Helping a dying friend
Click here: An Old Friend Calls in a Promise (or scroll down to end of page) to read a moving story by Bayla Kraft, about how helping her dying friend Karen changed the way she experienced her own life. See also a few helpful pieces under What to say (or not say) to those who are dying or grieving.
Advice for helping a friend with cancer (Suleika Jaquad, author of the Life, Interrupted blogs).
The Art of Being a Healing Presence: A Guide for Those in Caring Relationships by James E. Miller with Susan Cutshall. How to be present in a way that is healing, nourishing, and potentially even transforming.
At the end of a loved one's life, why is it so hard to let go? (Craig Bowron, Washington Post, 2-22-12). Craig Bowron is a hospital-based internist in Minneapolis. "When families talk about letting their loved ones die 'naturally,[ they often mean 'in their sleep' — not from a treatable illness such as a stroke, cancer or an infection. Choosing to let a loved one pass away by not treating an illness feels too complicit; conversely, choosing treatment that will push a patient into further suffering somehow feels like taking care of him. While it's easy to empathize with these family members' wishes, what they don't appreciate is that very few elderly patients are lucky enough to die in their sleep. Almost everyone dies of something."
Because You've Never Died Before: Spiritual Issues at the End of Life by Kathleen J. Rusnak. Wrote one reader: "This book is a good introduction to the big gap between those of us who expect to live at least another 5 years and those in life-threatening situations. Very compassionate and well-written."
Being Mortal: Medicine and What Matters in the End (Atul Gawande). (from a review by Sara Nelson: 'Yes, “death is the enemy,” he writes. “But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee... someone who knows how to fight for territory that can be won and how to surrender it when it can’t.” In his compassionate, learned way, Gawande shows all of us—doctors included—how mortality must be faced, with both heart and mind.' From the book itself: "The terror of sickness and old age is not merely the terror of the losses one is forced to endure but also the terror of the isolation. As people become aware of the finitude of their life, they do not ask for much. They do not seek more riches. They do not seek more power. They ask only to be permitted, insofar as possible, to keep shaping the story of their life in the world-- to make choices, and sustain connections to others according to their own priorities."
Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death by Joan Halifax (foreword by Ira Byock). Be still, let go, listen, and be open to the unknown
The Beneficial Effects of Life Story and Legacy Activities by Pat McNees (Journal of Geriatric Care Management, Spring 2009). Get PDF file of journal article here (61.9KB)
A Best Friend Is Gone. Grief Is Here to Stay (Martha Randolph Carr, Washington Post 3-7-05)
Can't We Talk About Something More Pleasant?: A Memoir Spanning the last several years of their lives and told through four-color cartoons, family photos, and documents, and a narrative that elicits both laughs and tears, Chast’s memoir is both comfort and comic relief for anyone experiencing the life-altering loss of (in this case, cranky, eccentric) elderly parents
Caregiver's Handbook (Robert S. Stall on how to care for both the caregiver and the elderly care-receiver, San Diego County Mental Health Services)
Caring for a Dying Loved One: Providing Safety and Comfort to the Dying (Angela Morrow, RN, About.com, 12-28-09)
Comfortable with Death (Elizabeth Zimmer, Obit Magazine, 5-14-10, on helping others transition out of life)
Coping With Crises Close to Someone Else's Heart (Harriet Brown, NYTimes 8-16-10), essay on why some people distance themselves from those suffering a crisis or offer "pseudo-care" instead of real help)
Despite the losses, so much gained (Leah Keith, Modern Love, NY Times, 4-11-13), “When my rare tumor was found, I thought it was the worst thing that could ever happen to me. Now I know I was the luckiest woman in the world,” writes Keith. “For 13 lucky months, I got to stare into the abyss and feel safe jumping into it because a man who loved me promised to hold my hand all the way down.”
