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Growing together at the end of life: Having honest, emotional conversations

Lisa Fields
March 12, 2018
Image via Getty Images/diego_cervo

A life-limiting diagnosis can be a frightening prospect, but some people learn to use the opportunity to their advantage. They decide to place more emphasis on significant relationships than they have in the past and become closer with their spouses, children, siblings, or dearest friends.

“Once we get past that shock of life-altering news, we can look at this as a gift of time,” said Dr. Maryjo Prince-Paul, associate professor at Case Western Reserve University’s School of Nursing. “It comes with an opportunity to do self-inventory, to take a reflective look at who am I and how do I want to leave a legacy.”

Some people may come to view their illness as a blessing of sorts if something meaningful emerges from the situation.

“Facing the end of life can put things into perspective and provide individuals with an opportunity to discover what and who is important,” said John Mastrojohn, executive vice president of the National Hospice and Palliative Care Organization. “Though not often thought of this way by most, the time near end of life is often one of incredible healing and growth.”

If you find yourself with less time than you had anticipated, you can choose to deepen relationships with loved ones during your final weeks, months, or years. This may require you to step outside your small-talk comfort zone and open up emotionally, but the results can be deeply satisfying.

Common messages

Prince-Paul’s research focuses on ways that people communicate and nurture relationships at the end of life. She has found that there are some universal conversation topics that people discuss toward the end of life. These include love, gratitude, apologies, forgiveness, and farewell messages. The undercurrent to all these deep conversations is love.

“How do we often affirm relationships? We tend to use emotional expressions of love. Love is a fundamental need,” Prince-Paul said.

Giving thanks

For some people, expressing gratitude becomes important when time seems short.

“Reflecting back on their life often provides individuals an opportunity to remember the many things they are thankful for,” Mastrojohn said. “Having an opportunity to express their gratitude is meaningful to them, as well as to those they are showing appreciation.”

Offering apologies or granting forgiveness

There are no rules about forgiveness. You don’t have to automatically apologize or forgive someone just because you’re nearing the end of life. You must feel motivated before you take action.

“We want people to take self-inventory,” Prince-Paul said. “What is the importance of doing this?”

It may be difficult to get someone to apologize to you, but there are ways to move conversations in the right direction.

“You may want to start by talking about yourself, including things that you have said or done for which you think you need forgiveness,” said Dr. Norman Abeles, professor emeritus of psychology at Michigan State University. “Sometimes this starts a conversation of mutual forgiving, which can be helpful to you and your loved ones.”

A new dialogue

You may have trouble opening up emotionally, especially if your family has never discussed feelings. But at the end of your life, you may feel compelled to say things that have gone unspoken.

“Is there any harm in letting someone know [your feelings]?” Prince-Paul asked. “You could say, ‘These are some of the things that I probably should have said before that I want to tell you now.’ You honor the relationship.”

If you’re unsure how to begin, start small.

“It is sometimes difficult to tell others how proud you are of them or even to tell them you love them,” Abeles said. “You might start by telling them things you like that they have done and accomplished and you never had the chance to tell them. If you are comfortable, you can say that you love the things they do and that you love them.”

Sometimes, your relatives may have things that they want to say to you, but they aren’t sure how to begin either. You can encourage conversation with two simple words.

“You can’t go wrong with the words ‘Tell me,’” Prince-Paul said. “‘Tell me’ means that I am inviting you into my sacred space. I can hear this is really important to you. Thank you for having the courage to tell me.”

If you’re at a loss for how to start a substantial conversation on your own, nurses or other caregivers may help to move things forward.

“If the person is in hospice care, think about asking a member of the hospice team for assistance,” Mastrojohn said.

Considering the alternatives

Sharing feelings of love, gratitude, or forgiveness can make you feel vulnerable, so you may hesitate, even if you’re ready to impart your message. Before you decide to shelve the entire topic, think about how you’ll feel if you continue to keep your feelings secret.

“It’s important to realize that time is limited and there may not be another opportunity to say these words,” Mastrojohn said. “You need to ask yourself, ‘How would I feel if I didn’t have the opportunity to say ‘I love you’ or ‘I’m proud of you’ or anything else I might want to say?’ If you feel you may be missing an opportunity and you’d regret it, then the sooner you do so, the better.”

It may be easier to tiptoe -- rather than plunge -- into the depths of conversation.

“Begin by talking about all the good things you have experienced over the years and tell them you want to talk to them about that,” Abeles said. “If they seem comfortable with that, you can talk about some disappointments, sad experiences, and things you would have liked to say to them earlier but felt uncomfortable doing so.”

Loved ones can benefit, too

Once you introduce openness, honesty and meaningful reflection into conversations with your dearest friends and relatives, you won’t be the only one who feels emotionally closer. Your loved ones are affected by the exchange of loving words as much as you are, and they may want to continue the dialog.

Caregivers may want to share similar words of appreciation with you, to help you understand why you mean so much to them.

“Think about telling the person who is dying how they enriched your life or perhaps other positive ways they influenced you,” Mastrojohn said. “Individuals are more open to share when trust and a non-judgmental attitude are at the foundation. Being open and both physically and emotionally available can make a profound difference.” 

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