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Relationships carry incredible weight at the end

Tue., June 14, 2011, midnight

Q: I know at the end of one’s life, it is unlikely that a person wishes they had spent more time at work. But is there any research that tells us what people do long for at the end of life?

A: Think about a time of crisis in your own life. What did you think about? What was the first thing you had to do?  Tidy the garage or remove the chocolate ice cream stain out of the family room carpet? Probably not.

What we do think about is each other, our relationships.

Dr. Ira Byock has cared for hospice and palliative care patients for more than 25 years. He says forgiveness, gratitude and love are what matter most to patients and their families at the end of life.

In his book, “The Four Things that Matter Most” (Simon & Schuster, 2004), Byock summarizes the essential message into phrases: “I forgive you. Please forgive me. Thank you. I love you.”

Byock writes: “Ask a man who is being wheeled into transplant surgery or a woman facing chemotherapy for the third time what’s on his or her mind and the answer will always involve the people they love. Always.”

When Catherine’s dad called to tell her his colon cancer had returned and metastasized, she flew to his Florida home to spend time with him.

They sorted through sentimental family photos and treasures, visited favorite restaurants, relaxed on a friend’s boat along the Intracoastal Waterway.

At the end of the bittersweet time together, he told her, “Thank you.” She replied, “It was my pleasure, Dad.” He said, “No, Cathy, thank you for everything, over the years, for everything.”

She cried at the airport, at the gate and on the flight back to Seattle. When her dad died four weeks later, Catherine was grateful for his loving words.

The lesson we learn from Byock’s patients is to speak now and not wait until the crisis arrives to say these simple phrases to each other. We all have relationships that need attention so tend to those relationships now.

Call someone you hurt and ask for forgiveness – even if that pain was inflicted years ago. Tell your children, your spouse, your parents how much you love them and why.

Life brings challenges. Thank the people who have carried your burdens with you.

If we wait until a crisis hits, we could miss our best chance to say the simple words that matter most.

Q: It seems like within just a few months of a loved one’s death, friends, and sometimes even family members, stop talking about them. How do you keep a person’s memory alive?

A: In the United States, grief is often seen as something to get over quickly. Most companies don’t offer bereavement leave, and those that do limit it to two or three days.

People are expected to return to “normal” as quickly as possible. In contrast, other cultures honor their dead, and the grief process, for a much longer time.

For instance, Rebecca’s brother-in-law, Pietro, was born and raised in Sicily before coming to the United States as a young adult. Many of the widows in his village wear black clothes for the rest of their lives.

Pietro died last fall, and his widow, Rebecca’s sister Lucia, will travel there soon on business. She’s debating whether it would be hypocritical to wear black there when she doesn’t at home.  

Those hoping to honor their deceased for an extended time in the United States must fight against cultural biases against prolonged displays of grief. Still, survivors have found creative and healing ways to keep memories alive.

Some take out in-memoriam classified ads in the newspaper for years after a loved one’s death. In a recent ad in The Spokesman-Review, family members wrote this to a child who had died young: “It’s hard to believe it’s been three years since we’ve seen your smile … it seems like an eternity.”

Others create sustaining projects.

In 2002, Susie Stephens, a national bicycle advocate and environmentalist, was killed while crossing a street in St. Louis. Her mother, Nancy MacKerrow of Spokane, started planting trees in Susie’s honor. She calls this project the Susie Forest and has planted more than 120 trees around the world.

At the tree-planting ceremonies, MacKerrow shows those gathered photos of Susie and explains Susie’s passion for the environment.

Catherine knows a family that has memorialized their son with river rocks. Carved with his name, “Zack,” on each stone, the 3-inch rocks are given to friends to take and leave at their favorite destinations.

The family shares Zack with the world, knowing that when the rocks are discovered or viewed, their son’s name, and his memory, will be shared. Stones remain in countries all over the world.

Your friends, and other family members, may no longer talk about your deceased loved one, but you can keep the conversation going in ways limited only by your imagination.

Catherine Johnston, a health care professional from Olympia, and Rebecca Nappi, Spokesman-Review features writer, welcome your questions about what to do in times of illness, dying, death and grief. Contact them through their EndNotes blog at blogs/endnotes.

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