Developmental Landmarks and Taskwork for the End of Life (Ira Byock, DyingWell.org)
'Dignity therapy' gives comfort to dying patients. Helping terminally ill patients pass on their final thoughts may help give them a better quality of life, reports Harvey Chochinov, head of a Canadian research study (Jonathan Shorman, USA Today 7-11-11, on study published in Lancet Oncology)
Dying: A Book of Comfort, ed. Pat McNees. “This remarkable collection, coming from personal experience and wide reading, will help many find the potential of growth through loss.” ~ Dame Cicely Saunders, founder of the hospice movement
A Dying Person's Guide to Dying (Roger C. Bone, Hospice.net)
Dying to Live, Part 1 (snippets in this promo video for a documentary suggest indirectly how to be helpful to someone with a life-limiting illness). Part 2 of this mini-video helps encourage more comfort facing death, or being with a dying friend. You can buy the whole documentary on video, Dying to Live. Intimate interviews on coping with common end-of-life issues: grief & loss, hospice, palliative care, euthanasia, bereavement, suicide, counseling, child death, green lifestyle, terminal illness, psychology, nursing, death and dying.
Dying Well by Ira Byock. In this classic guide, Byock makes a forceful case for hospice care and against physician-assisted suicide. He demonstrates how the physical pain and emotional despair of the dying may be handled.
ElderCare Online's Caregiver Support Center
The Etiquette of Illness: What to Say When You Can't Find the Words by Susan P. Halpern. How to be helpful or comforting, yet not intrusive (and how, if you're the patient, to ask for help). Above all, what not to say.
Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan and Patricia Kelley (a very helpful guide)
For Dying People, A Chance To Shape Their Legacy (Julie Bierach, Weekend Edition, NPR, 4-9-11). Imagine that you've just been told you have only a short time to live. What would you want your family and community to remember most about you? In St. Louis, a hospice program called Lumina helps patients leave statements that go beyond a simple goodbye. At the website of BJC Palliative Home Care and Hospice you can download a patient handbook and/or a caregiver instruction manual (PDFs), and a PDF of Courtney Strain's What you can do when a friend (like me) faces the end of life. Examples: Hallmark doesn't fix it all. ... Write a letter or send an email. ... [Talk to me when] I'm strong enough to sit and laugh or cry with you ... Instead of asking, "What can I do for you?" offer some concrete suggestions — like bringing a meal or treat, doing laundry, or running errands.
Franny's Last Ride (Mike DeStefano, at The Moth, YouTube). (Moving, but with some profanity)
Frequently asked questions about end-of-life experience and care (Ira Byock, DyingWell.org)
Goodbye to Jumpy: Lessons for the Health System (Janice Lynch Schuster, AgingToday, 1-17-13) The family vet's handling of the death of her son's beloved pet hamster offers a model for humans' doctors. Schuster acknowledges "him for the compassion and human touch he showed to my little boy, who had just confronted the first of what is ultimately a lifetime of loss."
Grief Counseling Resource Guide: A Field Manual (NY State Office of Mental Health). This guide for bereavement workers may be helpful to others, also. See for example, Alan Wolfelt on "companioning" -- to honor the spirit, not the intellect; to be curious, not an expert; to learn from, not teach, the bereaved; to walk alongside, not lead; to "discover the gift of sacred silence," not fill "every painful moment with words"; to "listen with the heart," not analyze the head; to bear "witness to the struggles of others," not direct those struggles; to be "present to another's pain," not "taking away the pain"; to respect "disorder and confusion," not impose "order and logic" -- and yet to help them organize day-to-day tasks and get them done. At the heart of grief counseling is "validation," according to Ken Doka: "reassurance that what they are experiencing is normal." And yet there are many different ways to grieve. Reading this helpful short guide for counselors will help regular people know how to be helpful instead of unhelpful! See also Companioning vs. Treating: Beyond the Medical Model of Bereavement Caregiving by Alan D. Wolfelt
Helping a Friend Who Is Dying (Alan D. Wolfelt, Hospice)
Helping dying patients offers Canadians life lessons (Carmen Chai,National Post, Canada 12-6-10)."Canadian hospice care workers say their daily experience caring for dying patients has changed their personal lives — but in a positive way, according to a new study that looks at how people are shaped by exposure to death....many of respondents in his study admitted to rearranging priorities in their lives after learning from their dying patients that they wished they had spent more time with family or focused on enjoying life instead of working."
