How do I find the right words in the face of illness and death??
Dealing with death paralyzes many people. What to say? What if one reacts the wrong way?? Our author Petra Gotthardt has worked for years as a volunteer death companion in a palliative care unit and explains to you how to find a more mindful approach to death with open and gentle questions.
Sitting there searching for the right words: a patient bursts into tears. She received a cancer diagnosis two days ago. Unexpectedly, a colleague (cancer patient) reports on yesterday's check-up. New metastases have been found. What should I say?
Many are paralyzed by the fear of reacting wrongly. People from the environment avoid the conversation, evade on WhatsApp messages or letters. They may also withdraw. At the same time, they feel they are not doing justice to the situation in this way. How to deal with the ie as a therapist:in?
Openness and careful questions are the basis of a mindful accompaniment of the seriously ill and the dying. This was not easy for me, even after years of voluntary end-of-life care in the palliative care unit. However, some aids to ease the way into these difficult conversations helped me over time.
A patient bursts into tears. She received a cancer diagnosis two days ago. What should a therapist say?? (Photo: Marjan Apostolovic – Getty Images)
At the time of diagnosis, the course of the disease is uncertain. There is not yet a well-founded prognosis, many examinations are imminent. Patients and their relatives need courage and confidence for the upcoming therapies. Taking an "observer position" allows me not to get emotionally entangled: When does my compassion overboard? When it gets in the way of an open exchange? Can it be that my own fears and horror about the diagnosis contribute to make the situation more difficult for the person concerned?? These questions help me to regain my composure and to shape the conversation in a way that is good for the person concerned. So I can also avoid rushing in with hasty consolation and thereby not recognizing the real needs of others. I have made the experience that this reflection leads to a pleasant slowing down of the conversation.
I listen, fight my urge to give advice, and briefly summarize what I have heard: "So you are about to have this operation?", "In the next few days there will be further examinations?", "The doctor says that there are many chances to cope with the illness?", "How can I support you in what lies ahead??", "What do you want from me now??".
This framework of questions helps the patient:s and me to. We can take hold of each other, take time to be close to each other and discuss what is really important now.
To use the time and be completely with the other person
It is hard to bear witness to the fact that the strength is slowly fading and the complaints are increasing. Conversations now require a certain humility. What is meant here is the acceptance of the inevitable. The humble look I direct into my inner mirror should lead to this,
– to put your own importance behind, – to take a step back yourself, – to face the situation respectfully.
Imagine that a patient unexpectedly says at an appointment: "I don't think I have much longer". Your reference to the fact that this is not at all clear and that there are certainly still many therapy possibilities could be out of place now. On the other hand, the question "What is important to you for the time you have left??" to open new perspectives.
Instead of denying the death, the question "What is important to you for the time you will have left??" Open up new perspectives to the ill person. Advice like "You need to eat more now. Drinking!" or "Tomorrow the world will surely look different" often slip out of our mouths." or "Tomorrow the world will surely look different" often slip out of our mouths. After all, it is unbearable for us to realize that it is slowly coming to the end. We want to do everything to make the other person feel a little better, to get back on his feet. But let's be honest: Do we really have the right to become the "know-it-all" helper in this existential situation?? In the end, we do not know how it feels when life is coming to an end.
The following image helps me: The disease – the further it progresses – shifts like a solar eclipse in front of the personality of the person with the disease. It is becoming more and more important, there is hardly any talk about anything else. Is this the right way?
In contact with a dear friend, I noticed that when I talked to her, I asked more and more often about the symptoms, the course of therapy or the last conversation with the doctor. The view of the personality of my friend was reduced by it. She lost the chance to focus on other important topics during my visit. If we are aware of this "trap", we can redirect the conversation to other topics. A space opens up in which previously unsaid things have a place. I make it clear to myself: this is my friend speaking, who has only a short time of life ahead of her and to whom all the time in the world should belong right now. This situation differs considerably from conversations in which time still seems infinite. "What would we like to discuss now?" "What is this meeting inviting us to do??"What would you like to report today, what would be a nice topic of conversation for you??"What do you want from this visit??"This is what it should be about – as long as the strength is still there.
I may say that I am helpless.
To give succor
Two years ago, I was sitting at the bedside of a dying man who squeezed my hand tightly, wouldn't let go, and kept murmuring the same sentence: "Why is it so hard? Tell me: Why is it so hard?"Not to be evasive now, but to provide real support, is probably the biggest challenge. Provided that I have the strength to do so at this moment. What could help now?
Simply be there and take your time with an answer. I've given myself permission to be honest now. I may say that I am helpless. Have the strength to be open and attentive at this so important moment: "It's so hard for you… I'll stay with you" This rejoinder may open an opportunity to ease the despair and fear a little together. Be it just to be silent together.
On the other hand, it may also be that the dying person does not allow a conversation about parting and dying until the very end. He/she also does not find conciliatory or loving words and does not respond to gentle attempts to talk about death. It is then a matter of enduring silence and not imposing further conversation.
Having someone who is simply there is already a great support for many affected people. One patient in the palliative care unit told me noticeably relieved. Smiling softly: "You know? I really had to raise my daughters to the end of my life. I really had to raise my daughters to the end of my life. They are now 45 and 48 years old and have not yet accepted that I will die soon. Today, however, I made it clear to them that it will soon be over and that they should please let me go – it was quite difficult to get them to do it… now it's done."
So I learned: sometimes it is appropriate to tell the person who is dying, "You may go, we'll be fine, I can let go when the time comes." As unspeakably difficult as it is.
For further reading:
Borasio, G.D. (2016). Dying with self-determination – what it means, what prevents us from doing it, how we can achieve it. Munich: C.H. Beck Publishers.
Bauer, C.J. & Weis, T. (2014). It feels so good to talk to you – encounters with dying people. Berlin: be.BRA PUBLISHER.
Thich Naht Hanh (2014). Talking mindfully. Listening attentively – The art of conscious communication. Frankfurt: O.W.