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    Talk About Death

    Finding the right words.

    Breaking the Ice continued...

    But how to begin? The Rev. Ronald Purkey, executive director of the Hope Hospice in Rochester, Ind., says the first step is to find out what the dying person is thinking. "I ask, what do you think is going to happen with your illness?" he says. If the patient replies, "Getting better every day," as one of Purkey's terminally ill patients did recently, there's probably little chance of a conversation at that moment. Yet as death approaches, the barriers usually break down, he says.

    To patients and families, he gives a popular pamphlet called Gone From My Sight by Barbara Karnes, which outlines the emotional and physical changes that occur as a person moves closer to death. "When people first get sick, they want to take care of the family members," says Purkey. "The closer they get to death, the more introspective they are." This is often the opportunity for meaningful discussion. "You can turn to the individual and say, 'How do you think you're doing right now?' " says Connie Borden, RN, executive director of Hospice by the Bay in San Francisco. "If the answer is, 'I'm not doing so well,' the individual is looking for a chance to talk. Don't hush the person up. Try to ask, 'Is there something you want to say to me?'"

    Winding Down

    There can be moments of surprising bluntness. Elinor Sheldon, Roberta's niece, told her aunt that a family member was going to buy Roberta new pajamas. Roberta's reply: "She can buy me the pajamas to be cremated in."

    As death approaches, words become less important, according to hospice workers; touch and silence become more meaningful. For Roberta's family, music remained vital. Sheldon had tried to talk to Roberta about the differences they'd had and was rebuffed. Finally, she had the conversation she'd wanted by singing "Amazing Grace" to her aunt, who lay in bed, close to death. "I wasn't sure I could do it, but I did," she says. "I felt she could hear me. She squeezed my hand."

    Jane Meredith Adams has written for WebMD, Health, The Boston Globe, and other publications. She lives in San Francisco.

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