Helping Our Loved Ones Die Video 1 of a 12-part video series, by Stan Goldberg, author of Lessons for the Living: Stories of Forgiveness, Gratitude, and Courage at the End of Life
Helping Yourself Live While You Are Dying (Alan D. Wolfelt, on Hospice.net)
How to Conduct Compassionate Interviews at the Scene of a Tragedy & Dealing with Our Own Responses to What We See and Hear: A Guide for Journalists by Russell Friedman and John W. James (The Grief Recovery Institute Educational Foundation--a 28-page PDF file well worth downloading, whether or not you're a journalist. This may be helpful also if you aren't sure what's helpful in talking with a friend who is dying or grieving--because, of course, people who are dying are also grieving.)
How to Comfort the Dying (wikiHow, a little crude, but a good basic checklist)
How to give death a good name (Elizabeth Grice, The Telegraph, 6-23-08). With society now obsessed by the desire to prolong life, Grice asks if we have lost the art of dying well and examines practical steps to change our attitudes
How to Help a Grieving Friend (PDF, Fox Valley Hospice)
How to Say Good-bye When Someone You Love Is Dying . Regrets and lessons from grieving survivors (Paula Spencer Scott, Caring.com)
How to Talk to a Dying Friend (eHow)
How to tell children a parent is dying
I Don't Know What to Say...: How to Help and Support Someone Who Is Dying by Robert Buckman. "One of the biggest problems faced by terminally ill patients is that people won't talk to them, and the feelings of isolation add a great deal to their burden." Buckman offers advice on how to talk to a dying person, how to relieve their and your own distress, fears, and guilt. See Jane Brody's piece on Art and Grace, When It’s Time to Say Goodbye (Personal Health, NY Times, 12-30-03). She writes, "Many people are more afraid of dying alone than they are of death itself. By knowing how to act and what to say when visiting a dying person, you can bring caring and comfort that eases the person's passage over this most momentous threshold. "
If someone you know has suffered a loss... (Bob Carnevali, Easing Grief). How to interact with someone who is grieving -- things to do and things not to do! (Here is his Grief Recovery journal/blog.
Intimate Death: How the Dying Teach Us How to Live by Marie de Hennezel. A bestseller in France, this book conveys well the power of effective palliative care--of being present for the dying, and helping them with unfinished business. She recommends playing John Rutter's Faure: Requiem and other choral music for someone who is dying.
Jane Brody's Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare Medically, Legally, and Emotionally for the End of Life -- a practical book, with explanations and to-do lists for everything from advance directives and why a living will is not enough to funeral plans, living with a bad prognosis and dealing with uncertainty, caregiving, hospice, communicating with doctors, assisted dying, organ donation, autopsy, and legacies. Offer to read up on these things for your friend, and/or to give her a copy of the book.
Just Because I’m Dying Doesn’t Mean I’m Any Less Capable of Being Your Friend (BJC Hospice -- an interview conducted with Courtney Strain weeks before she died). “Don’t be afraid to engage with someone who is dying. We’re afraid because that person reminds us of our mortality. Don’t be scared to do the wrong thing.”
Keeping a Promise When a Life Is Near Its End (Ellen D. Feld, MD, The New York Times, 11-10-08)
A Life Worth Ending (Michael Wolff, New York Magazine, 5-20-12). "The era of medical miracles has created a new phase of aging, as far from living as it is from dying. A son’s plea to let his mother go." ("Part of the advance in life expectancy is that we have technologically inhibited the ultimate event." "The purpose of long-term-care insurance is to help finance some of the greatest misery and suffering human beings have yet devised.") Read the comments, too. And the Daily Mail has Emily Anne Epstein's piece about Wolff's message: 'The longer you live the longer it will take to die' : 'The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die.'
Living at the End of Life: A Hospice Nurse Addresses the Most Common Questions by Karen Whitley Bell RN, who "she delivers a wealth of useful information on pain management, choosing a hospice and general day-to-day care giving in a powerful, hard-to-forget way. Straightforward and empathetic, with an easy-to-navigate style, Bell details what to expect in both physical and spiritual terms, including practical considerations as well as ways to find closure and cope with loss." (PW review)
The Long Goodbye: a memoir by Meghan O'Rourke, which Alice Gregory reviews for NPR in 'The Long Goodbye': A Syllabus For Modern Mourning. An excerpt: "In the days following my mother's death, I did not know what I was supposed to do, nor, it seemed, did my friends and colleagues, especially those who had never suffered a similar loss. Some sent flowers but did not call for weeks. One friend launched into fifteen minutes of small talk when she saw me, before asking how I was, as if we had to warm up before diving into the churning, dangerous waters of grief. Others sent worried e-mails a few weeks later, signing off: 'I hope you're doing well.' It was a kind sentiment, but it made me angry. I was not 'doing well.' And I found no relief in that worn-out refrain that at least my mother was 'no longer suffering.'"
