Tough Conversations

Solutions Through Compassionate Communication.

Death Terms and Euphemisms

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From time to time, Tough Conversations will present articles by guest bloggers on topics of interest to our readers. M. Jane Markley, an expert on advance care planning, wonders why it’s so hard to talk about death:
Death Terms and Euphemisms

Have you ever noticed just how difficult it is for people to say the word “death” or “died”? You mostly hear the terms when something horrific has happened like an earthquake or a bombing but in day to day life it is rare. This is part of our culture of death avoidance. Just take a look at the obituaries. If we don’t say it, perhaps it won’t or didn’t happen. If you listen carefully you will hear many other phrases or words used but rarely “death”. [Read more…]

Talking to Grief – Part 2

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“What can we do to help?” friends asked me as my husband lay dying and soon after he passed. At first I didn’t know how to answer.Talking to Grief - Part 2

I was still feeling my way through early-stage grief, from the inside out. At first I didn’t know what I needed, but others sometimes recognized a need and offered specific help. Or just showed up with it. Sometimes my head was clear enough to ask. Sometimes not.

I previously wrote about helpful things to say to a person going through a loss (Talking to Grief). But it’s not all about words. Support comes in words and actions.

[Read more…]

Talking to Grief

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by Carolyn Miller Parr

Talking to GriefWhat can you say to the parent of a 17-year-old son who dove into a wave this summer and came up paraplegic? Or your 53-year-old family member who suddenly discovers he is riddled with cancer? Or “Sarah,” a church friend, who will soon celebrate her 56th wedding anniversary, holding her husband’s hand and watching his slow but unstoppable surrender to dementia and death?

Recently I have felt surrounded by grief. It knocks at my own door and I see it everywhere. I can smell it, touch it. Anyone who watched the Pope’s visit on TV saw plenty of it. He waded into it: immigrants, homeless people, prisoners, babies attached to oxygen. Francis knows how to speak to pain.
[Read more…]

You went to…a “Death Cafe”?

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Yep. Talking about death and dying can be a tough conversation. I recently visited a “Death Cafe” where a discussion about death and dying was frank and open.

But “fascinating” best describes the candor and compassion of the two-hour conversation.

The idea of a death café has intrigued me since learning about it a year ago. As an elder mediator helping families resolve disputes concerning an older parent or relative, I wanted to see how willing people are to talk about this often closeted topic. I was pleasantly surprised. The nine of us talked about dying and death, both personally and objectively.

Begun in England several years ago, death cafes are informal gatherings of individuals who talk about death and dying from all vantages. A hospice worker organized the first U.S. death café. Surprised by how willing people were to discuss death when they heard about her profession, she decided to organize one. “People,” she explained, “have a need to talk about death.”

The facilitators stressed that people’s remarks should remain confidential, and that the café is a safe space to talk openly and candidly.

We first explained why we were attending and then asked to complete the sentence: “Death is ___________.” The one-word replies included “transition,” “ painful,” “ peaceful,” “ necessary,” and so on. Next, we focused on “contradictions in our thoughts about death.” While I couldn’t think of any, someone suggested that suicide has its contradictions. While a person committing suicide may think he or she is ending their physical or emotional pain, they rarely consider the pain their suicide will inflict on others.

Another topic explored what we want to do before our death. Answers broke into two categories: one on travel; the other on accomplishing something, whether it is gaining inner peace, fulfilling a life mission, or seeing one’s children succeed.

Throughout I observed a sense of “permission giving.” Once one person shared her feelings about, say, the death of a loved one, others felt free to jump in. Conversations ranged from the intimate to the humorous, from the loss of a child to contending with different ways of planning a funeral.

The café ended with a feeling of commonality: we saw that we could share with strangers some of our deepest concerns about death and dying; and we garnered new perspectives on a topic that most of us had seldom or even refused to discuss.

Sig

Ever Heard of “Death Cafes”?

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Recently the Associated Press carried a news item about “Death Cafes.” They involve meeting up with a group of people you have never encountered before and talking about death. Not an easy conversation, to be sure.

Still, advances in medicine, the aging of our population, and increased longevity are conspiring to force us to be more realistic about the choices we make as we get closer to death’s door.

Take a look at the following article and then let us know your reactions.

http://m.apnews.com/ap/db_289563/contentdetail.htm?contentguid=PHH2FGnR.

Many thanks.

Carolyn and Sig

Let’s De-Mystify the ‘D’ word

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The ways to talk about death and dying are manifold. One recent example was a public comment by Japan’s Finance Minister urging older Japanese citizens “to hurry up and die.” Concerned about escalating medical costs for Japan’s burgeoning senior population, he issued this less than appropriate remark last month.

