What do you say to people who are just beginning to deal with dying?

There are some phrases that we tend to use a lot. I can’t tell you how many times I have said, “I wish things were different,” or “I’m so sorry.” Of course, you must not only say it but mean it. And even in the midst of shock and anger and despair, there are always healing things you can say. For example, I often hear myself saying, “You have such a beautiful family,” or “I am feeling a lot of love in this room.” It is not only pointless but harmful to pretend that dying is not happening.

On the other hand, if you do it right you can help people find lasting meaning—even something beautiful in it. More important than anything we say is to listen—asking questions, being quiet and present.

How do you figure out what patients need?

You have to identify what is important to each person. There are some questions I always ask. One is, “What is the worst thing about this for you?” You might think you know in advance, but patients and families can often surprise you. Sometimes it is simple things that bother them—such as a need to see a pet, have a specific food or drink, or even just get some fresh air. These are easy to provide. But everyone is different.

For one it will be pain, and as I said, there is always something we can do to decrease discomfort. For another it will be fear, and we can always take time to listen and help explain what is happening. For others, it is the worry that they will become a burden to their family and friends. But in many cases, we help them discover how much their loved ones really want to care.

It is important to help patients and families recognize that it is not all darkness. There is an immense bright side. For example, I always ask patients and families what they are hoping for. At first, they may have difficulty saying, and their answers often change over time. Some will say that they are hoping for a miracle cure. Others tell us that they want to die at home. Others want to see someone again, or make it to a particular milestone, such as a grandchild’s graduation. Whatever it is, we do our best to help people live their remaining days for what matters most to them.

You must encounter some really heartbreaking situations.

Of course, but every such situation can be handled poorly or well. I still vividly remember the first time I sat with a young man whose wife had just died. “She never said goodbye,” he said, crying. “I wish she would’ve.” In such a situation, you could just agree and say, “Yes, it’s really too bad.” But instead, we talked about why. As we talked, he came around to the idea that she had never said goodbye because, for her, doing so would have seemed like giving up, and her way of loving was never to give up. It still hurt deeply, but through our conversation he found some peace.