How To Help A Friend With Only Days To Live

We all will probably face this someday with a family member or friend.

(a short collection of articles on the subject)

I assume being a good listener is important, but is there anything helpful that I should say?

Signed,
Hoping to Help

Dear Hoping,

For purposes of my response, I’m going to assume this is a close friend, not simply an acquaintance. If your relationship is weak, they may find stress rather than comfort in your presumption of intimacy. But if they feel safe with you, if you’ve earned their trust, you should assume nothing less than that. This is when true friends show up. Here are some thoughts about how to show up.

First, you ask: Can you say anything useful? I don’t know. But what I do know is that they probably want your companionship more than your advice. They are unlikely to want someone who attempts to beguile them from their obvious predicament with magical homilies. Don’t pressure yourself by assuming you need to fix something. What they will want most from you is for you to sit with them in their predicament. Experience it with them. Love them in it.

Second, my experience is that in situations like this, we fault more often on being too tentative than on being too intrusive. It is often the case that more intimate is more appropriate. We often act as though we believe not talking about the fire-breathing dragon in the room is safer/kinder/better than taking a person’s hand, sitting beside them, and staring at the dragon together.

Third, spend less time telling them how you feel about their impending death and more time asking them how they feel. Ask about their beliefs. Ask about fears. Ask about regrets. Ask about their legacy. Ask about their proudest life moments. These are perspective questions—ones that invite connection around larger issues of life. Beginnings and endings are moments of perspective. These are the kinds of thoughts that are naturally occurring to them anyway. So, go there with them. If they inquire, feel free to share your perspective on these questions, but don’t cross the line into coercion. Never take advantage of your psychological advantage of being the healthy one to impose your nostrums.

Finally, relieve their stress. My father taught me once that stress is like arithmetic. Everyone has a certain tolerance threshold. Mine might be 40. Yours might be 45. But we all have a number. The amount of stress we feel at any time is equal to the sum of all the stressors acting on us. Some might be 3s (I have a chip in my windshield that might spread). Some are 5s (my water heater is leaking now). And some are 10s (I’m dying). Thinking about stress this way helps point out two things:

Everyone has a tolerance limit. Everyone begins to crumble when the sum of all their current stressors exceeds their tolerance limit. Everyone. Even if your tolerance level is 327. If your stress sum is 600, you will break down.
You don’t have to remove the big stressors to help someone get below their limit. If your friend is dying, you can’t fix that. You can’t take away the 10. You may not even be able to do much with their 9s and 8s. But if you take away enough 2s, 3s and 4s, you might help them get back to manageability.

Once I learned this, it changed the way I talk with loved ones who are suffering. I no longer make vague offers like, “Please let me know if there is anything I can do to help.” This is a worthless offer. Basically, it says, “Here’s one more thing for you to think about—think about helping me feel helpful!”

Instead, I teach them about the arithmetic of stress, then I hand them a pen and paper, and I say, “Write down EVERYTHING that’s on your stress list right now.” I sit with them and encourage them to work all the way down to the nit-picky 1s and 2s. When the list seems complete, I go to work. I don’t ask for permission. I take charge of all the fixable things on the list.

I hope these ideas help. And I hope the sacred last moments you share with your friend are filled with the real intimacy.

Ask people, ‘What’s the worst part of this for you?’ Don’t be afraid to ask that question.”

In Cottle’s practice, she’s witnessed how answering these questions can be therapeutic for those facing the end of life. When you’re unsure what to say to someone who is dying, consider asking the “magic question” or similar questions. Invite the person to reflect on their lives. Give the person a chance to define the legacy they’re leaving behind. These questions will often allow the person to process their circumstances in a dignifying way. When did you feel most alive?
Looking back, what were some of your favorite roles that you played in your life?
What are some things you want your family to know or remember about you?
Tell me, what are your wishes for your family or loved ones?

“When you talk to people about their life, you allow them not to be a naked patient in a gown, but a mother, business executive, or whatever their role is. This is much more satisfactory than if you are just treated like a number in a room.”

