Ep 26 - Four Things to Say When Someone is Dying

Four simple phrases: “Please forgive me,” “I forgive you,” “Thank you,” and “I love you” — carry enormous power to mend and nurture our relationships and inner lives.  In this conversation with Dr. Ira Byock  he explains how we can practice these phrases in our day to day lives and the impact they can have. 
 Dr. Ira Byock is a palliative care physician from the USA and the author of three books - "Dying Well",  "The Best Care Possible" and "The Four Things That Matter Most" the topic he discusses with us today. 

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Transcript

Episode 26 – Four Things to Say When Someone is Dying  

Kia Ora and welcome to The Ending Life Well Podcast. This podcast series for carers focuses on advice and practical solutions for carers who have been thrown into the deep end looking after a loved family member or friend in their last days, weeks, or months of life. 

Our episode today is Four Things to Say When Someone is Dying  

Denise

Hi, I'm Denise van Aalst, a senior palliative care nurse and educator at Otago Community Hospice. Today I'll be talking with Dr. Ira Byock, a leading palliative care physician from the USA, who's also a public advocate for improving care through the end of life. Ira’s the author of ‘Dying Well’, ‘The Four Things That Matter Most’ and most recently, ‘The Best Care Possible’. Ira, thank you so much for joining us today.

Ira

Denise, thank you for having me.

Denise 

Ira, your books have really had a huge impact in the world of palliative care. And I thank you for sharing your wisdom and your insights. Today, I think I'm probably most interested in The Four Things That Matter Most because I see the content of that as having real relevance for the family carers that we are particularly talking to. I think that the content of that can have a profound effect on not only the person who's dying, but the people that are caring for them, who have to live beyond that death, and being able to take on board, what you're talking about, can really have an impact on how they are going to live the rest of their lives can’t it?

Ira

It certainly can. And everybody benefits. Grieving is hard enough. The sadness of grief, you know, can hurt like hell and is overwhelming sometimes. But it's kind of a normal, almost healthy pain, it's the other side of loving is the pain of loss. Complicated grief, the grief that really ruins people's lives so often, has to do with the regrets, with the ‘what ifs’, with the ‘would haves’ or ‘could haves’ that were left undone or unsaid. And I think while that's not hopeless, and I've certainly helped counsel people who never had the chance to say the things that are now left unsaid, it's something that one can work through. It's so helpful to actually, take charge and say the things that would otherwise have been left unsaid if, if the person were to die, suddenly, as sick people sometimes do.

Denise 

That's right. And one of the things I noticed in your book is seizing these opportunities, because none of us actually know when that time might come, when that sudden event might happen, sometimes without any warning whatsoever. And this is that opportunity isn’t it and it's perhaps one of the advantages of a terminal diagnosis is we have some warning, we have a chance to say these things.

Ira

It's a big wake up call isn't it, that life is a precious gift, but it's a fleeting gift. It's a finite gift. And so today is a good day to say things that matter most to the people that you love.

Denise 

I'm reminded of something I heard years ago that has always sat with me. And that was if you knew you had 24 hours to live, who would you call? What would you say? And why are you waiting?

Ira

Well, it's brilliant, right? And it's one of those things that mortality will teach us if we let it. You know, so often we don't let it, we don't want anything to do with illness or dying or grieving. Avoidance isn't going to prevent these things from happening. And so, it is that reminder to live fully to, you know, make sure that our relationships are, the term that I use Denise, is complete. That at any moment, there's nothing critically important left unsaid. And when I say the word complete, I don't mean complete, like it's over. I mean, complete, like a circle is complete, if it's unbroken, that its whole.

Denise 

I think that's a really important point that you've made that complete doesn't mean over. And there's a freedom then, in being able to simply celebrate and enjoy whatever else lies ahead, because we haven't got something heavy hanging over us.

Ira

You know, it's so interesting, you use the term celebration. One of the things I did concurrently with being a hospice physician for years was I practiced emergency medicine, I had board certification as a specialist in emergency medicine. And so I saw people gravely wounded or having had a heart attack and having died suddenly. And boy, does that ever remind you how fragile our life is. So as a husband, as a father, as a son, as a brother, what this work has taught me is how to apologise. How to apologise far more quickly than I think I ever would have had I not been doing this work. 

