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Cancer and Health

Terminal illness

I don't know what to say

By Dr. W. Gifford Jones

How many times have you been in this agonizing position? A beloved family member has a terminal illness. Or a good friend is dying of cancer. You enter the hospital room and don't know what to say. The majority of people flounder badly when faced with this situation. But you can avoid falling into some of the pitfalls which cause anguish to both you and the patient.

Dr. Robert Buckman , a cancer specialist at the University of Toronto, has written a book, "I Don't Know What To Say". He stresses the first step is to establish the correct physical setting and atmosphere to achieve rapport with the patient.

Don't look at your watch as soon as you enter the room. Instead take off your coat and pull up a chair. Indicate you're there to spend some time. Physical distance between you and the patient is important. Don't sit on the opposite side of the room. That's too impersonal and awkward for intimate conversation. But sitting too close may make the patient feel hemmed in and trapped. The most comfortable distance is two to three feet. Keep your eyes on the same level as the person you're talking to. And look at the patient directly when he or she speaks.

Listen, and, above all, show you're listening. But it's impossible to do this well if you're intent on rehearsing a reply. If you do this you are in effect prejudging what you think is going to be said rather than listening. And don't interrupt a loved one's conversation. Instead encourage the talk by saying, "Tell me more."

But there are also moments when you shouldn't push conversation. Sick, troubled people, when they stop talking, may be thinking of something sensitive and painful. So wait quietly even though silences at these times seem to last for ages. Their next remark may be the very thing they really want to talk about.

There are times when silence is preferable to words. As Dr. Buckman says, "not knowing what to say at certain times may be because there isn't anything to say." This is when hand holding or putting your arm round the person's shoulder may carry more impact than words.

What do you say if a loved one says," I feel dreadful and you're no help." Professor Buckman says the normal reaction is to reply, " I'm doing my best," or " Stop criticizing me." But these responses tend to trigger a further emotional rift. It's wiser to bite your tongue and remember this anger isn't directed at you personally.

The best approach is to say," How dreadful do you feel?" Or "You really sound low." This stimulates more discussion and encourages the patient to say what he's really worried about.

Constable de Montmorenci, on receiving a mortal wound in 1567 remarked, " I have not lived 80 years without learning how to stand dying for a quarter of an hour." Many people are not that tough, and may ask you very direct questions that must be answered correctly.

For instance, a loved one may ask, "I am going to get better, aren't I?" The natural reaction is to say," Of course you are." But remember that you will lose credibility later on as the condition gets worse, and what the dying need most is someone to trust.

It's better to reply," What did the doctor tell you?" Or "I hope so." This indicates some ambiguity about the future, that it may be difficult but you will continue to be there and supportive.

Some patients may say, "I'm not ready to die." If that happens don't say," You mustn't talk like that." It's better to reply," Tell me what is worrying you the most." Or if it's a parent then simply hold hands and try to reassure him or her.

Try to circumvent one common scenario. We all have the tendency to flock around a patient who is suddenly confronted with a serious illness. But when the patient's condition gets worse too many of us disappear into the night. One should never abandon a friend or loved one in the latter days of a terminal illness.

There is no magic formula that suits every occasion. Communication, however,whether by talking, by sympathetic silence or by touching, is still the greatest comfort to those who are sick, frightened and lonely. But also bear in mind that most of us are not professional actors. So don't try to deceive dying patients. They are best served by kindness and honesty. The best therapy for them is to know they can count on a sincere friend who has learned to listen, to talk at the right time and when there's nothing more to be said, to simply hold their hands.

W. Gifford-Jones M.D Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is:
Dr. Walker can be reached at

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