Anonymous

    Simple and straightforward. We often spend to much time repairing the past and preventing the future. This excellent advice to be in the present. The worrisome and more difficult conversations often follow easily from this starting point. Great advice.

  • http://www.healthcare-information-guide.com 2dougmac

    This presents a jumping-off point which anyone, professional or lay-person, to start a discussion. 

    Come to think of it, this could apply to a number of situations of dis-ease. Brilliant.

  • Jasdeep Mann

    Breaking the ice is really hard. It is quite daunting to be in a situation where someones world is coming to an end and every word that you utter reflects on you (this is what we perceive) but in reality it is the human touch and presence that make a big difference to the family of dying and the dying person. Apart from being there if we can do something that would really help the family-nothing like it. very helpful indeed.

  • Anonymous

    It is really very, very easy to talk with a terminally ill person.  Talking with a terminally ill person is not the same as “end of life conversation”–that is talking to someone that medical necessities are being withheld or someone that is about to be cold blooded murdered!!   Now, about talking with someone who is terminally ill and having already asked about their comforts–the next question you want to ask is “Do you know what will happen to you after you die?”  Believe me, that is already on their minds!!!!  That leads directly to “Are you ready to meet the Creator of all life?”  From there it is either they will talk with you or they will have you thrown out, in which case, it is best that shake the dust from your feet, and leave.

    • Anonymous

       Perhaps it’s better not to attend at all with that question, 7citizen7. Interesting point of view but not advice I can recommend. In fact, the comment is so laden with inappropriate advice and assumptions that I have to outright deny it. Hopefully readers pick that up on their own.

      • 7citizen7

         I am taking it from several non-Chrisitans that I have known that, after being told they were terminally ill, have given their lives to the Lord simply because someone chose to share the Gospel with them.  That is the most important decision of anyone’s life–how, where  and when they die are not important–only what will happen to their spirit after they die because that is for all eternity.   Other Christians that I have known that were terminally ill were the happiest people, knowing they were soon going home to be with their Lord Jesus Christ.  Comfort to a dying person is more than just physical comfort.

        • drseno

          7c7, I’m sure this is true for some, not all. It seems you really believe what you think is true. Good. It’s true for you. Most people believe what they think is true. No one denies you thinking what you do. Be careful not to misinterpret the meaning and usefulness of my post just because it didn’t include what you believe is important. Just let it be, in other words.

          • laydzi

            Yes that is true everybody has a right to believe in what they believe , but let us not us not lose focus on what is the imperative topic here by complicating it further we all need the simple rightful and understandable moral ways to deal with it.

          • drseno

            As the author of this article, it’s important to me that we not lose it’s meaning and usefulness via arguments gone awry. There is nothing in what I’ve written that misses the point or the focus (an it’s a critical one) of helping people know how to talk about dying and death. It’s *my* point. What is yours? So, please take responsibility to make your comments relevant. How could it get any better than that?

          • Ryan Vick

            I agree with 7citizen7. “chance for salvation”. if the dying person becomes angry, that is a risk you have to take, we christians must share the good news. notice I did not say cram it down your throat. “given their lives to the Lord simply because someone chose to share the Gospel with them.” amen! we must perpetuate that. if nobody discusses religion…. well maybe we should WAIT until asked about it, but I don’t think a brief mention hurts.

    • http://twitter.com/serratiasue Debra Paron

      7c7, at the end of life, we must support the dying person and family, not use their vulnerability as leverage to foist our own belief systems on them.  The Platinum Rule applies here–treat others as *they* wish to be treated.  To find that out you need to ask with sincerity and to listen.  If you are Christian and fell seriously ill in Saudi Arabia, would you want Muslim doctors and nurses trying to convert you to their religion?  Or would you want them to tend to you with compassion and respect for what you believe?

