Talking Before Death

After many years in ministry if there's anything I have learned it is how to talk about difficult things.

It's incredibly tricky, this opening up business. No,wait. No, actually it isn't tricky at all. Yes, it takes courage. Yes, it takes forethought. Yes, it often takes diplomacy and, naturally there can be unpleasant fallout. But discussing difficult issues, particularly end of life issues is emotionally difficult, not technically difficult and, yet, I still insist on it. Because NOT having these conversations can be emotionally devastating for years.

Here are simple steps to discuss important issues at the end of life. Remember, we are all dying and living in equal parts if we are living well, so consider your own answers to any question you ask of another.

Step 1: Consider the Conversation and Understand Your Motives* Is this an opportunity to impart information: medical directives, location of important files, funeral preferences, banking concerns?If so, make sure that this is a convenient and productive time and that records are kept of information imparted.
* Is this an opportunity for storytelling?
If so, introduce it as such with an invitation like, "I would like to share a memory from my life." Or "Our being together like this reminds me of that time..." People are open to storytelling when they know its purpose and are not pressed for time. People also like to swap stories, so if it is your need/intent to tell a story, it is only fair that you be willing to listen to someone else's story in return.
* Will this be a time of conflict or reconciliation? Do you need to bring up something that will cause hurt feelings or remind of past hurts? If so, think through why you need to tell this story and why now. Often people can hear very difficult things as long as they feel they were told in the most compassionate way possible. Thinking through why you need to have this conversation now can help you to clarify your communication and hopefully build bridges over past chasms.

Step 2: Set the Stage
Blurting things as someone walks out the door seems to be an infernally popular way of saying important things to people. It really isn't helpful. Whether you are the person near death or the comforter, leaving something big until the last second isn't very respectful and is kind of, well... cowardly. I have found that planning it for the middle of the visit does best unless there is no other subject about which you need to communicate, in which case charge forward at the beginning.

Also, if you know that you are about to have a whammy of a conversation play it out in your head. Where will people sit? How long will this take? Does there need to be privacy? Will things get thrown? Consider the options carefully and set the space, time, and details as well as you can for a smooth conversation.

Step 3: Speak clearly and succinctly. Make time for discussion.
This seems so simple but this isn't a grocery list we are talking about. For example, imagine you are in a hospital bed and you want to tell your 23 year old son that you are going to discontinue chemotherapy because you feel that it is no longer the right choice for you. There are as many ways to do this as there are people, but many people would respond favorably to a greeting, followed by some small talk, followed by how you have come to change your mind about chemotherapy. Then state succinctly, "And that is why I would like to stop the treatments but I wanted to talk to you about it first." Then, and this is the tricky part, let the other person process and make space for them to say what they are thinking and feeling.

Step 4: Recap why you are having this discussion in the first place.
Communication is delicate under the best of circumstances and these are the not the best of circumstances so repetition or reiteration is helpful. Examples of closing recaps include:

"Oh, Sally, I am so glad you came over so I could tell you about my childhood. I've been thinking about the past so much lately, and it feels good to be able to say it aloud to a friend."

"Jimmy, I hope I haven't bored you to tears, but there are a lot of financial elements to my life and we both would rather talk about baseball. Thanks for having this discussion with me about these concerns. I feel better. Let's get back to the baseball now"

"Mom, I know this is hard to talk about these things for both of us, but you are important to me and I love you. I don't want any misunderstanding from years ago to stand between us any more."

Good communication is something we all strive to learn but the times we need it most are the most complicated situations. By considering the conversation, setting the stage, speaking clearly, and giving a recap of the purpose we can have the significant conversations we need at the end of life. Or any time.