Apologising is a way of saying our relationship is more important than the embarrassment I feel for having screwed up again. It's really an interesting thing. And having that apology acknowledged and accepted by the person who you just snapped at or did wrong, again makes the relationship whole. So to celebration when there's nothing left undone between myself and the people I love, the time we spend together has this intrinsic sort of sweetness and value. And I don't know another word, but celebration. It's not, you know, Twizzlers and confetti but really, celebration is the best term I know to acknowledge the intrinsic value of this moment of just being together.

Denise 

Yeah, and I think you're right, you know, but we are all human, and we are all going to make mistakes. But it's being prepared to admit that we've made them and, you know, as a, as a parent and now a grandparent, it's a wonderful gift that we give the generations that follow us to see us admitting being wrong. You know, I don't expect them to be perfect, because I'm not perfect. So Ira, the four things that matter most, tell us what they are.

Ira

Well, the four things that matter, most aren't things at all, they're four sentences, 11 words. Please Forgive me; I Forgive You; Thank you, and I Love You. Please forgive me and I forgive you are important because who among us has perfect relationships, with our parents, with our spouses, with our children, with our brothers and sisters, close friends even you know. It's normal that there'll be misunderstandings and hurt feelings and sometimes real screw ups, real transgressions. And thank you and I love you is most often just stating the obvious, expressing appreciation for being in relationship and, and expressing love. And I wrote this book The Four Things That Matter Most, but here's a, a fun fact. For the two years or more that I was writing it, it was called Saying Four Things Before Goodbye. Right? There's a whole chapter on saying goodbye. But the emphasis was on saying these four things before goodbye. And Denise literally, we were within a week or two of the book going to press and my editor called me up sort of in a panic and said, “Ira, Ira, we have to change the name of the book”. And I said, “why?” And she said, “Well, the marketing people say if the word goodbye is in the title, this book is going to end up in the death and dying ghettos of the bookstores. You know, down in the back, there where nobody looks”. And I say, “But, but, but Leslie, I mean, that phrase saying four things before goodbye, it probably appears eight or nine times in the book somewhere, right?”  And she said, “yeah, yeah, that's okay. It can be in the book. It just can't be in the title”. So we thought really hard. And, and I came up with this title, Saying the Four Things That Matter Most. And I like it, because, as we said just a moment ago, because you just never know. So why wait, today's a good day to do it.

Denise 

And, you know, it turns out really, it was a wise decision, because it has opened up your book, to many more people.

Ira

Yes, I begrudgingly agree that the marketing people were correct.

Denise 

Because really, this is about how we choose to live.

Ira

Right. Which is what became the subtitle for the book. The Four things That Matter Most - A book about living.

Denise 

Which in the hospice is what we still focus on, you know, about, about living well, making the most of what time we have. It's not about curing people, it's not about complicated treatments, it's about focusing on what makes this individual feel the best they can, to make the most of living.

Ira

You know, I think that what we do in the field of hospice and palliative care, is about preserving opportunities for human development, to grow within ourselves and closer to one another through the end of life. Yes, it's about living, but it's about well-being. The first book I wrote was called Dying Well. I chose that title so carefully. When you hear the phrase dying well, you first hear it as the right way or a better way to go through the process of dying, which is fine. But it's more provocative, to hear the well in that phrase, dying well as an adjective that actually describes the person who is dying. Can a person be well? Can you die well within yourself, right with yourself, right with the people you love, right with the world, right with your god or with nature? I think this notion that it's the human potential, includes the potential for well-being, through the very last moments of life, I personally think has so much cultural importance and an importance for all of our lives.

Denise 

I think that's a really good view. You know, we all have choices. Sometimes we make bad choices. But coming back to those four phrases, that's our chance to kind of reset isn’t it, and change those choices we've made in the past, so that we move forward in a different way. It is our relationships with the people around us that have such a huge impact on how we are living our lives.

Ira

You know, the things that matter most in our lives aren't things at all. They're almost always other people. Right? If you ask somebody who's being wheeled into, you know, heart transplant surgery, or is facing chemotherapy for the third or fourth time, you know ‘what matters most to you now?, the answers will always include the names of people they love. We intrinsically matter to one another.

Denise 

And although our job, our career, what we might have spent our life working might be important to us in that moment, it's not about spending time in the office, it's not going to be about that job, it's going to be about the people.

Ira

They matter more than the things that we do and the things that we have. I learned that people matter to one another more than the things that we do. The things that we do give our lives meaning very often. We drag ourselves to work to, you know, to provide for our families, we may have a career that meaningfully pushes something forward for society, but ultimately, we do that for the people we love, the people in our communities, the people in our countries. They're all connected to service and love of others. 

