Wrapped in a fuzzy pink shawl, and sunk into the confines of her recliner at the age of 92, Dee was mentally alert but physically a wreck. "I've outlived my life, and I'm ready to go," she sighed.
Dee had already fought a good battle. Twenty years earlier she had survived a near-fatal car accident followed by a lengthy recovery. Back then, she had welcomed the family "fight" chants that boosted her will to live and put her in the fast lane to recovery.
"She's a fighter!" declared Dee's devoted sons, Don and Dean, as they proudly described her lifelong traits of perseverance and independence. So when their mother calmly announced that she would no longer take medications and that she had canceled all future medical appointments, they objected loudly: "Mom, you can't do that! It's not time to give up!"
Adult children who observe an elderly parent's decline often react like Dee's sons, who responded in the only way they knew how: with loud protests, scolding and increased pressure to keep fighting. Actually, Dee was not resisting her sons for the sake of her independence; she was long past that. She knew that her best efforts could not improve the quality of her life or fix what ailed her. Dee chose to forgo medical interventions that she considered useless, risky, costly, and likely to increase her dependence and prolong her decline.
"I just want my boys to listen to me. They leave me feeling guilty, as though I've let them down. Why can't they accept that I can't fight anymore and that I will welcome death?"
A feeling is neither right nor wrong. It just is. To be told, "You shouldn't feel that way," is rarely helpful advice for anyone. "I know how you feel" may be the second-least-helpful counsel. Dee's sons laid claim to understanding feelings they had yet to experience. A more neutral acknowledgment like, "This must be hard for you," or "Help me understand how you are feeling," and then remaining silent while listening to their mother's response, might have been more beneficial.
Fortunately, listening is a skill that can be learned. The most meaningful conversations take place when people are fully present, without distraction and with a generous intent to listen and accept what is heard. When you turn off the TV, mute the telephone, and sit down at eye level next to someone (as opposed to standing in the doorway), you convey caring.
Indicate your willingness to listen by inquiring, "What's on your mind?" or "How is your spirit today?" or "What do you understand about how things are going?" Such questions can provide an opening, an invitation to confide fears and worries that might otherwise be held back so as to not offend or alienate someone on whom a patient depends.
"God gave us two ears and one mouth for a reason," goes an old saying. The message is that we should listen twice as much as we talk. Wait at least seven seconds after someone stops speaking. Chances are good that they'll continue talking and perhaps reveal something they've been hesitant to say.
Try not to finish other people's sentences unless you are certain they cannot finish without your help. Withhold advice unless asked. Good listeners often repeat back the last word or two of what was said or say, "Tell me more," and "What do you mean?" to continue a conversation.
A gentle word of caution: It is hard to imagine the total, bottom-of-the-glass exhaustion that many dying people feel as life ebbs away. The effort to turn in bed, or even lift a cup to sip water can seem impossible. Common signs of such total fatigue include closed eyes, deep sighs, and a failure to answer a question or cooperate with a request. Rather than urge a response, consider asking, "Would you like to rest now?" or "Can we talk more later?" and accepting a brief nod yes or no as an answer.
"How are you doing?" Every day millions of people ask that question to millions of other people who respond "fine," even though both may be suffering greatly. The ending of a life can offer precious opportunities for authentic connections between people who care deeply for each other but withhold their feelings to maintain a façade of strength and protect a loved one from overwhelming emotions. The admission of fears and anxieties does not indicate weakness. Listening to each other exchange honest expressions of sadness and loss as well as words of love can be both gratifying and consoling.
Even if you're in the habit of talking over others, mentally composing a list of sharp retorts, or impatiently waiting for your turn to speak, it's not too late to learn to listen. Now is always a good moment to begin.
For help with having conversations about end-of-life care, visit The Conversation Project.