Everyone Needs a Hand to Hold Onto: Supporting Loved Ones Near the End

When it’s all said and done, is it really all said and done? That’s one of the major questions facing all of us as our loved ones are in their final days: What do you say and do? What should you say and do?

The best advice is to play it by ear and understand that while you might mean well, it’s not about you. Let the senior set the tone as to how much or how little is said. Be aware that there are times when the less said, the better. And understand the power of touch, not to mention sound.

Dr. Ira Byock, professor emeritus of Medicine and Community and Family Medicine at the Geisel School of Medicine at Dartmouth and author of three books on end-of-life issues, addressed this topic at length during a past National Palliative Care Week in Melbourne, Australia. Byock, who has been involved in hospice and palliative care since 1978, pointed out that we can learn a great deal from our mortality, if we allow ourselves to do so — while quickly adding that most of us avoid doing so “at all costs.”

What matters most

The biggest lesson is that the best things in life aren’t things. Rather, it is the relationships we’ve forged that matter most. Byock has seen it himself, again and again: The foremost thought on everybody’s mind as they are being wheeled into an operating room is their loved ones. They stand as everyone’s most precious possessions, and as a result such relationships must be serviced — and can be, right up until each of us takes his or her final breath.

Byock wrote about that in his 2004 book, The Four Things That Matter Most, the thesis of which is that these things should never go unsaid, in any relationship: “I love you;” “I forgive you;” “Please forgive me;” and “Thank you.” In other words, forgiveness and gratitude are the basis for every healthy association, things that can and should be shared regularly, right up until the end.

Start with self-examination

Byock noted in his Melbourne speech that before anything else it is important to forgive oneself, something that is (again) somewhat difficult, as too many of us tend to fixate on the many ways we’ve erred in life. He preached self-acceptance, as well as an understanding of human frailty, while adding that forgiveness is not akin to absolution. Rather, he said that it means that each of us needs to come to the realization that the past cannot be changed, while recognizing that it need not control our future.

With that as a foundation, we are free to make it right with others. And here Byock mentioned a client who had been emotionally abused all his life by his father. With the older man on his deathbed, would his son be able to share the four things? In time he was able to do so, if only with the considerable coaxing of a mental-health professional. And his father responded in kind, though Byock said that isn’t always the case. Nor, he added, should it be the expectation, as a person can only tend to his or her side of a relationship.

Never too late

The point is, it’s never too late to make amends, nor to reinforce an existing bond. As Byock said in his Melbourne speech:

“By celebrating all of life, by being joyful in the face of reality, by honoring the relationships that matter most, we can re-infuse a sense of health and wholeness, and make it possible for people to live fully and indeed to die well. My use of that term ‘dying well’ is indeed the highest health outcome.”

His own mother had died, he told the crowd, when she suffered a heart attack while driving on a California highway in 2003. Happily, there had been nothing left unsaid between them. But too often there are loose ends. Too often, as mentioned, loved ones don’t know what to say as a senior faces his or her final days. (And because of that, they often avoid being on hand altogether.) But they truly need to be there for them, as it is a matter of providing physical and emotional support. Someone looking at the end of his or her life is often wracked by various fears — fear of the unknown, fear of isolation, fear of leaving loved ones behind, etc.

Being there

It is up to the loved ones to let them know they are on hand to help — that they will talk if the senior wants, or just listen. That they will make their final arrangements for them, invite clergymen in if that’s what they want, even tend to mundane household tasks if they are at home. Again, it’s a matter of the senior setting the tone. Sometimes they just want physical contact — someone to hold their hand, for instance. (An elderly man in Byock’s orbit wanted nothing more than his son to shave him.)

Maybe the senior wants lots of visitors. Maybe he or she wants very few. Again, that’s a situation the younger folk can monitor, and remedy. Ditto for the amount of noise in the senior’s immediate area, if they are at home. While it has been determined that it’s wise to keep the volume on a nearby TV and radio at a minimum, it is also true that music can improve the mood of someone near the end.

In the final analysis, it can be difficult to watch a loved one slip away, but in reality it should be regarded as an honor to be there. You are on hand to help him or her make a transition. You are there to celebrate a life. And there’s much to be said for that.