Words. How we say them and how they are heard are often two different things.  One morning my husband and I had a few words over what I gave him for breakfast. I would say it was a “tirade.” He would say it was an “explanation.” That little exchange got me thinking about how words are heard from where the person hearing them is rather than the dictionary definition of the words.

That little exchange then led me to think about words we use in end of life work. Words that reference approaching death and death itself. Words nobody really wants to hear. 

The hard, difficult words we say are often received by where the listener is, not just in their thinking, but in their feelings. Words like dead, dying, killed, passed, suicide, at peace, death, all evoke different reactions in different people. Some words are more “uncomfortable” while others are less intimidating, less forceful.

Is what we can hear and interpret based on what we are comfortable or uncomfortable with? Does “at peace” sound more comforting than “He is dead?” Does “killed themselves” sound more jarring than “died by suicide?” I’m thinking maybe it does.

In our work with end of life, we have to say many words that no one wants to hear. Words that present a harsh, sad, scary reality. In educating families, caregivers, patients, and the community, we are speaking words no one wants to hear let alone believe. YET that is our job.

Maybe we who work with end of life situations need to be more aware that others do not necessarily see death as something as natural and normal. That others may take offense at our choice of words because of where they are in their thinking and feeling. That their understanding and reaction to our words has nothing to do with us but with them. 

Our job as end of life workers is to educate. We walk a thin line. Our words can be heard and misunderstood so easily. They can be interpreted differently than we intended. 

To avoid the pitfall of misunderstanding I ask three questions before I leave a patient/family encounter: Is there anything you want to ask me? Did you understand everything we talked about? Is there anything else you want us to talk about?  

Something More… about The Words We Use When It Comes to Dying  

If you are in end of life care, please educate your patients and families well. Your CAHPS scores will reflect how well your families understood the dying process. End of Life Doulas who will be at the bedside when death occurs, referrals will depend on how well your families understood the days, hours, minutes and seconds before their special persons death and after.