Denise 

Yeah, because love is not just for our immediate family. As you say, we can have a love for our community, a love for the people we serve, and that may have as much meaning for us. Ira when you talk about forgiveness, ‘please forgive me, I forgive you’. I think that they could be the most challenging phrases for somebody to say, especially in a relationship that's been fraught.

Ira

Forgiveness is often misunderstood. And we think it means absolving people of responsibility or exonerating them, taking the weight off of them. It's really about taking the weight off ourselves in all honesty. There's this phrase ‘forgive and forget’. It is the most ridiculous phrase I've heard.  Forgetting is amnesia, right? Forgiving actually requires people to remember the transgression or the anger, the thing that's caused the anger or the thing that divides us, right, but letting go of that as in the book I talk about emotional economics like writing the loss off one time. In finances you can carry the loss from month to month and it accrues interest and it grows and it gets more and more annoying. Or you can write it off one time and go about your business. It doesn't mean that you forget it. But you can take the loss one time and kind of be free of that baggage. 

And that's really important. In The Four Things That Matter Most I tell several stories in which people made the very deliberate, difficult decision to forgive the other person for not being perfect. You know, I tell the story of a fellow I call Avi. And Avi was the son of a man that we call Simon, and Avi was born out of wedlock. Simon had another family, and he never acknowledged being Avi's father. And Avi grew up wanting love from Simon but never getting it and he became very bitter toward Simon and hated him. And it was a very major emotion for Avi. Now Simon ended up getting a brain tumour and his life was clearly limited and Avi’s mother went to a counsellor, Lynne Halamish and asked Lynne, “What can I do I know that Simon is dying, and my son is consumed with this hatred of him, what can I do? Would you see Avi?” and Avi didn't want to see a counsellor, but out of love for his mother, he went and saw Lynne. And Lynne said “before Simon dies, you have to say these four things; ‘please forgive me, I forgive you, thank you, I love you’.” “What do you mean, I can't say this, I hate this man, I'm not going to.” “You've got to do this for your own well being”. So they work together for several weeks. And again, purely out of out of a favour to his mother, he went and he saw Simon. And he said something along the lines of ‘please forgive me for I guess for never being the son that you actually wanted or could accept and, and I forgive you because I realised you were emotionally unable to give me what I needed and say what I needed to hear. And thank you for at least giving me life’. And he told Lynn “I can't say I love you to, I can’t, you know”. So she said “well ask it as a question”. So he said “I love you?”. Right? In his weakened state. Simon returned the sentiment and asked for forgiveness and said he was sorry, he never been any bit of a father to Avi and thanked him for coming and expressed his love. He talked to Lynne later about realising that some of these patterns were coming into his own life and his relationship with his own small children. And he was able to get free of it. 

One of the lessons, that's important to understand about saying the four things that matter most is you can only take care of your side of any relationship. You can expect or depend on the other person what they're going to say or if they're going to return the feelings in kind. But if you show up and if you arrive with good intentions, and you, without any sense of manipulation or needing to hear the other person say them back to you, if you can say these things authentically. In my experience, people always feel better for having made the good faith effort.

Denise 

I would imagine in those circumstances, even if the other person doesn't respond in kind, there would still be a sense of a weight being lifted, because you are letting go of the anger, the distress, the negative emotions, which seem to weigh so heavily on us. You're able to let them go in saying to that person ‘I'm sorry for this’ and ‘I forgive you for that’.

Ira

That's been my experience, time and time again. And, you know, sometimes, sometimes we're surprised. About a year ago, I got a letter from a woman who said that eight years ago, she had written me to say that she had just read The Four Things That Matter Most and The Best Care Possible, my last book, and I talked about these some of these same themes in there, though, in a different circumstance. And she had written me to say that she has six children, but her oldest son had become really estranged, had misunderstood something that she and her husband had said to him. And she read these books and said “should I call him up, he's told me never to call. But I feel like I want to make every effort to heal my relationship, I'm worried that if I die he's going to be left with this emotional baggage, what should I do?” And she reminded me that at the time, what I told her was, if he's told you not to call him, you should probably respect that. But you are his mother so, if it feels comfortable, continue to send him cards at holidays and his birthdays and just tell him you love him. And you can say the ‘please forgive me’s and ‘I forgive you’s and, and ‘I love you’, right. And she wrote me, I got this letter from her a year ago, which was like, eight years after we'd had our exchange, “Out of the blue, my son, I did what you said Dr. Byock, and I continued to send him cards but I respected not calling him. She said he started texting me, and in fact, we got together and Dr. Byock I have my son again”. And she wrote saying, “who would have thought. I basically was just doing this because it was my way of taking care of my side of our relationship. But healing has happened”.

