Can someone talk to me about death

How do I find the right words for illness and death?

Dealing with death paralyzes many people. What can you say? What if you react incorrectly? Our author Petra Gotthardt has been working on a voluntary basis as a dying companion in a palliative ward for years and explains to you how to deal more carefully with death with open and cautious questions.

I sit there looking for the right words: a patient breaks down in tears. She was diagnosed with cancer two days ago. Unexpectedly, a colleague (cancer patient) reports from yesterday's check-up. New metastases were found. What should i say

The fear of reacting incorrectly paralyzes many. People around them avoid the conversation, switch to WhatsApp messages or letters. You may also withdraw. At the same time, they feel that they are not doing justice to the situation in this way. How can you as a therapist deal with the topic?

Openness and gentle questions are the basis of attentive support for the seriously ill and dying. Even after years of voluntary terminal care in the palliative care unit, it was not easy for me. However, some aids that make it easier to get started with these difficult conversations helped me over the course of time.

One patient breaks down in tears. She was diagnosed with cancer two days ago. What should you say as a therapist? (Photo: Marjan Apostolovic - Getty Images)

Listen mindfully

At the time of diagnosis, the course of the disease is uncertain. A well-founded prognosis is not yet available, many studies are imminent. Sick people and their relatives now need courage and confidence for the upcoming therapies. Taking an “observer position” enables me not to get emotionally entangled: when does my compassion overflow? When does it get in the way of an open exchange? Could it be that my own fears and horror at the diagnosis contribute to making the situation more difficult for the person affected?
These questions help me to regain my composure and to organize the conversation in such a way that it is good for the person concerned. In this way I can also prevent rushing forward with hasty comfort and not recognizing the real needs of the other. I have made the experience that this reflection leads to a beneficial 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?”, “There will be further examinations in the next few days?”, “The doctor says that there are many There are opportunities to cope with the illness? ”,“ How can I support you with what lies ahead? ”“ What do you want from me now? ”.

This framework of questions helps the patient and me. We can calm down, take the time to be close to each other and discuss what is really important now.

Use the time and be with the other person

It is difficult to see how the strength slowly fades and the discomfort increase. Conversations now require a certain humility. What is meant by this is the acceptance of the inevitable. The humble look I turn in my inner mirror should lead to

  • to put one's own meaning aside,
  • to take back yourself,
  • to treat the situation with respect.

Imagine a patient unexpectedly saying 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 options could now be out of place. On the other hand, the question "What is important to you for the time that you still have?" Can open up new perspectives.

Instead of denying death, the question "What is important to you for the time that you will still have?" Can open up new perspectives for the sick person. (Photo: pexels)

Advice like “You have to eat and drink more now!” Or “Tomorrow the world will look different” often slip out of our minds. After all, it is unbearable for us to realize that the end is slowly approaching. We want to do everything so that the other person feels a little better and that things look better again. But hand on heart: is it really up to us to act as a “better-knowing helper” in this existential situation? Ultimately, we don't know what it feels like when life is coming to an end.

The following picture helps me: the further the disease progresses, like a solar eclipse, it pushes itself in front of the person's personality. It is becoming more and more important, hardly anything else is talked about anymore. Is this the right way?

In contact with a dear friend I noticed that when I was talking to her I asked more and more frequently about the symptoms, the course of the therapy or the last conversation with the doctor. This narrowed my view of my girlfriend's personality. So 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 room opens up in which there is room for the previously unsaid. I make it clear to myself: My friend is speaking, who has little life left to go and to whom all the time should belong to the world right now. This situation is very different from conversations in which time still seems infinite. “What would we like to discuss now?” “What is this meeting inviting us to?” “What would you like to report today, what would be nice topics for you to talk about?” “What do you want from this visit?” That is also what it should be about - as long as the strength is still there.

I can say that I am helpless.

Provide assistance

Two years ago I was sitting on the bed of a dying man who was holding my hand tightly, not letting go, and always mumbling the same sentence: “Why is it so difficult? Tell me: Why is it so difficult? ”Now, not to evade, but to provide real assistance, is probably the greatest challenge. Provided I have the strength to do so at this moment. What could help now?

Just be there and take your time with an answer. I have given myself permission to be sincere now. I can say that I am helpless. Have the strength to be open and attentive at this very important moment: "It is so difficult for you ... I will stay with you" This response may open up an opportunity to alleviate a little bit of despair and fear together. Even if we are silent together.

On the other hand, it can also be that the dying person does not allow a conversation about parting and dying until the very end. He also does not find conciliatory or loving words and does not respond to cautious attempts to talk about death. It is then important to keep the silence and not to impose any further conversation.

To have someone who is simply there is a great support for many of those affected. (Photo: Fotolia)

"Being able to let go"

A patient in the palliative care unit told me, noticeably relieved and with a soft smile: “You know? I really had to raise my daughters until the end of my life. They are now 45 and 48 years old and so far have not accepted that I will die soon. But today I made it clear to them that it would soon be over and that they should please let me go - it was really difficult to get them to do it ... now it's done. "

So I have learned: sometimes it is necessary to say to those who are dying: "You can go, we will get along well, I can let go when the time comes." As unspeakably difficult as it is.

For further reading:

Borasio, G.D. (2016). Dying Self-Determined - What it means, what prevents us from how we can achieve it. Munich: C.H. Beck Publishing House.

Bauer, C.J. & Weis, T. (2014). It's so good to talk to you - encounters with the dying. Berlin: be.bra Verlag.

Thich Seam Hanh (2014). Speak mindfully. Listening Mindfully - The Art of Conscious Communication. Frankfurt: O.W. Barth.

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