How do you comfort someone with a terminal illness? Is optimism appropriate? Should you hold back tears? What sort of help is actually … helpful?
It depends on the person and the situation. There’s no universally correct thing to say during such a trying time. There are only attempts to be compassionate and empathetic, and to express your love and support. No matter how carefully you choose your words, they’re not going to come out perfectly every time. That’s OK. Move on, says Constanza Roeder, the founder and president of Hearts Need Art, an organization providing creative support for adults with cancer. “Keep showing up to let that person know you’re there for them,” she advises. “There is grace to be found in those types of interactions, which can highlight a type of love that transcends even death.”
Here are some pointers, courtesy of Roeder and other end-of-life experts, on comforting someone near the end.
Help them accept the reality of loss
As death becomes more of a personal reality, a loved one’s role isn’t to offer assurance that things will be alright, says Dr. Terri Daniel, an end-of-life educator. It’s to be present when things aren’t alright.
Professionals in end-of-life matters, such as chaplains, counselors, social workers and nurses, don’t provide comfort per se, “other than medication for addressing physical pain,” says Daniel, who founded the Afterlife Awareness Conference. Instead, what’s important is helping both patient and their family deal with the loss. ”The fact is that we cannot take a patient’s emotional or spiritual pain away,” Daniel adds. “In a healthy relationship with suffering, we shift from wanting to relieve it to wanting to work with it.”
Confronting mortality comes with what Daniel calls psychospiritual pain, which revolves around concepts such as faith, reason and guilt. This type of pain, she says, “is not something to be dismissed or denied. It is full of value, and if we ignore that value, we are doing a disservice to that person’s life.
Check your self-awareness
In order to be fully present in your interactions with a terminal patient, you need to have high self-awareness, says Roeder. The work she does reminds patients that they are, in fact, alive, human and loved during a time when medical charts, beeping machines and the sometimes frigid nature of medical treatment can leave them feeling isolated and alone.
“Our subconscious is trying to dispel our own discomfort,” says Roeder, a cancer survivor herself. Before you offer advice or even condolences, she recommends taking a beat to evaluate how you feel and whether you’re projecting your own feelings onto your loved one. “If you deny how you feel, those painful thoughts and feelings will fester, and will ultimately affect your behavior in a negative way,” she says.
The mundane stuff matters
Every major life milestone, including death, comes with to-do lists. Helping someone get their affairs in order might seem like a waste of whatever time you have left with them, but it’s not a meaningless experience to them. Andrew Taylor, a lawyer in the UK, says the process of completing legal work can help terminal patients internalize that they’ll be remembered.
“People want to have their voice heard, as they fear their story is lost once they are gone,” he says. “They want to know that they have expressed themselves fully and completely.”
This is important outside of a legal context as well. Roeder recalls a situation in which a dying patient was worried about leaving her son, but couldn’t find anyone in her family or her church community willing to talk through her practical concerns.
“No one was willing to face the terrifying reality that this might be the end,” she says. “Instead, they responded with, ‘You beat cancer once. You can do it again.’ Their discomfort with the harsh reality of her situation drove disconnection and left her to face the scariest time of her life alone.”
Explore and celebrate the patient’s life
Yocheved Golani, a life coach certified in spiritual chaplaincy and end-of-life issues, says the end of a person’s life is a time of intense reflection.
“Dying people tend to experience what’s called a ‘life review,” he says. “They will assess and reassess their experiences, life lessons and missed opportunities. Let them. Life reviews are the combination of a call for help and an emotional settling of affairs.”
To facilitate this process, Golani advises making eye contact, holding their hand and providing soothing reassurance through open conversation. “Follow the lead of the person before you,” he says. “Listen to them carefully. They might repeat particular phrases, speak of specific incidents and call out for people important to them. Acknowledge that, and ask them to tell you more.
“Use your own words to ask, ‘What do you want to say? What’s on your mind?’” he adds. “Ask about fond memories, and the goals that the person achieved. Focus on the positive aspects of their life. This act of reminiscing can be very empowering, as the person can bask in the satisfaction of self-respect, memories of happiness and of anything especially important to them.”
Begin here
Once you start talking, you’ll come up with words that make sense for that person and your relationship with them. But if you need help getting the conversation started, here’s some advice on what to say and what to think twice about. These aren’t hard and fast rules, just suggestions to get things going.
Words to borrow:
- “I remember … ” Roeder isn’t a fan of canned sentiments, but she agrees that it’s meaningful at the end of life to know the effect you’ve had on those around you. “Share cherished memories, and what you admire about them,” she says. “Most people share these types of reflections at funerals. But why wait? Communicate how your loved one or acquaintance added value to your life now.”
- “Tell me how you feel” or “Where are you, emotionally?” Make it clear you’re there to listen and talk about whatever’s on their mind. Acknowledge their specific concerns, desires and questions.
Words to reconsider:
- Roeder suggests reframing any statements that start with the phrase “at least.” You may think it’s a nudge to look on the bright side, but it’s really a reminder that you have no idea what the patient is experiencing.
- You might instinctively want to say that everything is going to be OK. But resist the impulse to offer words of assurance or spit off platitudes. Even though they’re usually spoken with the best intentions, they can still come off as dismissive.