Denise 

She created that opportunity by, I guess by being a mother. But I think there's such an important message in there that sometimes these things are just too hard to say in person. But actually putting them in writing. It gives us time also to think about how we want to say it, what we want to say. We can write it down, we can leave it overnight and look it again in the morning. We have the opportunity to put it just the way we want and still give that message, if we feel we can't say it face to face.

Ira

Indeed, saying it in a letter allows you to say it honestly. And to stay on point, to stay on message. And then maybe invites a conversation by phone or nowadays a video call or an in person visit. So that red hot anger is not distracting, and doesn't ruin the otherwise, you know, heartfelt intention to take care of your side of the relationship.

Denise

Ira one of the things that you said about forgiveness is that people don't need to feel forgiveness in order to give forgiveness. Now I think that's really important. Can you elaborate on that? 

Ira

Sometimes, by doing things, the emotional state follows we often think that one has to feel something before you take action. And most of the time, I guess I agree with that, but it's not always the case. So sometimes we can act as if we felt the emotional resonance with forgiving another person and just kind of believe that it's important to do and go ahead and do it. And sometimes our hearts will open in the process of doing it.

Denise 

Which is really what has happened with Avi isn't it? In that he went offering forgiveness, which he probably didn't really feel at that time. But did by the end of that conversation.

Ira

Yes that's why Lynne Halamish, who’s just a brilliant counsellor will really push people to say these things. And if you can’t say I love you well ask it as a question. You know, I love you? Wow, that's really courageous. I mean, it's, it's gutsy stuff. But I have to say, it's, it's non-toxic, you know, it's not dangerous. You know, asking for forgiveness, offering forgiveness, expressing gratitude and love is pretty darn safe. As long as you're not trying to manipulate the other person. You don't have ulterior motives. If it's really genuine I think it's safe. You know, part of the reason I wrote this book is because I wasn't at all convinced I would ever be able to educate enough clinicians to guide people through this process. And I thought, well, what the hell, right? People shouldn't be dependent on having a physician, a nurse, social worker, a chaplain who gets it, they ought to be able to do this one for themselves. Right. So let's put it out there. And frankly, that's been my experience I, in all of these years of kind of teaching this stuff, I can't remember a single story or incident I've heard, where it had a damaging effect frankly. That's pretty a remarkable thing to be able to say.

Denise 

And I think too, one of the things I picked out in your book is that when we do offer that forgiveness to others, actually we often end up forgiving ourselves. Because there's always two sides, we have been a part of a relationship and in forgiving others, if we forgive ourselves for what we might not have got right, that is also really healing.

Ira

The hardest person I think, in our lives to forgive is ourselves. I think that's true of everyone, it's certainly true of myself, I mean, I, I have high standards, you know, and I like to think of myself as a as a loving patient, sensitive person. But I can be cranky, and I can snap at people and, I'm just telling the truth here I. I wish it was otherwise. 

Denise 

So you're human, like the rest of us? And isn't that actually also a gift that we give those around us because if someone was perfect, and calm and reasonable at all times, I might find that difficult to live with, because I too can be cranky and impatient. But I think we often have a bit of a double standard, we are much more forgiving of the people we love around us than we are of ourselves. We often seem to hold ourselves to a higher standard that we should be perfect, even when we forgive people around us.

Ira

Well, there's a sense of shame. I'm speaking very honestly here. It's embarrassing. I feel ashamed when I've screwed up again, and that's hard to ask for somebody's forgiveness and be specific and really own it. But it's necessary for the apology to be real. 

Denise 

You mention about being specific, that's something that also applies to saying thank you, isn’t it? Thank you, a broad, thank you doesn't necessarily have a lot of meaning. But when we say thank you with the specifics, and this is something that you've touched on in the book, that has great meaning for the person receiving the thanks.