Making Plans for the Last Chapter of Life (Talk of the Nation, 8-31-09--listen or read transcript). Sherwin Nuland and Ira Byock tell Neal Conan how they talk with patients who are facing the ends of their lives.
Movies about death and dying. (Sometimes all someone wants is to cuddle and watch a movie together. And these might work.)
Mister Lytle: An Essay (John Jeremiah Sullivan, Paris Review, Fall 2010) Wonderful long tribute to a dying 92-year-old difficult literary mentor, somewhat in the manner of the old South: "I found him exotic; it’s probably accurate to say that I found him beautiful. The manner in which I related to him was essentially anthropological. Taking offense, for instance, to his more or less daily outbursts of racism, chauvinism, anti-Semitism, class snobbery, and what I can only describe as medieval nostalgia, seemed as absurd as debating these things with a caveman. Shut up and ask him what the cave art means. The self-service and even cynicism of that reasoning are not hard to dissect at a distance of years, but I can’t pretend to regret it, or that I wish I had walked away."
Music for Funerals and Memorial Services. This is also a good page for finding music to sooth, cheer, or uplift -- and to help a dying person grieve the coming loss of life, and celebrate the life they lived.
The Myth of the Stages of Dying, Death and Grief by Russell Friedman and John W. James (PDF, Grief.net). You will find many more articles by these authors here, about grief recovery and on people's reaction to loss and what to do about it.
The Needs of the Dying: A Guide for Bringing Hope, Comfort, and Love to Life's Final Chapter by David Kessler (writing about the need to be treated as a living human being, the need for hope, the need to express emotions, the need to participate in care, the need for honesty, the need for spirituality, and the need to be free of physical pain). Kessler also wrote Visions, Trips, and Crowded Rooms: Who and What You See Before You Die
One woman’s dying wish made another a mom (Ellen McCarthy, Wash Post, 6-24-15) Linda Rahal, an immigration lawyer, had been leading a perfectly happy single life -- filled with travels and Ironman competitions -- when a former client made a dying wish. After a lengthy international legal battle, Linda became a mother by adopting her client's daughter from Serbia
The Passing: What to Expect When Witnessing a Loved One's Death (Paula Spencer Scott, Caring.com). Relatives describe the death experience
POLST. What is a POLST and Do I Need One? (Angela Morrow, RN, About.com 3-1-10). A POLST is a “physician’s order for life sustaining treatment.” A relatively new document, the POLST is a way to translate a living will or an oral advance directive into physician's orders that must be followed by emergency personnel and health care providers. The POLST may state a patient's preferences for, against, and about CPR, medical interventions, antibiotics, and artificially administered nutrition and hydration.
The Pros and Cons of Living with a Terminal Illness (Ellen Diamond, Pulse, 5-9-14) "Life is a terminal illness, and we all are living with the knowledge of our certain deaths. Yet we get up in the morning and make breakfast as if there's no tomorrow. Are we all in denial? In a way, yes. But is that a bad thing?"
Providing Comfort for a Dying Loved One (End-of-Life Care Partnership). What you may see as death approaches. Ways you can comfort your loved one.
Recommended Reading, Viewing, and Listening (including children's books about death and loss)
The Rituals of Modern Death (Haider Javed Warraich, Opinionator, The End, NY Times 9-16-15) "I didn’t see the true face of death until I was the one filling out the death certificate....Much like the overarching experience of patienthood, the end of life has been sterilized....These days, instead of a shaman, patients are surrounded by strangers in scrubs. Death – one of the most complex events that can occur in a hospital – is usually handled by the youngest physicians....With time and experience I have learned that after a patient passes, my responsibility is to be more than just someone who checks off the boxes."
