End-Of-Life Conversations: We Need To Talk

End-Of-Life Conversations: We Need To Talk

Amanda and her mom

by Amanda Geffner

During my mother’s brief battle with terminal cancer, I was only 31, still single, and in grad school with career plans best described as uncertain. At the time, I placed a high priority on showing my mother — and myself, if I’m to be fully honest about it — that I was doing okay and going to be fine, despite the impending tragedy. It wasn’t a belief in which I was fully invested, but it felt like the right message to send.

I recall my mother eating tiny bits of melon (it was all she could keep down) as I modeled a dress bought from a street vendor. My brother and his longtime girlfriend quickly planned and held their wedding in her home. We wanted to let Mom know the lives she’d help create for each of us would go on, which provided her a modicum of comfort — or so I believed. I didn’t let her see the part of me that felt life would not, indeed could not, go on without her. That part I kept hidden, to spare her, and — again, to be fully honest — because I was too scared to voice this even to myself.

And so, on the day of my brother’s wedding, after the vows had been said, I sat on my mother’s couch with my head in her lap, weeping silently, hoping she couldn’t tell, and swallowing the words I couldn’t share about how much I would miss and still need her after she was gone. In retrospect, I can forgive myself, and my mother, for not managing to go there together, given each of our limits and the extent of our fears at the time, but today I find myself encouraging others to be more open with a dying loved one, if they can.

When someone we love is facing death, of course we care tremendously, but we often tiptoe around it, in an effort we perceive as protective for both our loved one and ourselves. However, our protectiveness often serves to increase our loved one’s sense of isolation, as well as our own. Instead, what we can do is acknowledge the painful truth, as well as our fear of it, and just be open and truly present with them. This takes courage, centering oneself, employing long deep breaths, and keeping oneself in the moment. Doing so allows us to better prepare ourselves and also better prepare the loved one who is dying.

But many people avoid this kind of preparation. They feel that talking about death is equivalent to hastening its arrival, as if being silent on the topic might actually trick the Grim Reaper into skipping over your loved one. Sadly, it doesn’t work that way. Whether we’re facing the end stage of a terminal illness, the gradual failing of an aging parent, or the awareness that we, too, will die someday, death is a reality for all living beings and there is no causal connection between talking about it, or avoiding the topic, and its certain eventuality. On the other hand, some true comfort and peace of mind may be derived from an open and honest discussion, as well as an acknowledgement of the dying person’s wishes with regards to burial, cremation, organ donation, type of funeral or memorial service, individuals he or she wishes to have involved in planning such events, and various forms of legacy.

It wasn’t until my mother was gone that I found out she had asked her second husband to have her cremated. She and I never got to speak about these matters, due, in part, to the suddenness and brevity of her illness. Although I respected my mother’s wishes, the lack of a formal plan for saying goodbye (religious or otherwise) made the loss more painful for me, and I truly wish I’d been able to discuss with her my feelings about her having a burial plot, which would have been of comfort to me and others in my family. Moreover, there are often necessary talks about unfinished business and how to go on living fully to the end. Blessings to be given, forgiveness to be asked, and given, reconciliations to be made, silences broken, feuds (in best of worlds) resolved. A dying spouse, for instance, may reassure his or her partner that it’s okay to live — and love — again.

Discussions about the death process itself, though it seems taboo, may indeed be essential. Issues of setting (home or hospital), hospice and palliative care can be critical to a dying person’s well-being, yet might be left unaddressed when well-meaning loved ones fear the impact of being honest about the topic. The cost of such seeming protection can be devastating in terms of prolonged suffering, unwanted procedures, and missed opportunities for connection and comfort. While trying to heal from a serious illness or injury, we generally avoid considering the possibility of non-survival, yet there is wisdom in the Buddhist practice of regularly contemplating our own death (i.e., an acceptance of death and of the fact that it might come at any time). Such consideration might also serve to put us more at ease and acclimate us to both potential outcomes. Angelo Volandes’ The Conversation and Atul Gawande’s Being Mortal: Medicine and What Matters in the End are two books by doctors, both of which address the above philosophy in practical and poignant ways.

The members of a spousal bereavement group I’ve recently had the privilege of facilitating have taught me much about what couples (as well as other family and friends) can do to prepare, together, for a peaceful and emotionally supported death. Choices about surroundings and meetings with friends and family, about music, art, aroma, comfort objects, massage, meditations, prayers, and even the holding of small celebrations in one’s final days, can all provide immense reassurance to both the dying and the surviving.

A mother now myself, with my career well underway, I think of how I’ve made good on the promise to my mother: I am okay. And I think, too, about the talks we might’ve had in her final days, had I been the person I’ve now become. I like to think my mother knows this, too.


Amanda Geffner, MA, LCSW, is a clinical social worker with Family Centers, serving Greenwich, Stamford, Darien, New Canaan, CT, and Westchester County, NY. Family Centers is a United Way, New Canaan Community Foundation and Community Fund of Darien partner agency that offers counseling and support programs for children, adults and families. For more information, call 203-869-4848 or visit www.familycenters.org.

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