Ira

It does indeed, it kind of helps complete that relationship doesn't it? To really let them know that the gratitude you feel, is not just abstract but is really, you know, earned. I can think of so many examples from my own life. I have this friend Michael, who he's my age, we're both 73. We went to school together and and he has a play that he wrote that's, that's going to be coming out in October and I put it in our calendar, I’m needing to fly to Florida that's all across the country where I from where I am, to be at Michael's opening. And my wife Yvonne said, “I see you put this in our calendar. So we're going?” and I said “yeah, I think we're going” and I said “you know why?” Because in 2003 when my mom suddenly died, out of the blue, Michael showed up at my mother's funeral. You know, he didn't need to do that. He lived several hours away. And that well, at least an hour and a half from where we were. He didn't know my mother very well at all, frankly. But he showed up at the funeral. Wow. And I've never forgotten it. And I feel so grateful to him, it meant so much to me to look around and ‘what, Michaels here?’ Wow.  And if you think about it, you know, when we actually turn attention to it, usually we can say that we're grateful that, we thank people for, you know, several things that we can recall over the years that they did, or, or in ways that they were considerate or generous toward us that they didn't have to be.

Denise 

And when we let somebody know, by saying thank you with those specifics, when they understand the impact they've had on our lives, that's such a gift that we then give that person.

Ira

it really is. It really is a gift that keeps on giving. And, you know, in the context of knowing that someone we love and are caring for may be dying, their life may well be short, saying those things to them and hearing the four things from them, really is a gift that keeps on giving for the people left behind. These are memories that make people whole, that really engender the best legacies of our families, our relationships and in our lives.

Denise 

I also coordinate a biography service for our hospice, where we have volunteers go and help people tell their stories, which we then compile into a book and they can put photos in. And very often those books have messages for their family. And that's very often where they also say why they're proud of them, what they value in them and thanking them for what they've contributed to their lives. And my goodness, those messages can have such a meaning for the families.

Ira

Indeed, I think if there was a fifth thing that parents could say to their children it is, I'm proud of you, I'm proud to be your mom, or I'm proud to be your dad. Who else on the planet can give that gift in a parent's voice and talk about a gift that keeps on giving.

Denise

Ira in your book, I remember the story of Ernesto and Julia and it was so much about you know, for them it didn't seem like there was a lot that was unspoken, but for them, there was such joy and finding joy through their family, through each other, and through that acknowledgement of those things. And I thought it was just a lovely way of illustrating, when people have an awareness of a dying, of celebrating, and we come back to that word of celebration, but of celebrating their life and their love for each other. And they just seemed to really illustrate that didn't they?

Ira

Remarkable people, you know, in a sense, very simple, hardworking people, immigrants from Mexico, I believe, to this country, they raised two children who were successful. Ernesto was a janitor and wasn't somebody who was easy with expressing emotions, but we were able to do this work together and to create legacy that he could leave in the way of stories for his children. And the part that still cheers me up is remembering and, and, and I have a visual image of course of it. Standing with him for the last time, he was in a hospital bed in his trailer in the, in the mobile home in which they lived, and, and I, I said, told him what a privilege it's been to be his doctor and, and said goodbye, and I was heading toward the door. And, and he kind of weakly with one hand motioned me back to his bedside and I came over to his bedside. And his voice was kind of raspy and weak. And I couldn't quite hear what he was saying. So I kind of leaned down and with his arm he reached up quickly and you know, around my neck and pulled me to him, and he kissed me on the cheek. And I was startled, but I looked back and, and, and I thought Julia had just seen a ghost. And she said “I don't think I've ever seen him kiss a man in his whole life.” It was so tender. This is why for me being a doctor remains the best possible job and profession, calling that I could imagine.

Denise 

And that is an illustration of the power of a thank you. Because that thank you lives with you still and obviously always will.

Ira

Absolutely. 

Denise 

For me that the work that we get to do is such a privilege, and we touched before on, you know, that awareness of the fragility really of life, and how short it can be and get daily reminders of the importance of these four things that matter most, of sharing those with the people around us. The one, I love you, in some ways, for some people would be the easiest thing to say. I probably use that daily, with my family, but for others, that could be a really difficult thing to say and yet something someone really needs to hear. It's a powerful phrase.

Ira

Of course. If you don't have time to say anything else, saying I love you really kind of captures it all. Men have the hardest time saying this by far, there is a gender gap without question. And fathers, fathers have difficulty sometimes saying I love you to their children. I think it's getting better. I think it's much better in my generation. And I hope and I believe it's actually easier in the generation of my own adult children. Who are great parents by the way, I'm proud to say. And I think even today, sort of the manly men sometimes mistakenly have a mystique around saying I love you. But they're better for it when they do and their children are, are better, you know, for hearing it. 

