Columnist and psychotherapist Lori Gottlieb advises a reader who fears discussing end-of-life affairs will make her husband think she wants him gone.
Question: My husband has terminal cancer, and I don’t know how much time I have left with him. I don’t know how to talk to him about end-of-life. We own a business together, and he is a pivotal part of its ongoing success. I don’t know how to do this without him, nor how to ask him without making him think I am “looking forward” to him dying (which I most certainly am not). I have been in fight-or-flight mode for three years. I am exhausted.
From the therapist: I’m so glad you wrote to me, because you’re describing the experience of watching a spouse die in which most people feel alone – the whiplash of the good news/bad news roller-coaster, the stress and fatigue of tending to someone you love, and the confusion about how to broach end-of-life conversations. Carrying so much can be incredibly isolating, which is all the more reason to talk with your husband. But while you still need to discuss business logistics, I want to suggest that you open with a dialogue that centres on grief – his, and also yours.
What do I mean? Sometimes people are surprised to learn that when one person in a marriage is seriously ill, grieving doesn’t start after the death occurs. Instead, both partners grieve throughout the illness, but often in their own ways.
I once treated a woman who was dying of cancer, and although her husband had been loving and attentive throughout their ordeal, he had also been grieving in silence. One night, as he was relaxing in front of the TV, his wife came in to show him another study about a possible experimental cancer treatment that she had found online. He snapped.
“Can’t we just have one night off from cancer?” he said, uncharacteristically raising his voice. To which she replied, “I don’t get a night off from cancer!”
His reaction didn’t make him an uncaring partner. Instead, it brought to the surface something many couples dealing with a terminal illness don’t discuss: we experience loss while the person is alive, and because our energy is focused on doctor appointments, tests and treatments – and because our spouse is still here – we might not be aware that we’ve already begun grieving. So the grief comes out in other ways: anger or denial, avoidance or distance.
How does this relate to you? Because not talking about your grief relegates you both to your own silos at the very time you need each other most. One of your concerns seems to be that talking about your husband’s death will make him feel that you’re “looking forward” to his dying. I don’t know if you used quotation marks because this is what he said, or if this is your own fear. But what it presents instead is an opportunity to talk about what is perhaps his worry over being a burden, and yours over how much you’ll feel his loss.
Another reason spouses might hesitate to talk about their partner’s impending death is that they don’t want to give the impression that they’ve lost hope. But there are two kinds of hope: one is hope for more time. The other is hope that whatever time remains can be honest, loving and less lonely. Silence won’t spare either of you; it will only make you face the future separately while you’re still together. Talking about his death might be painful, but avoiding it is painful, too – both scarier and lonelier.
You can ease into the business conversation by starting to talk about your grief, which might go something like this: “I love you so much, and I want us to be able to talk with each other about the huge loss we’re facing together. I’m already unable to imagine life without you, and I want to know what you’re going through, too. I don’t want either of us to go through this alone.”
Your husband might not know how to articulate his feelings, but you can ask questions to help guide him: Is there anything you want to say to me now? What are you afraid of? What would comfort you?
You can also ask about medical wishes: What kind of care do you want if things change? Who should make decisions? What matters most – being at home instead of hospitalisation? You can also gently ask about his wishes around legacy: What do you want me to carry forward? What do you want me to remember most? What would make you feel that your life continues to matter? (For example: my dying patient wanted to work on her obituary with me.)
I’m in no way suggesting that all this happens in one conversation. But by opening the door, you make space for the other important topics, too. Once you start sharing your hopes and fears, your anger and sadness, your love and gratitude, you create a way to communicate about every other difficult thing through the language of honesty, intimacy and trust. Then it feels natural when you tell him that you’re worried you won’t know what to do with the business, and that this anxiety is distracting you from what means the most: focusing on being present with him right now.
He might even feel relieved that you brought this up because most people who are dying find it comforting to know that their loved ones will be OK. Perhaps the two of you will also consider bringing in a financial professional to help navigate this transition so you both feel secure that you have the support, should you need it, of another person who has the necessary knowledge to help you run the business smoothly, too.
The business conversations matter, and you should make sure to get all the information you need. But don’t let them become a substitute for the conversations that might turn out to be among the most loving and meaningful of your marriage: what it’s like for him to be dying, what it’s like for you to be losing him and what you both want to say while you still can.
- Lori Gottlieb is an American psychotherapist, writer, columnist and speaker.
This article originally appeared in The New York Times.
Written by: Lori Gottlieb
Illustration by: Marta Monteiro
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