A Serious Illness Can Isolate a Family: Gestures of support help greatly, writes Louise Bonnett-Rampersaud, for the Washington Post (8-4-09). "What I've come to realize," she writes, "as I've watched my husband struggle for his life over the past four years [vascular Ehlers-Danlosis] that there are certain things people can say and do to make that wait more bearable, and there are words and actions that miss the mark, triggering even more distress. It boils down to what I have come to call 'terminal etiquette.' Families in this kind of crisis suffer with an "incredible sense of isolation." Child-life specialist Jeanne Higgins Bergin advises "that people should acknowledge the situation, be empathetic, reach out and offer specific ways to help the family." Offer, "for example, to cook, clean, do laundry, run errands, include our children in their family's activities, plant flowers, rake leaves and shovel our snow." Offer to drop off milk, bread, and bananas every Monday and Friday -- "creating a sense of routine and continuity in a family's life that has been turned upside down."
Share The Care: How to Organize a Group to Care for Someone Who Is Seriously Ill by Cappy Capossela, Sheila Warnock, and Sukie Miller
Should terminally ill patients be able to choose when they die? (PBS, 10-14-14 ) After being diagnosed with terminal brain cancer, 29-year-old Brittany Maynard moved her family from California to Oregon to die on her own terms. Oregon law allows Maynard to take lethal prescription medication to end her life. Jeffrey Brown gets debate from Barbara Coombs Lee of Compassion & Choices and Dr. Ira Byock of Providence Institute for Human Caring.
Signs and Symptoms of Approaching Death (Hospice Patients Alliance)
6 Ways to Help When Someone Has Cancer (Jessie Gruman, a three-time cancer survivor, a Parade slide show). In brief: Acknowledge the situation; offer help only if you can deliver; guard patient's privacy (don't share news without permission); listen--really listen; remember that hope is a gift, not everyone feels (don't insist patient feel positive); ensure our dignity (make us feel valued--not just a cancer patient).
Spiritual Directors International (SDs accompany people on a spiritual journey) has excellent resources -- including spiritual directors, but also PDFs of articles from the journal Presence (download, for example, The Compassionate Observer by Jane E. Vennard). To learn more: What is spiritual direction?> (contains answers specific to various spiritual traditions).
Talking with a Sick Person (excerpt from the helpful book Handbook for Mortals by Joanne Lynn and Joan Harrold. Read more excerpts here.
10 Signs Death Is Near (Paula Spencer Scott, Caring.com). What to expect and how to respond to the natural dying process
Things To Do When Time May Be Short (from Handbook for Mortals
Tips to How to Help a Grieving Loved One During the Holidays (PDF, Fox Valley Hospice)
What doctors know about death that the rest of us don’t (Danielle Teller, Quartz). "...doctors know...There’s nothing more noble about dying from cancer than from alcoholism. There isn’t a battle against death to be fought, just treatments to endure when the disease is treatable and symptoms to endure when the treatments are futile. Death has always been inevitable, but once their deaths are imminent, doctors just want to be comfortable and to spend the last days with family. It turns out that this is what most of us want, and we can have it if we can just bring ourselves to let go of narratives that don’t make sense and get more comfortable with the truth."
What Dying People Want: Practical Wisdom For The End Of Life, a book by David Kuhl
What people talk about before they die (Kerry Egan, hospice chaplain in Massachusetts and author of Fumbling: A Pilgrimage Tale of Love, Grief, and Spiritual Renewal on the Camino de Santiago
What you can do when a friend (like me) faces the end of life (Courtney Strain for BJC Palliative Home Care and Hospice, PDF file)
When Life Becomes Precious: The Essential Guide for Patients, Loved Ones, and Friends of Those Facing Serious Illnesses by Elise NeeDell Babcock. When someone you care about is diagnosed with cancer, what should you say? What should you not say? What are the best ways to offer help, or to help children understand what is happening?
When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions by Paula Span. What will you do when you get the call that a loved one has had a heart attack or a stroke? Or when you realize that a family member is too frail to live alone, but too healthy for a nursing home?