Denise 

I agree about it being a generational thing. And, you know, look at it my own father was not a phrase that fell readily from him, but I certainly, you know, think that I've been able to pass that on as an unconditional love. And like you I have adult children and I love seeing the parents they've become, because I think they’re so much better a parent than I was. There’s just that potential there. And you know, when you said I love you is almost a short, said sincerely, in some ways that almost encapsulates the I thank you, I forgive you, and I ask forgiveness doesn't it when it's said deeply and sincerely. 

Ira

Yes, indeed. It really, again, it's, in an emergency if you haven’t got time to say anything else say I love you.

Denise 

Very true. Ira, you talk about how we care for infants. And that's an instinctive thing, it's innate. If there is a baby that is crying, we instinctively are going to reach out we rock them, we comfort them. And part of that that sits with that love, doesn't it but you took that further how then actually caring for someone who's older and frail is that same thing. We have a fear of being dependent as an adult. We think that means we've lost our dignity. But you phrase that beautifully. And I just want to read what you'd said that ‘dignity resides in wise recognition of one's predicament, and a gracious acceptance of help from others’. And that really resonated with me that we think nothing of caring for a baby, and most of us will equally care for an adult. Why is it so hard to accept that care, that love, as a frail adult?

Ira

I think we're proud. And as we go from being children, to adolescents to adults, we are proud of our independence. We want to be strong, be independent and care for others. It's much easier to give care to people who are frail or in decline, and certainly to babies who are, you know, frail and in need of our protection and care, than it is to accept care ourselves? I cringe at knowing that for so many people, being ill and physically dependent on others feels undignified. You know, needing care from people when you are ill, or have disability related to your illness or the frailty of age doesn't make you undignified, it makes you human and allowing yourself to be cared for is part of kind of completing the fullness of our human potential as families and communities. It's not undignified it really is, is just part living fully as humans.

Denise 

I thought that that gracious acceptance of care is such a key thing. When the people I've cared for have been able to accept it, it's it's almost feels like a gift that they have given me in allowing me to help them. Because we all need to feel useful, we all need to feel needed. And when someone allows us to care for them fully it's such a blessing to us as a carer, to be able to do that.

Ira

Indeed, I would only say for the person who is dying, acceptance of physical dependency and acceptance of care really is a developmental task. It is a challenge. It's not easy for any of us. But it is part of that task of working through and growing through this part of human life. And when you are able to accept your physical dependency and care from others, you're able to once again establish a sense of wellbeing in the present, in who you are at this age and stage of life.

Denise 

Dying will come to all of us. Accepting help from others, giving help to others, as you say it rounds it out. It's that circle of life. 

Ira

Indeed, the way to get through the hardest parts of life is together, with love, with patience, with forgiveness, and in gratitude for one another.

Denise 

Ira that really sums it up, doesn't it? Yeah. Thank you. 

Ira

This has been a wonderful conversation.

Denise 

I’ve really enjoyed it. 

Ira

Let me say one last thing to the people listening to us. I don't expect anybody to buy this book. And I don't make money on the books, that's not the purpose of it. I mean, I'd love you to read it. And if it moves you and helps you in your life, fine. But you already know from listening to this podcast enough to go do this stuff, right. And if you need a conversation opener, all you need to do is say to the person who you want to have this conversation with, I heard this really great podcast the other day, and this doctor said, you know, before, you know, before anyone dies, or or today is a good day to say things that would be left undone if one of us were to die suddenly. And that's enough to start the conversation. So go forth. And, and I hope our conversation today is of value to the people listening.

Denise 

Ira thank you. I know that anyone who's listened to this will have got something really useful, and really just supportive in a way of them moving forward and starting those conversations. And I thank you for your time today. I thank you also you have given us a couple of handouts that will be attached on our website so that people can follow through. There's information at the end of this podcast on how to find those if people do want something written to read, to follow as well. So Ira, thank you very much for your time.

Ira

My pleasure. Thank you.

Denise 

And thank you, listeners for joining us today. This podcast was brought to you by Otago Community Hospice, with support from Hospice New Zealand. If you found this discussion helpful, check out our other episodes of Ending Life Well, A Podcast Series for Carers. You can also find the written resources that Ira has provided and other resources regarding caring for a person who is dying at otagohospice.co.nz/education.