Communication Currents

Facing the prospect of talking with a dying loved one can generate a great deal of apprehension, anguish and an array of questions. A new book, Final Conversations: Helping the Living and the Dying Talk to Each Other, explores the tangible benefits of communication at the end of life and provides answers regarding the best ways to approach and improve these interactions for those who must go on living.

Communication scholars Maureen Keeley and Julie Yingling interviewed over 80 people who shared their recollections of their final interactions with dying loved ones. Across these interviews, they found that four messages dominate last interactions: love, identity, spirituality, and everyday talk. What follows are brief explanations of why these topics are important and some advice for having a final conversation.

The message of love was nearly universal and communicated directly (through words, such as, “I love you, and nonverbal actions, such as holding hands, kissing, and hugging) and indirectly between the Living those who participated in interviews.) and the Dying (their loved ones). Messages of love are important because they continued or recreated a connection and affirmed the relationship. One of the people interviewed shared her grandfather's conversation with his family prior to his death:

Let yourself love somebody because that's the most important part of life . . . the most important person is the person that's there until the end. That's the most important person in your life. He was holding his wife's hand the whole time. And then he leaned over and gave her a kiss. He was very affectionate with her. And when he said that he looked at her . . . you could see the tenderness between them.

Ultimately, the messages of love gave the Living a sense of completion and closure of their relationship with their dying loved one.

Common to three-fourths of the interviews were messages of identity. The Dying often focused their final conversations on the Living's personal characteristics (e.g., physical attributes or personality strengths) or descriptions of what the relationship had meant to them. For the Living, hearing personal insights from the Dying triggered an examination of how the Living saw themselves or how they perceived their role within the relationship. For instance, Tory, another respondent, said that her dying brother told her “I'm going to miss the fact that you always have a band aid for my wounds.” This simple message was meaningful to her because it allowed her to see herself in a new light:

I gave him another way of looking at things or just listening. . . . I think maybe that's what he meant . . . it was such a good feeling for him to say that . . . because all this time, I thought I was more needy of him than he was of me.

People see themselves most clearly through the eyes of those they love and respect. When that loved one is dying, the Living is compelled to listen, to believe, and to take to heart the powerful identity messages exchanged because the trusted and loved messenger is dying and therefore has no reason to lie.

Messages of spirituality were found in two-thirds of the final conversations. Direct statements of religious faith or spiritual experiences were exchanged between the Dying and the Living. For instance, Karen's dying father told her:

You don't need to worry about me. . . . I'm going to heaven. . . . Jesus is my savior, and he is yours, too. Don't you ever forget it. . . . I'm going to heaven and I'm going to be fine.

Others describe an extraordinary occurrence like respondent Betty Lynn's experience of a golden light or ray of energy that hovered over her just seconds before her close friend was pronounced dead. For the Living, such uncommon events served to validate their beliefs, provide comfort, and in some instances, redirect the living one's own spiritual journey. These final conversations offered hope in an after-life, and the promise that the Living and the Dying would be together again someday.

Everyday talk and routine interactions were acknowledged in half of the final conversations between the Living and Dying, helping the Living to realize that ordinary, even mundane conversations were an important part of their final interactions. Everyday talk includes chatting about other members of the family, the weather, gossip about friends or neighbors, and even responses to the evening news, sports, or television shows. Routine actions included ordinary things such as sharing meals, watching television together, listening to music, playing cards and games, or assisting with daily grooming and hygiene needs. The Living also recognized the importance of familiar exchanges of understood expressions, eye glances, and smiles. In his interview, Sam reported that he had videotaped his mother's final conversations with his sisters' and him, about which he said:

We realized at the time that the interactions that were going on were really important. And it wasn't just that we were videotaping . . . some kind of major event. We were videotaping the mundane . . . unimportant things on the surface, but there were some real valuable things happening during that sharing . . . you can see little microcosms of my family on it.

Sharing ordinary interactions indirectly conveyed to both the Living and Dying the importance of those relationships; this type of sharing also gave them the opportunity to maintain a sense of normalcy within their relationships. Relationships are largely made up of routine and ordinary moments; so why should communication at the end of life be any different?

At the end of life, the Living may be trying to communicate in the midst of stress and emotion, which makes interactions more difficult and challenging. Keeping the following suggestions in mind may help the Living and the Dying have final conversations that are positive, productive, and powerful. Good communication takes focus, favorable circumstances, and skill. From their interviews with those dealing with this issue, Keeley and Yingling share this advice:

First, forget your set expectations. Be ready to listen and follow the final conversations where it naturally takes you. Second, set the stage. Be sure to try to talk sooner rather than later because as the Dying get closer to death, they may be more physically limited. Try to choose a quiet time and private place for your final conversations. Third, be ready to use your best communication skills. Specifically, be other-centered by focusing on what the other person is saying and needing. Ask questions and paraphrase what the Dying are saying to clarify meaning as well as to let the other person know that you are truly trying to understand the message. Be sure to watch the Dying's nonverbal communication because a person's facial expressions, body movement, voice, and touch can tell you what the person is feeling and thinking.

In sum, let the Dying one lead the way and be ready to receive what they offer. Communicating with the Dying is never easy. Grief, fear, uncertainty, and even anger can silence our tongues. Yet, not having a final conversation with a dying loved one can be much worse. We may be left wishing for one more interaction, longing for one more hug. Final conversations do not take away the pain or grief that accompanies the death of a loved one, but they can and do offer a roadmap for how to travel this difficult journey—one that every one of us has to take when a loved one is dying.