November 15, 2011 in Features

Let dying patient dictate the conversation

Catherine Johnston Rebecca Nappi
 

Q. What kinds of questions are appropriate to ask a dying person?

A. The most important thought to have when you enter the presence of a dying person is no specific thought.

“The agenda for conversation needs to be the agenda of the one dying, not yours,” says hospital chaplain Luann McBride of Olympia.

Take cues of what is important to the person by what is in the room: pictures, books, a special quilt, letters and cards. These items can be topics of conversation with the one dying, McBride says.

“If the one you are visiting is able to communicate with you and is encouraging your visit, still keep the visit brief, though you may express your desire to sit, to be with them. Few words are needed,” she says.

While you may be tempted to ask many questions, remember that dying is exhausting. Don’t expect to converse and laugh as you once did. A patient may have to “work” just to breathe or raise a hand to extend to you, says hospital chaplain Joy Martin of Olympia.

And listening is more important than asking questions. Dying people may appear to be in a transitional reality, looking intently into space or reporting conversations with people who have already passed away. Do not dismiss these behaviors.

In their book “Final Gifts,” hospice nurses and authors Maggie Callanan and Patricia Kelley explain that dying people often make statements or gestures that seem to make no sense, leaving family to dismiss the behavior or medicate the patient unnecessarily.

The authors observe that dying people’s messages fall into two categories. Patients may describe what they are experiencing, or request something that is needed for a peaceful death.

When Catherine’s grandmother was dying, she kept reaching out, as though she was trying to hug someone close to her. Then she asked her visitors, “Have you met my husband?”

The visitors replied, “Why, yes, we have.”

Her husband had died nine years earlier. To have said that her husband was not in the room and already passed away would have challenged their grandmother’s present reality.

When you come to the bedside of dying people, pay attention to their words and gestures.

As Callanan and Kelley advise: “By keeping open minds and by listening carefully to dying people, we can begin to understand messages they convey through symbol or suggestion.”

Q. My brother-in-law just died. My husband was never close to him, and they have been out of touch for several years. What would be an appropriate response?

A. Encourage your husband to acknowledge the death to his brother’s family, through a card, letter, flowers or a memorial donation, no matter how angry he feels right now. And he’s likely pretty angry.

We will know our siblings longer than any other family member. Our parents usually die before us, and we’re in our 20s or 30s when children come along. But our siblings have been with us from the get-go.

So anger about a sibling’s death is common and expected. Even when siblings have been close, anger surfaces.

Diana Hornbogen, a Spokane psychotherapist who specializes in family mediation, lost her 40-year-old brother when he was “snuffed out by a drunk driver.” She felt rage at the injustice, and she mourns the fact they won’t grow into older-age siblings together.

“This man was so alive and so much fun,” she said.

Hornbogen said that when siblings are estranged, and one dies, the grief gets complicated.

She recommends that whenever possible, estranged siblings attend memorial services. Weddings, family reunions and funerals give families the opportunity to reconnect.

Most family feuds begin over issues that look superficial and silly in retrospect, such as arguing over who gets the childhood Christmas ornaments when mom and dad die.

Some estrangements, however, result from abuse and people need to gauge how safe or unsafe they feel reconnecting with a family where abuse happened.

How honest should your husband be in a condolence message to his brother’s family?

If he sincerely wishes he and his brother had patched up their differences, he should say so. He shouldn’t rehash with them the reasons behind the estrangement.

Hornbogen said estrangement between siblings is so common that it touches almost all families, even famous ones. The twin sisters who penned the famous advice columns Ann Landers and Dear Abby didn’t speak for 10 years after a perceived insult. Actress Julia Roberts feuded for years with her actor brother, Eric.

When siblings are estranged, it ripples through an extended family. Their children lose family history and connections with cousins.

Hornbogen recommends that estranged siblings seek professional help to resolve feuds before one of them dies.

“I’m sorry” is the most honest response from an estranged sibling to the grieving family, because sibling estrangement is almost always a sorry mess in the end.

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 blog at www.spokesman.com/ blogs/ endnotes.


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