Strange as it sounds, the terminal diagnosis is often the "easy" part. After the diagnosis comes breaking the news to friends and family, dealing with colleagues and neighbors, finding new ways to speak about the unspeakable.
"Somehow it seems a little unfair," says one 55-year-old woman suffering from metastasized breast cancer. "I weigh my words to avoid burdening my friends, and they stay away because they think they don't know what words to use."
Don't let a concern for saying the "wrong thing" keep you away from a friend or loved one who's facing death. The best solution is often to say nothing at all, simply to be present. Or, if you are a close friend, to say, "I love you" and let it go at that. "I love you," according to the woman above, "is sort of a generic OK expression in the case of those who are dying."
Simple expressions of concern are what most of us, living or dying, welcome, especially if the expression comes from a good listener. Critical to talking with someone who is dying is practicing the art of listening: be present and wait; or ask a question and wait. Try to avoid offering instant solutions or pleasantries, instead saying, "That must be awful/gratifying/painful/frustrating/wonderful," or whatever single word fits.
One man uses this effective greeting with a close friend who is dying, pausing quietly between phrases: "How are you doing physically?"... "How are you doing emotionally?"... "How are you doing spiritually?"
"It's important to differentiate between 'spiritual' and 'religious'," says Sara, another woman in her fifties with cancer now defying intervention. "People willing to share their thoughts on the possibilities of something more than this mortal life have been really helpful to me. But I know others who want to dump their own religious certainties on me and that can be terribly offensive." The "just listen" admonition may be particularly appropriate here.
Joan, a non-observant Jew, also facing terminal cancer, feels strongly that this life is all there is. "I am perfectly comfortable with the belief that the end is the end," she says. "Others may need to believe in something more, and that's fine. I don't think I need to 'find God' right now--although perhaps I'll change my mind at the eleventh hour."
I have not talked with Joan about things spiritual since that brief exchange. What we talk about instead is the day at hand. If she is able to walk around the block, we rejoice over flowering shrubs or laugh at particularly homely-looking dogs being walked by matching owners. If a new manifestation of her disease is especially terrible (Black tongue today? Yick. Would cold carrot-and-apple soup taste good?), I try to listen to how it must feel.
Or we talk about small successes past. Recognizing and acknowledging the impact for good that one leaves behind, thanks to some deed or interaction, can be a comfort in the waning days of life. (Do you remember the time...? I was just thinking about ...")
With casual friends, neighbors and colleagues, questions, sincerely meant and sincerely asked, are often welcome and useful . The traditional "How are you?" can evoke the traditional "Fine" and end the exchange. (Which is sometimes all that's intended.) But a thoughtful question--"Do you want to talk about..". or "Will you help me find a way to be useful to you?" can establish a small connection on which other connections can be built.
One woman in her sixties tells me she is grateful to have had few bad reactions to the chemotherapy that is buying her a few extra months, and to have very little pain.
"But when someone asks if I'm in pain and I tell them 'no,' they assume I'm fine--or getting better. I'm not fine and I'm not getting better. I just don't happen to be in pain." Her wish is that friends could rejoice with her about that particular moment without expanding it to unrealistic degrees. Enjoying the moment is something you learn when moments are quickly disappearing; it's also a gift the dying make to the living.
Joan, undergoing chemo while keeping her high-level executive job, found subtle differences in her colleagues' tone and words often brought unexpected comfort or distress. "It's funny how small, insignificant details can loom large," she says. "I was happy to hear things at work like 'I don't know what we will ever do without you.' But I was infuriated one day when someone said, 'How are we going to run this department when you're not here?' Like--Do I care?!"
Sara found her spirits suddenly lifted, though, when a co-worker she barely knew came up to her and said, softly but emphatically, "I hate the news about your health." "It was as if she were offering to fight alongside me," Sara says; "and she didn't even have to say the C-word out loud."
Here are some easy words to say out loud: I'm sorry. I want to help if I can. You're a wonderful friend. I love you.