(If you’re wondering whether it’s the right time to talk, check out Part 1 of our post.)
You think your loved one is willing to talk about planning ahead, and it’s pretty clear at their stage of illness that it’s around the right time. So how to bring this up?
- Express yourself and give them time to respond.
If you’re nervous how they’ll respond, consider sending a message in an email, card, or Paperless Post (designs like this or this or simple and personalized). For something more personal, maybe even record yourself talking in a heartfelt video and send it as a message. You can say that you’re not sure how to bring up this topic, but you think it’s really important. Your loved one will have time to think about it, and it takes away the pressure that can often accompany these conversations if they come out of nowhere. If you take this approach, you don’t have to say much in your initial message. You’re asking permission to talk and getting a sense of how they feel about it. It’s no different than preferring that people text you versus calling you out of the blue: it can be considerate to choose a mode of communication that enables the respondent to address the message on their own terms, in their own time.
- Ask about how to make the right decisions.
Everyone with a serious illness should have a healthcare proxy. Often times your loved one’s doctor will provide this document to make sure it is completed. However, while a lot of people designate a healthcare proxy, most have not had a conversation with their proxy about what they want. and what their values are regarding medical treatment. If you’re the chosen proxy, explain that you really need to know what they want in order to make the decisions that they, not you, would want.
Cake sound bite:
Mom, I’m glad that you want me to be your healthcare proxy, and feel honored that you trust me in this way. It comes with a lot of responsibility though, and it assumes that I’d know what you’d want in different situations—could we talk about that?”
If the conversation opens up, you can use this as a segue into non-medical areas like wills and funeral planning.
It’s not just all medical… We don’t have to do it now, but both our wills are really outdated. Maybe we could talk about how to update them?”
- Have someone facilitate.
This can be particularly helpful if your loved one is in the hospital, where there are various members of a care team—doctors, nurses, social workers, and chaplains–who will know how he or she is doing with their illness. You can privately raise your concern with one of these trusted personnel, and ask if they might help broach the subjects that are the hardest. They can seem less threatening coming from a care provider who can ask your loved one, “What’s your sense of how you are doing?”
Outside of the hospital, there might also be people you can count on who have a reason to bring up certain topics. For example, a trusted religious leader might be able to broach the question of burial versus cremation. Or your husband’s favorite Aunt Sue might be able to ask what your children understand of his illness, which can then elicit his sense of how much time is left and prompt an open conversation. You can also book an expert through CAKE concierge to help facilitate these conversations.
- Use life review as a way to talk about remembrance
Sometimes people are more amenable to talking about the past. They might be interested in writing down some of the stories from their life. (Or their entire life story: it’s becoming more common for people to write their own obituaries. This certainly isn’t for everyone, but can be meaningful for those who want to have more say in how they’re remembered.) You could find old photos and ask them to choose their favorites. Are there any people from their past life that they’re thinking about—wanting to talk to or make amends with? What do they want their legacy to be?
I want to honor all of these memories you love. Do you think we could talk about what you’d want at a memorial service?”
Another part of life review, especially for older people, is that it can evoke memories of friends and loved ones who’ve passed away before. You might ask someone to reflect on those losses and if they would want something similar or different.
I know you saw (John) go through something similar not so long ago… can I ask, what did you think about the way that he went? I want to make sure we follow your wishes.”
- It’s ok to be vulnerable.
Let your loved one know that you’re hopeful, but also how much of a comfort it would be to better understand what he or she needs at this juncture. It might seem self-centered to bring up your worry, but actually this can take some of the pressure off of them. If you sense that they’re ready, ask about that:
“This is important, could we have a serious talk about this?” or “Can we think together about this?”
But … what if you try to talk and their response is something like this?
Or if the conversation is like what cartoonist Roz Chast captures so perfectly in her memoir Can’t We Talk About Something More Pleasant:
Don’t worry: even for palliative care doctors, this is can be a process with different stages–pausing, assessing if someone is ready to talk (the answer above is clearly no!), and coming back to it over time. Please talk with us in a personal consultation or let us know if you would like more advice on a specific situation!