When your dying friend needs help (what to say and do, and other frequently asked questions -- HospiceDirectory.org)
• How not to say the wrong thing (Susan Silk and Barry Goldman, Los Angeles Times, 4-7-13). It works in all kinds of crises – medical, legal, even existential. It's the 'Ring Theory' of kvetching. Comfort those at the center (the patient, patient's family), kvetch to those further away from the center.
• How to Talk to a Friend With Cancer (Claudia Wallis, Time, 10-5-07). Wallis gets advice from Lori Hope, author of a book to help friends and families of those fighting cancer: Help Me Live: 20 Things People with Cancer Want You to Know. Advice on what cancer patients do and don't want to hear and what is useful or makes them feel better.
• But I Don't Know What to Say... (Fran Moreland Johns, Beliefnet, author of Dying
• Ideas for a Time When Someone You Love Is Dying by James E. Miller, author of One You Love Is Dying: 12 Thoughts to Guide You on the Journey
• Five Important Things to Say to all our loved ones, regularly: Thank you; I love you; I'll never forget...; I'm sorry...; I forgive you. (St. Charles Church)
"We need, in love, to practice only this: letting each other go. For holding on comes easily; we do not need to learn it." ~ Rainer Maria Rilke
• The game that can give you 10 extra years of life . Game designer Jane McGonigal's TED talk about how, when she found herself bedridden and suicidal following a severe concussion, she figured out how to get better and feel happy again. (Video and/or transcript.) Her concrete suggestions are a good follow-up to The Top 5 Regrets of The Dying (Joe Martino. Collective Evolution, 4-27-13).
• What Not to Say at the Bedside (Judith Graham interviews Letty Cottin Pogrebin, who offers more advice in her book How to Be A Friend to a Friend Who’s Sick
• What do you (not) say to a dying friend (Janice Gaston, Scripps Howard News Service, San Diego Union)
• What to Say to a Dying Person (Myrrh Hector)
• How to Talk to a Dying Person (Lisa DeLuca, Caregiver Support). Advice from hospice social worker Margaret Bromberg.
• Words of Comfort for the Dying (Father Bill Haymaker, Big World Small Boat)
• What Does Someone Dying Need? (Rex Winsbury, on Hospice.net)
• The Etiquette of Illness: What to Say When You Can't Find the Words by Susan P. Halpern. How to be helpful or comforting, yet not intrusive (and how, if you're the patient, to ask for help). Above all, what not to say.
• Being there, How to Help a Friend Who Is Dying (PDF, Fox Valley Hospice)
• What Dad Wants Dad Gets (Joan Hitchens, Grief Reflections blog, 2-24-11)
• Youth Suicide: How You Can Help the Survivors (Florence Isaacs, author of My Deepest Sympathies...: Meaningful Sentiments for Condolence Notes and Conversations, Plus a Guide to Eulogies)
"We need, in love, to practice only this: letting each other go. For holding on comes easily; we do not need to learn it." ~ Rainer Maria Rilke
"Goodnight, sweet prince/and flights of angels sing thee to thy rest"
~from Shakespeare's Hamlet
"The great secret that all old people share is that you really haven't changed in seventy or eighty years. Your body changes, but you don't change at all. And that, of course, causes great confusion." ~Doris Lessing
"People will forget what you said, people will forget what you did, but people will never forget how you made them feel." ~Maya Angelou
"Our child dies a second time when no one speaks their name," says bereaved parent Mitch Carmody, quoted by Linton Weeks in the story Now We Are Alone: Living On Without Our Sons (NPR, 9-3-10)
"There is a sacredness in tears....They are the messengers of overwhelming grief, of deep contrition and of unspeakable love."~ Washington Irving
"If I don't have friends, then I ain't got nothin'.
~ Billie Holiday
"Nobody has ever measured, not even poets, how much the heart can hold."
~ Zelda Fitzgerald
"Love is the only thing that we can carry with us when we go, and it makes the end so easy."
~ Louisa May Alcott
"In my friend, I find a second self."
~ Isabel Norton
"A beautifully crafted collection of life-affirming passages from more than forty celebrated writers, thinkers, and religious voices of various faiths. These voices combine to speak eloquently to the heart of the reader about the nature of dying, and offer a way to provide words of comfort for those who remain behind."
--Ted Menten, author of Gentle Closings