The Art of Solace

15 Tips for Truly Connecting with a Chronically Ill Person
By Walter St. John, EdD

Being around a severely ill person—especially one who is facing a long-term recovery or who must live with a chronic condition—is not easy. It makes most of us deeply uncomfortable, even if we’ve known (and loved) the person for years. We struggle to say “the right thing.” We want to cheer the person up, but pasting on a smile feels fake and pointless. In light of his or her emotional and physical suffering, it may be tough to keep our own tears at bay. And frankly, the patient’s plight reminds us of our own mortality, too, which is most troubling of all.

Yes, for most people, the sickbed is uncharted territory. Unless you work in healthcare, you’ve probably spent little time around chronically ill people. But eventually, someone you love will be lying in that bed—and when that happens, knowing how to communicate with him or her will make all the difference.

Nature vs. Nurture

When someone you love becomes ill, you probably won’t instinctively know how to handle it. Providing solace doesn’t come naturally to most of us. As a result, we either act in a way that makes us feel better, or we withdraw. Neither meets the needs of the patient.

The good news is, relating to chronically ill people can be learned. You can learn to listen to the patient’s cues and respond appropriately. You can learn what to say and what not to say. You can create a relationship that brings comfort and peace of mind.

If you would like to feel more comfortable and confident around your ill loved one, the following fifteen tips can significantly improve communication:

1. Don’t try to be a preacher, doctor, or therapist.

Just be you. In many ways patients are different from the healthy individuals they once were. But they can still tell when you’re being phony or masking your feelings (especially if they know you well). It’s natural to feel uncomfortable—at least initially—but the best course of action is to simply be you. If your loved one detects that you’re putting up any sort of façade, he’ll begin to wonder what your true purpose is; for example, whether you might be hiding something important from him. Without being insensitive, let your natural mannerisms, feelings, quirks, and words shine through. This is the best way to maintain trust and a relaxed atmosphere.

2. Don’t squelch uncomfortable conversations.

Your chronically ill loved one will probably still want to talk about things like her favorite TV show, her children, and the news you tell her about your own life. But due to her condition, she will also bring up more weighty topics such as her fears, the pain she is in, and her worries about the future. Even if you’d rather not touch a particular conversation with a ten-foot pole, try not to respond in this manner: Can’t you ever talk about anything pleasant? Don’t you get tired of complaining about the same stuff all the time? Do we have to talk about your condition so much?

Remember, the patient deserves to talk—even if you don’t want to hear or process what she has to say. In fact, by squelching her concerns, you are sending the message that she doesn’t matter, and you reinforce feelings of isolation and resentment. The best course of action is to listen as objectively as possible, with an open mind and encouraging attitude.

3. Know how to say, “I don’t know.”

Whether the topic is medical, spiritual, or personal in nature, the patient will sometimes ask questions to which you don’t have answers. When this happens, it’s important to avoid giving a definite answer without seeming evasive, lest you jeopardize your credibility with the person. After all, you don’t want your loved one to think that you don’t care or that you’re hiding something, and you definitely don’t want to offer misinformation that might do more harm than good.

Don’t feel pressured to say something you don’t want to. Honest yet noncommittal answers to this and other queries might include: “I’m not the right person to answer that, but I’ll help you find out.” “Wow, that’s the $64,000 question, isn’t it?” “I need a little time to digest this.” Just don’t ignore the person entirely unless you have good reason, such as being verbally abused.

4. Don’t hesitate to call in spiritual reinforcement when it’s needed.

Some questions that your loved one might ask are so deeply personal—and so plain overwhelming—that you don’t feel qualified to deal with them. Questions that center on spiritual concerns almost always fall into this category. When someone asks, for instance,

“What happens after death?” or, “Will I go to Heaven?” trying to answer him can do more harm than good.

When spiritual needs and questions arise, don’t be afraid to admit that you aren’t qualified to handle them. You don’t want to inadvertently increase your loved one’s confusion or anxiety. In this instance, please call in a rabbi, priest, or other spiritual leader. And know that no matter how little spiritual training you may have, you can always be a confidant and source of support.

