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Hospice: A Child's Goodbye

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Yesterday, I had to have a sad conversation with a friend whose beloved father is dying of cancer. She called me to ask how best to deliver the news to her kids (age 9 and 11) and whether or not they should see him for the last time.

While I would much rather have gabbed about anything other than this, I was so glad that she called me (because this is what I have done for a living for the last decade).

Saying goodbye to a dying relative or friend -- what to talk about, when and how -- doesn't (usually) come naturally. Especially when children are involved. The Silver Lining is that there are many very practical ways to help children be a part of the dying process.

The first thing to do is to have a conversation with your children to explain what is happening and what they can expect. For example:

As you know, Grampa has cancer. It has spread to his whole body and he is not going to get better. That means that he is going to die.

Take a deep breath here to give the children the opportunity to absorb the information. Then, say something along the lines of:

Cancer is awful and terrible. It is important to know that it is no one's fault that Grampa is dying. It is also important to know that he is peaceful and doesn't feel any pain.

Give children the chance to ask questions. Silence, without jumping in to fill the silence, is key. Respond to children's questions honestly. Sometimes the simplest, most honest response is difficult during an emotional time. Children need honesty to feel secure. It can be hard to tell a child, I don't know, when you truly don't know the answer to a question, but this response is the right one.

When the child has no questions, say:

If you ever have a question, you can ask me. Anytime. Anywhere.

I know it's hard. It's so f-bomb hard. But this conversation needs to happen. I've always said that a child's imagination is far worse than reality. It really is. YOU have the opportunity to prevent a child's imagination from going to a place like, Did I cause him to die? See what I mean about being far worse?

The next step is to offer the opportunity to say good-bye to the dying person. When a child or grandchild says goodbye, the parent or grandparent suffers less. It may be a heart-wrenching encounter to witness, but the potential benefits outweigh the consequences of not bidding farewell. That said, it is imperative that no child be forced to say good-bye. There is no should here. It is also really important for each child to make his or her own decision. Children need to be assured that there is no right or wrong answer. Whatever they decide to do is a-ok.

If they are unsure about what to do, assuring them that you will be there to support them and help them through the process helps immensely. Offering a child or grandchild the services of a hospice social worker can be a great thing for the child or adolescent to prepare for saying goodbye and adjust to the grieving process.

If children do decide to say goodbye, it is important to prepare them for what they will see in terms of equipment and what the person will look like. The hospice team can also help you with this. For example, if a person is dying at home, the dialogue could go something like:

Grampa will be laying in bed. He will have a small tube coming out of both of his nostrils. The tube provides oxygen to help him breathe and keep him comfortable. He will also have a tube (called an IV) coming out of his arm. This enables him to receive medicine that keeps him comfortable.

Another pregnant pause here...

Grampa is asleep now and not able to talk. Even though he can't talk to us, we think that he can hear us, so you can tell him anything you would like to say.

Allow the child to spend as much (or as little) time with the dying person as needed. There is no rush, but also no mandate to stay for a particular amount of time. Again, there is no shoulding here.

After the children have said goodbye, it is important to have a conversation with them to assess how they are doing. For some, it may be incredibly heart wrenching. For others, it may be cathartic. Now is the time to encourage dialogue and listen.

The death of a family member is very much a family event. It is for this reason that children need to be included in the dying process and given the opportunity to say goodbye.

I'm so sad for my friend and for all of those who are having to cope with this pain. There is a Silver Lining in the tremendous support omnipresent in a hospice team. Calling on the team, even if you don't know exactly what you want or need, will be immensely helpful throughout the process.

Next week, I will talk about the grieving process for children.

To read more about Hollye's holistic and humorous journey over, around, above and below breast cancer, please visit her blog, The Silver Pen (www.TheSilverPen.com). You may email her at hollye@TheSilverPen or follow her on Twitter @hollyejacobs.