Follow the "Preparing for a Good End" series here.
In this series, we'll examine ways of making meaning in the face of death, offering tools founded in traditional wisdom and scientific evidence to help our readers live well right to the very end.
There’s a story I won’t forget from my time working as a registered nurse in our hospital’s COVID-19 unit during the heat of the pandemic.“Jerry” and “Debbie,” both in their 80s, had been married for decades, raising kids and grandkids together. After struggling for two weeks to fight COVID-19, their organs were failing irreversibly. Family members agreed it was time to remove life support and let them die peacefully.
We rolled Jerry and Debbie into a room in our step-down isolation unit and snuggled their beds close, helping them find each other's hands. They knew they were side-by-side as their hands curled around each other.
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The Human Longing for Closeness
“Ask a man who is being wheeled into transplant surgery or a woman facing chemotherapy for the third time what’s on his or her mind and the answer will always involve the people they love," Dr. Ira Byock, a palliative care specialist, writes in "The Four Things That Matter Most." "Always.”As Jerry and Debbie drifted in and out during their final days and hours, hearing the voices of family and friends over video calls and lying next to each other during their last day, they likely thought of loved ones, those alive and long departed.
Jackie’s Convincing Story
In her blog called The Palliative Provocateur, Rebecca Gagne-Henderson, Ph.D., APRN, ACHPN, a palliative care specialist who has worked with dying patients for 27 years, tells a convincing story about this human hunger."Jackie," a local gang member, learned she was dying at age 22. Initially bitter and hostile, she slowly softened under the care of her kind hospice nurse, Pat. In a vulnerable moment, Jackie told Pat the one thing she wanted before dying was for her mom and dad to care for her together. Jackie's embittered parents had divorced 17 years earlier, leaving her and her siblings in the care of revolving family members.
Through the perseverance of the hospice chaplain, Jackie’s parents miraculously agreed to stay with her for three days, bathing, changing, and feeding her, caring for her in a way Jackie likely dreamed of since she was 5. By the third day, the hate and anger between Jackie’s parents melted, and the three wept together as they forgave each other.
The next day, Jackie, once rife with bitterness over dying, told Pat, “Now I can die, and it is OK. I did what I was supposed to do."
After caring for seriously ill and dying patients since 1978, Dr. Byock said he believes that “healing and wholeness are always possible,” no matter how damaged a relationship is.
“The specter of death reveals our relationships to be our most precious possessions,” he writes.
Four Things That Matter Most
After 27 years of tending to dying patients, Ms. Gagne-Henderson told The Epoch Times that spiritual distress (unresolved relational and existential pain) at the end of life causes the “ugliest deaths, much worse than physical pain.”We know a relationship is complete, Dr. Byock argues, "when we feel reconciled, whole, and at peace," which helps one avoid the distress of an "ugly death."
Dr. Byock said he is convinced that saying these four phrases may be the most potent way to bring emotional peace to the living and the dying alike:
Please forgive me.
I forgive you.
Thank you.
I love you.
“Using the four things,” Dr. Byock writes, "we can deliberately decide to make our relationships whole. This can bring about a sense of completion before death is imminent.”
The 4 Things Are for The Living, Too
Finding meaning and reconciliation is essential to dying and living well. Death presses loved ones together like a pressure cooker, causing peace or turmoil. Dr. Byock encourages those seeking peace to pursue it sooner rather than later, not waiting for the raw motivation of death to press in.“I’ve lost count of the number of times I’ve met people in my office, an emergency room, hospital or a hospice program,” he writes, “who have expressed deep regret over things they wish they had said.”
This sentiment echoes Harriet Beecher-Stowe’s words, “The bitterest tears shed over graves are for words left unsaid and deeds left undone.”
Lack of reconciliation creates a flowing undercurrent of spiritual distress that keeps nagging until one finds relational healing. For grievers of estranged, dead loved ones, an unresolved relationship causes complicated grief, a psychological term for survivors' long, arduous, and sometimes unresolved grieving processes.
When we embrace the four things earlier in our lives, they become an attitude we cultivate. According to Dr. Byock, we then internalize the phrases, repeating them to ourselves and our loved ones—“Please forgive me ... I forgive you ... Thank you ... I love you.”
For the living and dying alike, these words transform legacies of pain into legacies of joy.
“The healing of a broken relationship,” Dr. Byock argues, “in the last hours or even minutes before death, can reframe the history of the relationship and the biographies of everyone involved ... They present an extraordinary opportunity, one that is available to us all to use in our lives to heal any relationship, any day.”
When Reconciliation Feels Impossible
To some, Dr. Byock’s four phrases may seem too simple for deeply painful relationships brimming with damage. Yet he's not the only palliative care provider who has seen transformation unravel from fractured relationships when one party dares to be vulnerable.Sallie Tisdale, a veteran hospice nurse, offers similar hope in her book "Advice for Future Corpses (And Those Who Love Them)." She writes to caregivers of the dying, "Make room for the possibility of changing the course of a life even at the last moment.”
Hearing is the last sense we lose in the dying process. Dr. Wyatt said she believes that you may experience peace and offer peace to a dying loved one when you whisper necessary words into their ear, whether they respond or not.
Dr. Byock acknowledges the many challenges of saying the four things, such as overcoming legitimate, deep-seated anger toward the one dying, but he writes that the four things can help you find better options than any amount of bitterness.
He also offers advice and hope for when a loved one dies too soon or becomes lost in dementia before you reconcile with them. He said he believes in saying the four things anyway. Perhaps they can understand or hear you. Either way, it will do you a world of good.
This article completes our series "Preparing for a Good End."
