Lesson Seven—Communicating With One Who is Dying

Having discussed the stages of grief, this lesson addresses how a caregiver can increase communication with his or her terminally ill patient. It is important to remember that while your patient can still verbalize his wishes, it is best to ask his desires, such as whether or not he wants to see visitors, be with caregivers, or simply be alone. As his disease progresses, he may eventually become non-verbal. Asking his desires while he is still able to verbalize them will make your caregiver tasks easier later on as you will most likely be able to know what he needs. Respect for your patient’s desires is the most valuable gift you can give him.

The following are useful suggestions while serving the dying Vaisnava:

1. Be sure your patient wishes to speak with someone.

Speaking with someone who is terminally ill is not always an easy task and may sometimes make you uncomfortable. Your patient is undoubtedly experiencing many emotions at this time. Discussing them with you or someone else may or may not assist him or her in reaching sound conclusions. If he does decide to speak about his innermost feelings, he may become frustrated and angry thinking that no one can possibly understand what he is experiencing. A devotee of the Lord, as with anyone else, needs to go through a kind of “mental processing period” to come to terms with his life being suddenly cut short. He certainly has the right to spend his last days as he wishes in order to make sense out of what may appear to be a senseless situation. If you, as a caregiver, approach your patient thinking he wants or needs to engage in a deep conversation about his situation, you may be surprised to find that he has no intention of doing so at that time. Perhaps it is the wrong time, or perhaps he does not need to discuss these issues with anyone. Remind yourself, and others, that your patient may not be ready or willing to discuss something so multifaceted. His reactions should never be taken personally. You can always apologize for intruding and simply ask your patient if he or she would like to be alone for a while. Assure him that when and if he wishes to discuss personal thoughts, you will always be available.

2. Concentrate on the patient, not on yourself.

It is not uncommon for someone to engage in a conversation, but not really hear what the other person is saying. This can occur if we are preoccupied with our own responses. We may also be looking for what we want the speaker to say. While caring for a terminally ill devotee, you may become anxious for him to reach sound, Krishna conscious conclusions. Naturally, you may wish for him to reach certain spiritual realizations before his imminent death. But, please remember that spiritual realizations must be nurtured, never rushed. While engaging in a conversation, reflect your good intentions to your patient. Reflect the privilege of listening to your patient and you will be rendering a most valuable service to the dying Vaisnava. Fully concentrate on what he or she is saying. Validate his feelings, his realizations, and his wishes. Truly hear what he is trying to communicate to you.

3. Avoid giving advice unless you are asked.

There are several ways to quickly put a halt to your conversation with your patient. One way is to begin a sentence with, “If I were you I would…” Your patient may very well become frustrated and state, “Well, you are not me!” And he would be justified in responding this way. After all, we cannot really comprehend what the dying devotee is experiencing. Still, we can express that we are trying very hard to understand what he is going through. If you are asked for advice, you may want to begin your sentence with, “Have you ever considered…” or “What do you think about…” Remember: Your patient may not want your advice. He may only need to know that you are trying to understand his unique pain.

4. Reassure the devotee that his or her life has made a difference in the world.

Part of the hospice philosophy includes helping your patient to understand that his presence in this world has made a positive difference. Certainly this is true with a devotee of the Lord. Your patient has made more of difference than he or she may realize. Speak from the heart and tell him that you’re a better person having known him. If you do not express this now, you may never get the opportunity again.

5. Be tolerant—Your patient may need to discuss the same subject again and again.

Often, a dying patient needs to verbalize the same thoughts over and over again in order to make sense of them. He may be experiencing fears and anxieties that he needs to discuss many times before he can rise above them. It is best for the caregiver to remain patient. Do not feel guilty if you are a bit frustrated discussing the same points many times. If your patient needs to hear your same answers again and again, then that is what is required. In this way, you can be very instrumental in assisting your patient to reach sound conclusions that he or she is comfortable with.

6. Remember the importance of non-verbal communication.

Has someone ever told you one thing, but you received a different message than the one that was spoken? For example, “He told me he read the book, but I didn’t believe him.” What was it about what he said that led you to such a conclusion? Often, it is body language that speaks louder than words. Below are some non-verbal messages that may decrease your communication with your patient:

--Poor eye contact (Depicts disinterest or discomfort)

--Body turned away from your patient (Depicts disinterest)

--Holding a barrier in front of the body (Depicts wanting to distance ourselves)

--Arms folded across our chests (Depicts defensiveness or wanting to distance ourselves)

--Rubbing neck (Depicts criticism)

--Peering over eyeglasses (Depicts judgmental attitude)

However, there are many ways to increase communication through non-verbal cues. I have listed some below:

--Sitting down with someone on his or her level (Depicts interest and care)

--Leaning slightly forward while someone else is speaking (Depicts interest and complete attention)

--Nodding while the other person is speaking (Shows you are trying to understand—not necessarily that you agree)

--Turning toward the speaker (Depicts interest)

When used appropriately, a light touch on someone’s hand or shoulder sends a caring and supportive message. It also improves trust between a patient and caregiver. Touch communicates a message of empathy. A warm smile is universal and always depicts love and care.

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