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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