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How Do You Tell Someone They Are Dying?

Family members often keep bad news from their sick loved one, who in turn keeps quiet to protect family members from the same bad news.

“I can’t breathe!” Mrs. Silva gasped. Earlier that morning, in freezing weather, she’d left home bundled in fur-lined boots and a warm, hooded coat and headed to a nearby beauty parlor to have her silvery hair styled. She barely made it to the shampoo chair before her pale face and labored breathing prompted her worried hairdresser to call 911. Within minutes an ambulance team arrived, administered oxygen, started an IV, and sped her to the hospital.

Her doctors agreed that she had cancerous growths in her lungs and that the disease had already spread throughout her body. They told Mrs. Silva’s daughter, Joanna, “Your mother is not a candidate for aggressive treatments. She doesn’t have long to live. I’ve asked a hospice representative to come and talk with the two of you.”

When I arrived, Joanna immediately told me, “Please don’t tell my mother that she is dying. I don’t want to frighten her or cause her to give up hope.” As close as Joanna was to her mother, she was unable to talk to her about her condition. She felt she needed to protect her mother and herself from an emotional breakdown.

I entered Mrs. Silva’s hospital room to find a frail lady who greeted me with a sweet smile. After we chatted a bit, I asked her what she understood about her illness. “I’ve suspected for some time that something was wrong. I’ve had trouble breathing and I feel so terribly weak. I’m tired and I want to go home. I saw what my sister went through when she had cancer, and I want nothing to do with surgery, chemotherapy, or radiation. And I don’t want to lose my hair!” she said as she patted her curls. Then she paused, glanced nervously toward the door, and crooked an arthritic finger to motion me closer. “I can handle this, but I’m worried about Joanna. I don’t want to upset her. Please don’t tell her that I am dying,” she whispered.

Overwhelmed patients and families usually feel relief and gratitude when they hear the unvarnished truth.

I recognized a familiar scenario. Family members often keep bad news from their sick loved one, who in turn keeps quiet to protect family members from the same bad news.

Joanna looked up anxiously as I rejoined her in the visitor’s lounge. I repeated my exchange with her mother and before I could finish, Joanna exclaimed, with tears in her eyes, “Of course she knows. She’s always sensed things. She’s trying to protect me, isn’t she?”

“Yes, just as you are trying to protect her.” Together we walked into Mrs. Silva’s room.

What followed was the first of many conversations that led to Mrs. Silva’s returning to her home with the help of family, friends, and hospice. She enjoyed visitors and kept her weekly hair appointments for as long as she could. Mrs. Silva died peacefully many months later, still in possession of her dignity and her beautiful silver curls.

Often a neutral outsider such as a member of a palliative care or hospice team can encourage and facilitate difficult conversation by offering guidance through what can be a frightening process. Even when the news is bad, overwhelmed patients and families often feel relief and gratitude when they hear the unvarnished truth. Honest conversations can be liberating because they end unrealistic expectations for a cure while releasing hope, a different kind of energy. Now, instead of seeking yet another futile treatment or consulting another specialist, many people are able to come together to take care of unfinished business and focus on quality of life in the hope of achieving a peaceful death.

For more information about hospice and palliative care visit Caringinfo.org.

Learn more about a variety of resources to help make, discuss and document future healthcare wishes and decisions at National Healthcare Decisions Day Resources.

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