We hear all the time from CaringBridge users that the only ‘wrong’ thing to say is nothing at all,” says Ojala. “And that happens more often than you might think,” she adds. “Even the nicest, kindest, most loving people in the world sometimes ignore or don’t know how to face the elephant in the room. A simple ‘I love you’ or ‘I’m thinking of you’ if you’re not sure what else to say, is probably just the right touch,” stresses Ojala. If you’re really stumped about what to say, it’s OK not to address the illness directly, but “ask what you can do and to make sure the person knows you’re there and available,” says Kimberly Borzym, a chaplain at Advocate Hospice in Chicago.

Do make clear that you’ll be there for them

“So many ‘friends’ disappear when one has a terminal illness,” says Maxey. “I guess death brings the idea of their own mortality uncomfortably close.” Maxey, who now lives in Nicaragua, says her current community is a lifeline because they follow through. “A funny card or email, a meal, picking up meds or coming over one day to wash our clothes, clean our kitchen or bathroom; that all means the world,” she says. Her advice for helping someone in her position? “Don’t just tell us to call if we need help. Chances are we won’t ask, not wanting to be a burden. Help us without waiting to be asked. Believe me, it will be appreciated, both for the help and for the fact of not being forgotten.”

When having a conversation with a sick friend, it’s important that you have the mindset that you’ll sit and be present. “Ask how they are doing, and then really listen to them without pulling away, either physically or emotionally,” says Nancy Molitor, a professor of psychology at the Feinberg School of Medicine at Northwestern University in Chicago. That means making eye contact, physically leaning in toward them, and being prepared to stay focused even when you’re hearing about more detail than you might want. You should also resist the urge to begin talking if there’s a moment or more of silence. “It gives the impression that you’re nervous and anxious and feel the need to fill the void,” notes Molitor. Remember, in some situations, silence is golden. Your friend or loved one may feel comfort just being in the same room with you, knowing you are there for them.

You might find yourself wondering “What do I say?” and “How will I know when I’ve said enough?” There are some common beliefs about talking to the death that has the potential to prevent us from talking at all. Here is a look at some of the misconceptions about talking to a dying loved one.

Talking about death allows a loved one to express unspoken fears and concerns. Oftentimes, sharing these feelings with someone who listens fully and without distress can help reduce pent-up anxieties.

Let compassion guide the conversation, remembering this is not about you. This doesn’t mean you can’t share your feelings; just be sure those feelings don’t add to a loved one’s burdens (like whether or not you’ll be able to cope once they die).

Silence is stressful for everyone.”

Chances are, if you believe this, you will simply talk and talk to avoid silence, littering the air with words that don’t mean anything. Some people will even use the fear of awkwardness to avoid seeing a dying friend. (“I don’t know what to say.”)

What’s more important in these instances is not trying to find something profound or moving to say (which will generally sound false) but just being there. In fact, the one thing better than being a talker is being a listener.

There are things you can do to encourage conversation. Sit at the same level as your loved one with no barriers between you. Lean forward and give them your full attention without folding your arms or fidgeting. In short, be there.

It’s also important to know that not all silence needs to be awkward. A calming physical presence is often all a dying person needs or wants.

“Talking about death will make things worse.”

Some people believe that talking about death will make it happen sooner. They may think that discussing death will stress the dying person and could bring about a heart attack or stroke. They may also fear that if the dying person accepts their own death that they will give up and die sooner

This belief is entirely unfounded. It harkens back to the days when doctors used to tell family members not to reveal a terminal diagnosis to an elderly parent, spouse, or grandparent. (“Knowing will kill them!”)

While talking about death can be stressful, it can also be therapeutic and healing for everyone involved. Of course, not everyone will want to talk about death or dying. That’s okay, too.

Talking about death will cause upset.”

It’s a common belief that talking about someone’s illness or impending death will only upset them. Many people are surprised to find that a dying person wants to talk about what’s happening to them. In fact, many dying people are thinking the same thing: that talking about what’s happening to them will only upset a friend or loved one.

“Talking about everyday things is hurtful.”

This belief prevents many people from discussing the day to day aspects of our lives. We may think that talking about the playoff game or our favorite television show will make it seem like we don’t care about what’s happening to our loved one. We might think that he can’t possibly be interested in the news or even in what happened to us at work today.

The truth is, most dying people are still interested in the same things they were interested in before they knew they were dying. If they are an avid sports fan, that’s not necessarily going to go away. There is every chance that your loved one will want to hear about what’s happening in your life, just as he did before.

Talking about everyday things helps affirm that, while life may be limited, your loved one is still alive and a part of your life.