Monday, April 13, 2009

What to say to the dying

What to say to the dying
Apr 13, 2009
The Straits Times

How to begin the conversation

Ask how treatments are going, for example: "What does your doctor plan on doing next?"

If the answer reflects an optimism regarding a cure that seems unlikely, given what you know of the person's condition, let the matter rest, at least for a while.

How to keep it going

A lot of important questions can be asked without challenging the dying person's optimism. If, for instance, he or she responds to an open-ended "How are you doing?" by reporting that "Dr Chan says the tests all look better," you might say something like: "Do you mean there's hope to really beat this thing?"

The person's response will likely clarify whether he/she has avoided talking about not getting well to protect you, or if he/she is too focused on the cure and is at present emotionally unable to consider the alternative.

Another gentle way to follow up is to inquire about events in the future, such as where and how a person wants to celebrate a birthday, Christmas or other holiday, or if he/she is still planning a trip which had been previously mentioned.

Listen closely

Listen for discouraged or exasperated comments along the lines of "I don't know why I'm going through all this!" or "I wish this would all be over with."

These statements should be recognised as openings to important conversation. Dismissing such remarks ("Oh, you don't really mean that") or covering them over with simplistic reassurances ("You're going to get better, I just know it") effectively closes conversation and isolates the person in despair.

If the dying person provides an opening, consider stating the obvious: "What you're going through sounds awful," and let him or her know you can listen: "I would love to hear how you're really doing."

In asking the hard questions, of course, you or your family must be willing to hear hard answers. Often, what people need most is for someone they love to simply listen.

Don't romanticise death and dying

Being ill, and deteriorating, can be tough. It is not sailing off into the sunset. As director Woody Allen said: "It's not that I'm afraid to die. I just don't want to be there when it happens." And 16th century scholar Michel de Montaigne wrote: "It is not death, but dying, that alarms me."

Be honest and say that dying is tough, it's okay to be afraid, angry or upset, but maintain that there's help.

Take care to avoid pushing your own agenda

However, it is almost always okay to say how you feel. "I love you so much and I'm scared of losing you" is a very direct statement that, nevertheless, respects personal boundaries.

Tips from well-known palliative care expert, Professor Ira Byock, director of Palliative Medicine, Dartmouth- Hitchcock Medical Centre in New Hampshire, United States, and Dr Noreen Chan, senior consultant of the National University Cancer Institute, Singapore.

What to avoid when talking to a cancer patient

Tips from breast cancer patient Shin Na, who died in January.

  1. Don't tell them stories about people you know who've had cancer and died.
  2. Don't tell them about miracle cures and say they must try them.
  3. Don't tell them God will heal them. God didn't promise he's going to heal anyone.
  4. Don't accuse them of giving up if they don't try whatever crazy concoctions or exotic alternative therapies you've discovered on the Internet.

Keep in mind that cancer patients go through phases. When I was first diagnosed, I was angered by people referring to chemotherapy as "toxic poison". I didn't want to hear that the drugs they were putting into my body were toxic and poisonous.

But now I realise I was being overly sensitive. Chemo is toxic. It is poisonous. But I wouldn't say that to a newly diagnosed cancer patient. It sounds too scary.

If someone had asked me how long I had to live just after I was diagnosed, I might have been offended. Now, I have no problem with that question. Some people just don't want to talk about their cancer. Some want to talk about it all the time. If you're unsure, ask them: "Do you want to talk about it, or would you rather talk about something else?"

This article was first published in The Straits Times.

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