We recently learned of another way to engage in a discussion around the topic of death: start a “death cafe.” Conceived by a Swiss sociologist, the idea has spread to the U.K., France, and most recently Columbus, Ohio. A death café, we are assured, provides a respectful and confidential setting for persons to share their thoughts about the kind of death they envision for themselves.

While Carolyn and I practically gagged when we first read the term ‘death cafe,’ we feel the concept is worth examining. For too long the topic of death has been among the ‘forbidden fruit’ of polite conversation. The idea of a formal setting in which to discuss death (whether it’s called a death café or something less blunt) brings the subject of death out of the closet.

Think about it:
Why not ask a loved one who may be dying what kind of funeral he or she would like to have?

Why not ask ourselves the same question?

Do we want to die in a hospital or at home or somewhere else?

In sum, wouldn’t we be better off if we could openly discuss the kind of death we envision for ourselves?

I suggest we all try it if only once. Consider discussing with a relative or friend the kind of funeral they or you would like. Share with them how you hope to spend your final days.

It’s time we unearthed the tough conversation around death and what we’d like to happen when our ‘time’ rolls around.

Sig

Breaking the Bad News (Cont.)

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Last week Sig asked: If you had a fatal illness, who should tell you? Your doctor?  A  loved one?

How should they say it?

My Dad, 93, was slowly dying. His body was riddled with the prostate cancer he’d lived with – and minimized — for 20 years. He’d signed an advance directive (“no extraordinary measures”) and a health care power of attorney. But he’d made clear that his own death was not a topic of discussion.

One afternoon he told us to call an ambulance. “I just don’t feel right,” he said.

Early next morning, in the hospital, he suffered a massive heart attack. A doctor met me in the hall. “He doesn’t know what happened. We don’t want to frighten him. There’s nothing we can do. We’ll make him comfortable. He might last 24 hours.”

I was sad but not surprised. Dad had fought the good fight. I went in to hold his hand.

He was alert, even cheery. He pretended nothing had happened. “I feel pretty good,” he said through his oxygen mask. “I hope the Redskins win tomorrow.” Denial, full strength. He was not going there.

But a few hours later he asked, “Why aren’t they treating me?”

I tried, “Well, Dad, maybe there’s nothing they can do.”

He was furious. “I’ll fire them and get a new doctor!” He tried to climb out of bed.

When a female doctor appeared a couple of hours later I privately asked her to tell him.

She was kind. She sat beside him, at eye level. She was indirect and used a lot of silence to let him absorb each sentence. She emphasized the things he could control.

“Mr. Miller, your daughter tells me you’re wondering about treatment.” Pause. He nodded. “You’ve suffered a heart attack.” Pause. Nod. “It wasn’t a little one.” Longer pause. “I’m afraid it did a lot of damage. . . . . . We can’t fix it.” A really long pause.

“And you know you also have cancer. . . . . that has spread,” she continued. “That’s why you can’t keep food down.” More silence.

Finally,  from Dad, “How long?”

“Not weeks.” [Her phrasing astonished me.] . . . . “Is there anything you need to do?”

Dad looked at me. “No. You’ll take care of Mom (in a nursing home with advanced Alzheimer’s), you know about the money . . .” Then he described the funeral he wanted.

The doctor told him he could choose hospice, he could control his pain medication, and he could decide whether he wanted to go home or stay where he was.

When she left, Dad said, “She said I have two weeks.” Nobody argued with him. He lived four more days.

Carolyn Parr

Passing the Buck on one tough conversation

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Last week my friend Gail told me she was put into an extremely difficult situation. Her mother’s oncologist called Gail to inform her of her mother’s terminal cancer and asked Gail to break the fateful news to her mother. By way of background Gail and her mother live in different cities. And Gail’s mother had an appointment with the oncologist two days later.

What should one do in a situation like that? How ethical is it when your mother’s doctor relies on you to inform your parent that she has an untreatable cancer?

Isn’t it the doctor’s responsibility to do that? How should one frame a message that is so heart-wrenching as informing your parent that her days are literally numbered. Once you’ve taken that step and bravely, and perhaps tearfully, broken the fateful news, how do you respond to such questions as: How serious is the cancer? How long do I have to live? Are there treatments that will possibly cure, or if not cure, delay the inevitable? And worst of all, what should Gail’s reply be if her mother asks: “What do you think I should do?”

Well, Gail broke the news to her mother. It couldn’t have been easy telling your parent that she is going to die…soon. Gail also promised to come home to accompany her Mom to her appointment.

Gail’s mother received the news with equanimity. Knowing that Gail’s knowledge was limited and that she had an appointment with the oncologist two days later, her mother had only one request of Gail: that she be strong because she would need her daughter’s fortitude and love more than ever in the months to come.

Sig Cohen