Death and dying

Everyone reacts differently when they have a life-threatening illness. Their reaction will depend on many factors that include personality, relationship styles, spirituality and religious beliefs, and how they have coped with difficult situations in the past. You, as their friend or loved one, wish to help by words and actions. Being able to talk about your friend's death with them is very difficult. However, this can also bring a growing closeness to your relationship, because the two of you can share your feelings.

Culture is very important in talking about death and dying. In some cultures it is not acceptable to talk about dying as you may bring it about sooner or show lack of hope for the person who is ill. However, most people at some point wish to talk about what is happening to them and there are some tips to help you to be a supportive friend.

How do I know when my friend wants to talk?

Give the person time to talk. You don't have to fill every second of your visit with talk to avoid a difficult situation. The person who is sick may say "Well, I guess this means I've had it" or "Looks like I'm not going to escape it this time" (e.g., cancer has recurred or spread to a different part of the body). You may be tempted to encourage them and say things like, "Oh, you'll be fine" or "Don't talk like that. I'm sure the treatment will fix it." However, often the person is wanting to talk but can't come right out and say "I'm dying." If you reply with a phrase that rejects their feelings (such as, "You'll be fine," or "Don't talk like that") the conversation won't go any further. A more helpful reply would be "You must find this very difficult" and you can ask them why they think they have had it. This acknowledges their feelings and says you are willing to listen to what has been happening to them.

What kind of feelings can I expect my friend to have?

There is a wide range of reactions in someone who is dying. These reactions will change and may change frequently. For example, if someone has just found out that they are going to die in the next few months, they may be sad; angry at themselves, the world, God, or you; guilty that they may have brought this illness on themselves; despairing or feeling depressed; pretending that everything is normal; or calmly accepting what is happening. There is no set pattern for these emotions, although generally the emotions will change rapidly in the first few weeks after the diagnosis as the person begins to adapt to the new reality.

The best way to help your friend is to acknowledge the different emotions that they are having. Stating things like, "You must be feeling a lot of different emotions" will help the friend to feel that you are really listening and hearing what they are feeling. If your friend is crying, don't stop the discussion to avoid their tears. Also, if you cry don't change the conversation. Expression of feelings by crying is normal and should not be avoided.

What should I say?

Listen rather than talk. Don't try to suppress or reject any feelings the person may have. Some of their feelings may seem absurd, such as guilt over their disease or denial that anything is wrong. Your listening will help them work through those feelings. If the person has just recently been told that they have a life-threatening illness they may repeat the same stories or thoughts repeatedly. This is normal as their life has dramatically changed and the mind is in great upheaval.

Don't give advice. First of all, the person likely will not take it in. Secondly, you may be adding extra stress, particularly if you are critical of their current treatment or health care providers. Only give advice if you are asked to give it.

What about my own feelings?

You may feel great sadness at the impending loss of your friend. You may feel angry - angry at the health care providers for not being able to cure this, or angry at God for letting this happen. You may even be angry at your friend or loved one who is ill - why did he smoke? Why does she have to die now when we have kids to look after?. These anger feelings are often an expression of fear. Fear of how you will cope when that person is dead. You may also fear their sickness or fear that you may not be a good caregiver. Anger towards the one who is dying may be a way of separating from them but it is not healthy. Bursts of angry thoughts are quite normal, but if your anger persists you should seek help. Talking with others not involved in the illness can be very helpful in getting out your own feelings. Examining your fears in a supportive atmosphere with another person will help the fears to seem less overwhelming.

How do I express my feelings?

Many people try to hide their feelings of sadness and fear from their friend who is ill because they wish not to upset them. However, expressions of sadness and concern for them are appropriate and should be said. Feelings of love and support are extremely helpful to the person who is ill. The greatest fear of many people who are dying is being abandoned. You can show your love by reassuring them of your presence throughout their illness. Recalling a time when they have been helpful to you is worthwhile. Knowing that they have made a difference to you gives meaning to their life.

Throughout the illness, there will be times when you are frustrated, impatient, angry, and resentful towards the person who is ill. Don't suppress these feelings as it may harm your relationship. Talking these feelings out with another person not connected to the illness will be helpful and give you the energy to carry on.

What about the person who seems to avoid talking about their death?

If it is in your culture to talk about death, yet your sick friend seems to avoid talking about it or even deny what is happening, this can be very difficult. You may wonder if they really have been told what is happening. The person usually does know very well that they are dying. They may be avoiding talking about it so as not to make others sad or hurt them. They may feel fearful themselves and so avoid the topic. They may also fear that you will abandon them if they talk about dying.

However, avoidance creates an invisible wall between individuals and families. The friends of the dying person feel shut out from the thoughts and feelings of their loved one and it tends to increase sadness and fear, rather than decrease it. Sometimes you can help by saying "I know it is tough for us to discuss what is happening, but I would feel better if we can talk openly about it," or "I know your sickness can't be cured and I would feel better if we could talk about this." Reassuring your friend that you will always be there for them before you do this will help.

If you don't feel comfortable with these types of discussions, talk to your health care professional who may be able facilitate a discussion about this.

Romayne Gallagher, MD, 
in association with the MediResource Clinical Team