“The Six Things that Matter Most”

(Dear Reader: I’ve been involved in a situation recently that reminded me of this post I published two years ago. I’ve revised it a bit and am sharing it with you now in the hope you find it useful.)

There often comes a time when a family is told their loved one has just a few hours or days left before dying.  It can be an agonizing time of not knowing what to do other than wait.   The loved one may still be able to communicate or, more often, is sleeping much of time.  What do you do when “there’s nothing more to be done”? Ira Byock, a leading physician in contemporary hospice and palliative medicine, came up with a helpful resource for such times.  He would take his prescription notepad and write four phrases: “Please forgive me. I forgive you. I love you. Thank you.” He would give that to a family member and invite them to consider if any of those statements would be appropriate to say to their loved one.  He wrote an influential book on the transformative and healing experiences he witnessed arising from people using these simple statements.  As the book became popular, two more were added: “Goodbye” and “I am proud of you.” The values represented in these statements — forgiveness, love, gratitude, and acknowledging the cycles of life — are universally present in the great spiritual traditions. When I was at Hospice of Santa Barbara, we took those six statements and had them printed on business cards.  Our staff and volunteers could then give them to families when appropriate.  I began to carry some in my wallet, a practice I’ve continued for more than a decade. Six Things I was grateful to have the card when my father was dying. He was in his last days at a nursing home. My two sisters and I used the list as a prompt for talking to him. He was no longer responsive, but it felt like the right thing to do. Maybe he heard us or maybe not.  Maybe he could sense what we meant through tone or feeling. Or maybe it was just for us. “Dad, please forgive me for the sleepless nights I gave you as a teenager.” “There were times when I was growing up when I was afraid of your anger.  I knew you were under a lot of pressure and loved us, but it was still scary. I forgive you.” “Thank you for providing for us, encouraging us and believing in us.” “For the way you worked so hard to honor mom and provide for us, for the integrity and honesty with which you lived your life, and for your service to our country during the war – we are proud of you.”  Dad wasn’t from a generation when many men would say “I love you.”  But we knew he loved us.  It was easy for each of us to say, “I love you, Dad.” The “Goodbye” statement can be tricky.  It can be tempting to say it to have some closure, but it may be too early.  (I remember one family had asked a harpist to play in the room; the patient woke up and said, “Get that music out of here…I’m not ready for the angels yet!”) But if, say, a family member is leaving town or death is clearly imminent, then “Goodbye” can be fitting. As I did presentations on hospice in the community, I would pass these cards out.  People would later tell me how helpful they were. But I also knew what everyone who works in hospice knows…the work is not just about the dying, but also about the living.  Whether dad was fully aware of what we were saying, it gave us closure. The list can also be helpful after a death when we didn’t have an opportunity to speak the words in person. We can write a letter to the person using the list as possible prompts.  We can then save the letter just for ourselves. Or we can take it to a place we associate with the person, including a gravesite, and read it.  When it’s served its purpose, we can keep it or create a simple ritual and burn it. “Six Things” can also be valuable when death is not on the horizon. Roughly half of Americans die with some form of hospice care, which means there may be time for meaningful bedside moments.  It also means the other half of us will die without such an opportunity – heart attacks, strokes, accidents, etc.  If these are the six things that matter most, why wait for a moment that we may never have?  Why not use them when we are alive and well? As time went on, I’ve found the “Six Things” a good way to take inventory from time to time in my own life on occasions like anniversaries and birthdays. Is there someone I want to say these words to now since there’s no guarantee I’ll have a chance in the future?  Or maybe take one each day, and say it to someone during the day if the time feels right? It doesn’t have to be a dramatic act, just a sincere one.  What do we have to lose? Once we do it, we often experience a sense of freedom.

Photo: UCSB lagoon


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