5. Understand that sometimes silence really is golden.

Many people find extended silences to be uncomfortable. It’s common to break them with idle chatter or statements like, “A penny for your thoughts!” Realize, though, that at times being quiet is most helpful and meaningful. Just sitting silently, perhaps with an arm around the patient, can communicate compassion that is beyond words. There’s no need to break a comfortable silence—your loved one might feel tired, weak, or contemplative and not want to chat. Your mere presence and availability can often be all she needs.

Be alert, however, for unnatural silence characterized by tension and anxiety, as it can alert you to the fact that the patient is worried, angry, or uncomfortable. And don’t use silence as a weapon—giving the cold shoulder to a seriously ill person will not help anyone.

6. Let the patient cry.

When most of us see someone crying, we tend to whip out a tissue and murmur something along the lines of, “It’s okay. Don’t cry,” because we’re uncomfortable with weeping. From now on, continue to pass the tissue when your ill loved one starts to tear up, but don’t pressure her to stop sobbing. Tears are a natural emotional release for emotions ranging from anger to sadness to fear, and they can be very therapeutic.

The best thing you can do for someone who is crying is to simply be present and listen if the person wants to speak. It may go against your nature, but refrain from interrupting with supportive statements—you can make those after the crying spell is over. At this point, your presence is the crucial thing. Don’t be embarrassed to show emotion yourself, either; crying can also be beneficial for you. And after the tears are dried, encourage your loved one to talk about her feelings (unless, of course, she doesn’t want to).

7. Realize that it’s okay to say “no.”

If you’re around someone who’s ill, demands will be made of you. That’s normal. Especially if you’re a caregiver, you’re agreeing to do things the sick person can’t handle himself. It’s crucial to understand, though, that you can’t say yes to everything. While you may be the “healthy one,” you still have physical and mental limits. And when you try to be everything to everyone, you’ll end up stretching yourself too thin, and perhaps even harming yourself or the patient.

It is much better to respond with a responsible “no” as opposed to an irresponsible “yes.” The situation could be as simple as the patient asking to eat an off-limits food “just this once,” or as complex as your family asking you to move in with Mom full-time to care for her. Regardless, saying no requires courage and conviction, and does not mean that you are weak or selfish. Just be sure to deliver your response with love. Explain your reasons and re-affirm how much you care for the patient.

8. Think before you speak. Choose words carefully.

Words are very powerful. An off-hand comment that you make and never consider again can impact another person’s mood or sense of self-worth for hours, days, or longer. As a caregiver, or even a visitor, your goal should be to choose words that are as clear and unambiguous as possible. Remember that what you say can help heal, or it can make the patient feel even more demoralized and sick. Using a little prior judgment can save everyone a lot of grief.

9. Share bad news. Don’t “deliver” it.

Say, for instance, that your mother is terminally ill and that your brother—her only son—has decided to end his marriage. If your family is having the Do we tell her? conversation, I maintain that sick people are still entitled to hear the truth and the manner in which you convey that truth is critical.

Try not to present the news as an idea that the other person will have to deal with on her own— don’t “tell and run.” This should ideally be a gut-to-gut, heart-to-heart conversation. Therefore, think about who the best person and when the best time to share the news might be. Make it clear that you are a partner in working through and/or coming to terms with the situation. Offer to help and don’t make everything about you and your own reaction.

10. Treat the patient like a person, not an illness.

When your loved one’s medical condition dictates almost all aspects of his daily life (and perhaps yours as well), it can be easy to focus primarily on his illness when you’re together. Even if you’re just visiting for an hour or so, you’re still acutely aware that the change in circumstances is due to the disease. Remember that you aren’t spending time with a disease. You’re spending time with a person who is still capable of interacting, understanding, and feeling. Unless your loved one’s illness has affected his mental abilities, he is largely unchanged. It’s important to always treat the patient with dignity and respect, and allow him to retain as much control over his life as possible.

11. Pay attention to body language (It can tell you what’s really being said).

Sometimes chronically ill patients might seem to communicate in a confusing or incomplete manner. Maybe your loved one is saying one thing but doesn’t seem to mean it, or perhaps her response to a particular set of circumstances doesn’t seem to fit. In these situations, body language can give you valuable clues as to what’s really going on.

