Part 2 – YES, and
In the ABC’s for living well, this four-part series for the letter “Y” explores various ways in which YES can carry multiple, nuanced messages. The practice of saying YES to tackling challenges, exploring new situations, setting boundaries, and overcoming fear is commonly recommended by life coaches. It makes sense to say YES to all of those things. However, when facing serious illness or at the end of life, saying YES to those things can become quite complicated. Supporting medically vulnerable people, hospice patients, and their caregivers has taught me that sometimes YES means YES, but it can also mean “YES, and”, “YES, maybe” or “YES, but”. Sometimes it even means “NO”. Part 2 explores the use of YES, and . . .
The phrase YES, and is often used by improvisational actors and writers to develop comedy sketches. It is also utilized as a research and development practice in science, technology, business, or educational brain-storming settings. Part of the YES, and magic is that it includes acceptance and affirmation (YES) to open up a topic, concept, idea, or premise. That acceptance and affirmation is immediately followed with an invitation (and) to build upon or add to the topic. Communication in this way is a powerful tool that fosters creativity, collaboration, and cooperative problem-solving. It equally empowers everyone involved in the conversation. It is useful in a number of caregiving situations, and it is especially useful toward experiencing or supporting what is known as a good death.
For patients, the simple yet powerful YES, and practice helps to affirm the reality of approaching death while inviting dialog about things that truly matter. Dying patients sometimes prioritize familiar activities saying, “YES, of course I can do that, and even more!” This represents a way for patients to feel a sense of agency while letting go of life, or to help with feeling more complete about life. They may try to keep up with taxing routines, activities, or conversations despite their own discomfort, attempting to normalize the extraordinarily unique circumstance of their final days. They may also focus their attention on the needs of others to assuage personal anxiety or to help loved ones who are coping with anticipatory grief. They may extend forgiveness, compassion, kind words, and care toward others, even though their own physical and emotional energy is waning; even if their relationship with others has been difficult or complicated. These actions represent their final gifts.
Visitors to a hospice patient may feel more comfortable talking about how things are going in their own lives instead of focusing on the patient. The patient may respond with, YES, that sounds like it was a good movie, and I want to talk about what happens when I’m not here anymore. This can trigger caregiver discomfort or an inclination to change the subject. But let’s remember that while it’s so very hard to say goodbye to a dying person, the dying person is saying goodbye to everyone and everything they have ever known. They are not only completing an era, or a chapter, they are completing a lifetime. When people have permission and a safe place to talk about dying and death, something transformational takes place. This is true for people of all ages, whether healthy, unwell, or at end-of-life. Authentic conversations about what we all ultimately have in common (mortality) can transform fears and anxiety into grace and peace for patients and the loved ones who care for them.
As noted in Part 1, talking about death with a dying patient can feel daunting and uncomfortable for caregivers. But in final days hospice patients may want to talk about mortality topics in order to feel more complete with life. These topics are relevant and important for those who are dying. While it may be difficult for caregivers to remain emotionally present as they are grieving their loved one’s imminent death, it is possible to be supportive of conversations that matter; conversations that support a patient’s good death. Some relevant mortality topics include:
- striving to feel complete with life’s journey
- describing hope for how they will be remembered (personal legacy)
- completing a last will and testament
- fear of physical, emotional, or ontological pain or suffering
- making peace or amends
- expressing love, hope, forgiveness, or gratitude
- desire for connection or communication after death
- spiritual needs; prayer requests
- revealing true thoughts and feelings that may have been kept hidden or secret
- reflection on the mysteries of life, death, afterlife, reincarnation, soulmates
- preferences for bodily disposition
- desire for loved ones to carry on
In closing this section, remember that utilizing YES, and phrasing doesn’t block or bring an end to the conversation, instead it provides an opening for patients and caregivers to safely say more, to explore and share heart to heart. Ultimately, this kind of sharing is beneficial for patients and caregivers alike. Part 3 of “Y” is for YES, explores the concept of YES, but.