After a cancer diagnosis, patients and their loved ones often initially focus on choosing a course of action and fighting the disease.
But if the cancer becomes terminal, the effort may shift from taking action and “fixing things” to easing the dying process and accepting that the end of life is near. For many people, this is an even more difficult and frightening place to be.
If a loved one or a close friend is nearing the end of life, you may desperately want to say or do the right thing, but you may not know what that is. And even as you try to be strong and supportive, you may feel so helpless and overwhelmed by fear and grief that you wonder if you’re up to the task.
Those feelings are normal, says Talia Zaider, a Memorial Sloan Kettering clinical psychologist. “It’s really important and helpful to recognize that most people don’t know how to navigate this territory, emotionally or pragmatically,” Dr. Zaider says. “I tell people that it’s OK to not know what to do and not know what to say. There is no manual here.”
Nor is there one right way to react to, cope with, or approach the end of life. “I have not met any two people who navigate this the same way, and that applies to the initial diagnosis, terminal illness, and how people grieve,” Dr. Zaider says.
With that said, if you have questions about how you can best support a friend or loved one through the end of life, Dr. Zaider offers this guidance.
Let your friend or loved one take the lead.
When people have a terminal illness, they may want to fulfill last wishes or create meaningful experiences with the time they have left. But not everyone does. Just as some people may enjoy reminiscing, others find memories of better times painful to think about and prefer to stay in the here and now. Depending on the stage of their illness, your friend or loved one may not be up to talking but could appreciate the chance to sit quietly in your company.
Take your cues from them. If you’re unsure of what to discuss, listen more than talk. If you don’t know how long you should stay during a visit, it’s OK to ask if they’re getting tired and need to rest or if there is something you could do to make them more comfortable.
Don’t wait until the last minute.
At the end of life, there may be certain conversations you or your loved one need to have. This could be about practical matters such as making final care decisions or getting finances in order. It may also involve discussions about what’s going to happen after your loved one is gone and their wishes for your life going forward.
These are incredibly painful talks, but try not to delay having them, since a deteriorating medical condition can make it more difficult for your loved one to express their wishes.
There are no perfect words.
We spend so much of our lives communicating — texting, e-mailing, talking on the phone. Yet when it comes to talking about dying or saying good-bye to someone you love, words may fail you. “With someone we know so well, we can feel that we are supposed to know what to do or say,” Dr. Zaider says. “Releasing yourself from that pressure to craft the perfect response or to find the perfect thing to say is important.”
Sometimes you don’t need to say anything at all. Nonverbal communication —sitting beside them, holding their hand, lightly massaging them if that would be a normal part of your relationship — is all the communication you need.
Support the immediate family.
Partners and immediate family members are likely mentally and physically exhausted. Emotional anguish, caretaking responsibilities, and having to make difficult decisions can leave families feeling isolated in their pain and grief.
They need support, too. Ask if you can stop by for a visit. It may be appreciated not only by the person who is ill, but also by their family, who may feel less alone. “Families remember these little acts of kindness,” Dr. Zaider says.
There may come a point that a visit is not welcomed or even possible. If that’s the case, a phone call, a thinking-of-you note, or an offer to pick up groceries or drop off dinner can help make things a little more bearable for families.
Don’t let fear keep you from being there.
Knowing someone is approaching the end of life can stir up all kinds of fears — of your own mortality, of how difficult it may be to see someone you care about very ill. Being scared and wondering if you’ll be able to keep it together is a very understandable reaction, Dr. Zaider says.
It only becomes a problem when fears lead you to avoid spending time with the dying person, Dr. Zaider says. It takes courage to be there, but it can also be of great comfort to the person who nearing the end of life — and could be one of the most important, meaningful things you’ll ever do.
“Maintaining a meaningful presence with a loved one at the end of life, and jointly acknowledging that death is imminent, can actually open opportunities to both give and receive comfort, to feel more prepared for the loss, to huddle and share grief with others, to celebrate a life lived well, and to highlight stories of pride and legacy,” Dr. Zaider says. “Research suggests that those who are able to engage in these kinds of conversations and who feel more prepared for the death of a loved one are then much better able to manage their grief in the aftermath of loss.”