      • 7citizen7

         Who is trying to force (as the muslims do) religion??  I believe I stated that you ask a question and if they responded, okay.  If not, shake the dust from your feet and walk out.  I never said a word about forcing or trying to convert.  As a Christian, it is a command by Jesus to tell as many as are willing to listen about the good news of salvation.  If a person is terminally ill and not a Christian, have never understood the full meaning of being a Christian, you  may be the last chance for their salvation.  That is what I meant–chance for salvation–not browbeating them!!!!!!

        • laydzi

          I do not recommend “walking away” if you were there to help in the first place! you are there to try and remember the person in need of help can be agitated and angry because he/she is powerless so do not give op but try and understand.

  • Anonymous

    Last year i had just telephoned my friend to ask how she was,she told me she needed a phone card to call her family in Africa to check on her sick aunt, as I had one with me I promised to bring it asap, when i arrived she made a call and just froze with shock ! I quickly got hold of the phone and was told what happened ,aunty died, she was not talking nor crying , so i brought her a glass of water , hugged her and thats when she started crying out and I just kept on saying “i’m sorry” , which made a difference as she started to verbalise her hurt and regrets as i listened i was also comforting her until we were able to make that call again for  more details.

  • http://www.facebook.com/profile.php?id=1187539687 Larry Paoletti

    My blog (www.eol2die4.com) uses a characterless cartoon format to introduce issues surrounding end-of-life.  It may help facilitate a discussion on this subject that is often treated as taboo.  Check it out!

  • Anonymous

    When speaking with my dear friend, Ellen, on the phone for the last time, I told her “I love you” and she could, struggling for words, tell me that she loved me too. We talked about wonderful hikes in the Olympic and Cascade Mountains together, trips to 31 Flavors and other times when life was good and we were happy. I told her that she will always be in my heart and my children’s memories. We both cried, but were glad to have told each other that the love of friendship was real. This was one of the most meaningful conversations I have ever had. I miss her terribly.

  • Anonymous

     Cool, very cool. Larry.

  • Christopher King

    You might be interested in a fascinating happening in Santa Monica, CA. I was invited by a friend to attend the “Death and Dying Dinner Party”. It’s a monthly potluck at a hospice agency that is free to attend to simply have a conversation about death. They do have a Facebook group.

  • thedeathtalker

    Glad to see others are starting to think about this. I’ve been talking about end of life conversations for years in Australia as “The Deathtalker”  and have a range of resources available on my website  http://www.deathtalker.com including two books to help have these conversations with kids and young people, “Jelly Bean’s Secret” and “Sometimes Life Sucks” I encourage people wanting some guidance about how to start the conversation to check these out. Molly Carlile, Deathtalker.

  • matronlpainter

    This is excellent advice and a wonderful way to show you REALLY care.  Having attended many families in the Nursing Home I work at in Cape Town, South Africa, showing care in practical ways and attending to pain relief facilitates the opportunity to ask such meaningful questions when they are in a position to be able to answer these and tap into their own resources and check in should they need an introduction to the greatest one ever, i.e. Jesus Christ.  Settling the questions of “what possibly comes next” relieves much anxiety and opens the door to further opportunities to resolve fractured relationships and heal heart wounds.  Where this may not be possible, facilitating forgiveness and writing necessary letters as well as meaningful touch are all ways I have found to be supportive.  Creating a sensory memory for all concerned assits in a positive approach and gives those who feel the urge to “do something” meaningful ways of interracting when this information may not be able to be given by the person busy with dying.  Liz

  • drseno

     Thank you for these resources. It’s helpful to know about experts across the ocean, whose work we should incorporate into our own.

  • Ryan Vick

    My buddhist friend believes we carry with us into the afterlife whatever emotional/mental state we are in currently, at time of death. what better state of mind to be in (peace, happiness) than immediately after accepting Christ as our savior.

  • Ryan Vick

    [repost -- initial post was deleted?] my buddhist friend believes we take with us into the afterlife our current (at time of death) mental/emotional state. what better state of mind to be in (peace, happiness) than immediately after accepting Christ as our savior.

  • http://www.facebook.com/profile.php?id=100002466546997 Puja Roy

    thaks for know–any medecine info visit this site–http://rajroyngnmix.blogspot.com/

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