Gratitude

Recently, two sisters, longtime friends, texted me that their mother was about to undergo placement of a Ventricular Access Device (VAD) to help her failing heart. Surgery was scheduled for the next morning, and they were to have a family phone call that evening. They asked what they should say … what might help her through the procedure, and what should be their last words to her if things didn’t go well, and she died during surgery.

Gratitude was the first thing that came to mind. I said that they and their siblings should think of something specific for which they were grateful to their mother and share that with her. If there were many things, so much the better.

That evening, they texted: “Thanks for suggesting the sharing of gratitude. We’re on the call with her right now, and it’s been such a beautiful sharing.” The next day they reported how pleased she had been, and how surprised they had been when she also shared with each of them the things for which she was grateful. One sister texted: “… the best part for me was a combination of hearing the beautiful things from all of my siblings.”

Thankfully, surgery went well, and she’s on the way to recovery. Reflecting on gratitude, I recalled it was a key element of what Dr. Ira Byock writes about in his first book, Dying Well, drawn from his experience as a hospice physician in Missoula, Montana. Dr. Byock interviewed numerous patients and families and was able to identify “Five Things” that both the dying patient and the family members need to say and, when possible, discuss. The “Things” are not just sentences to be said but emotions to be explored. They are: I forgive you; Forgive me; Thank you; I love you; and Good-bye. Some families can talk about these feelings and the stories that underly them more easily than others, but almost all eventually can say or discuss one or more of these with their dying loved one. When they do, both family members and patients seem much more at peace.

So that there will be time for these tough conversations, physicians need to let patients know when time is shorter than they hoped, as painful as that is for everyone. I remember Brianna (not her real name), a wonderful daughter who agreed to come to a teaching session I was doing with oncology trainees. She recounted the very tough discussion she and her mother had with their oncologist when the anti-cancer therapies were no longer working. “Dr. B was crying more than we were. Mom was getting weaker, and we weren’t really surprised at the news.” Then Brianna added to the group, “Mom turned to me and said, ‘So, do you want your inheritance, or do you want to spend it on a blow-out trip to New York and make some memories?’” Needless to say, New York it was, and Brianna, through her happy tears, told these young doctors that she never would have had that trip if Dr. B hadn’t leveled with them that day.

She added: “I’ll be forever grateful”.