Fidgeting or looking away might indicate nervousness. Crossed arms are a sign of defensiveness, while nail-biting or lip-chewing are symptoms of insecurity. Leaning toward someone points to cooperation, while leaning away might indicate suspicion or skepticism. When you learn to “speak” this language, you’ll be able to more accurately get to the heart of the matter.

12. Be (appropriately) hands-on.

Similar to a comfortable silence, touch is a powerful way to communicate without words. To a sick person, physical contact can convey support, comfort, reassurance, and more in the midst of a very frightening time. For some patients, a long period of not touching might even increase feelings of separation and isolation.

The appropriate way to touch someone depends on how close your relationship is, and what sort of contact he is comfortable with. Unless you are already very close and have a history of hugging, for example, it’s good to consider asking, “May I give you a hug?” the first few times. Also, keep in mind that your touching should be a natural, spontaneous gesture of caring. This is one of the best ways to create trust, especially during serious conversations about the patient’s feelings, pain, or fears.

13. If at all possible, honor the patient’s confidences.

Everyone needs someone to whom they can talk about their innermost thoughts, feelings, and concerns—especially people who are suffering from an illness. If you’re a caregiver or frequent visitor, you’ll probably fill this role to some extent. It’s important for you to maintain the patient’s respect and trust by not divulging confidential information—even once—because even one betrayal can be fatal to your relationship. And when you’re listening, remember to maintain a nonjudgmental and nondirective attitude. Even if you haven’t been explicitly asked to keep something confidential, err on the side of caution. Speak up against the patient’s wishes only if you feel that her well-being, or that of other family members, might be in danger.

14. Remember, smiling isn’t taboo!

There’s a saying that when you smile and laugh, you’re speaking in a universal language … and it’s even spoken by patients in sickrooms. Yes, when you’re visiting an ill loved one, you probably don’t feel like grinning, and you also want to keep things as peaceful as possible. But when you’re the patient, all of the seriousness and sadness can be wearing. Unless your ill loved one is a humorless person by nature, don’t feel the need to suppress laughter and smiles. Actually, laughter has numerous healing effects. It can relieve stress and even pain, and it’s also a wonderful way to “equalize” the sick and the well.

15. Don’t take anger personally. Do respond constructively to it.

Anger is a natural human emotion, and seriously ill people have a lot to potentially feel angry about. After all, they have a prognosis that might not be hopeful, and they have lost some amount of independence and autonomy. Plus, their pain and energy levels might make them less patient or less able to handle stressful situations. Therefore, it’s not unusual for caregivers to be on the receiving end when their loved one’s fuse blows for any reason.

While you can’t control the patient’s anger, you can control your own response. Make every effort to remain cool and collected, even if you have to pause for a few seconds or leave the room to keep your own stack from blowing. And after the episode is over, try to identify what really caused the outburst so that you can avoid similar situations in the future. Anger doesn’t happen in a vacuum—it is triggered by various emotions, perceptions, and events. Refrain from squelching or downplaying your loved one’s anger since she has a right to express it, and since it may even be therapeutic.

Worth the Effort

Taking time to learn the art of giving solace is absolutely worth it—and not just because it helps the patient.

We learn so much from our interactions with chronically ill loved ones. When you do all you can to make your time with the person productive and meaningful, you may gain great emotional and spiritual growth. And you’ll stave off regret—down the road, when you look back on this experience, you won’t wish you hadn’t squandered what could have been the richest, most real time you ever spent with your loved one.

 

Walter St. John, EdD, is a retired college professor and administrator who lives with his wife in Old Town, Maine. He taught interpersonal communications courses for more than twenty years and has presented communications workshops throughout the United States and Canada. He has hands-on experience with disabled veterans, multihandicapped youth, and Special Olympics participants, and he has written widely in the field of communications.

Solace: How Caregivers and Others Can Relate, Listen, and Respond Effectively to a Chronically Ill Person (Bull Publishing Company, 2011, $14.95) is available from major online booksellers and at bullpub.com/catalog/solace/.