The last journal issue of each year spans more holidays than other issues-and holidays are often fraught with excitable conversations. But one thing that does not take a holiday is sickness or the passing of friends and loved ones. Recently, I have been reminded of some of those times, things that were done or said well, and those that needed more sensitivity.

Communication etiquette is not always easy. I really do not believe that anyone has ill intentions to be crude at sensitive times. But rather, some people just don't know what to say and their attempts come out poorly. Much of the information in this Editorial comes from the two references at the end; the rest comes from personal experience and those of others. Sometimes, even the best communication intentions come out wrong; successful conversations, like all success, often come from experience.

An old story goes that a young man asked a wiser man, "What is the basis of your success?"

The wiser man replied, "Good judgment."

The younger said, "Where did the good judgment come from?"

The wiser one said, "Experience."

The younger said, "Where did the experience come from?"

The wiser one said, "Poor judgment."

Perhaps the information in this Editorial will help when your experiences are especially challenging-leading to good judgment and action that is supportive, not clumsy. The first section is about connecting with very ill people. Following that section are suggestions for relating with someone who has lost a loved one. Beyond that, for grappling with even weightier end-of-life problems (yes, there are some), read the Legal and Regulatory Issues column, The Value of Life: Economic Crisis or Patient Self-Determination.

Relating, Listening, and Responding to a Chronically Ill Person

You have a dear friend who just received some bad news, about herself, her spouse, child, parent-the details do not matter. What we say and what we don't say can make all the difference in whether or not you make a meaningful difference at a very difficult time. Some suggestions (St. John, 2011):

1. Be YOU, rather than the preacher, doctor, or therapist. Just be you. Don't feel that you have to put on a constant show of cheerfulness if you're normally a blunt, straight-shooter. And don't feel that you need to suddenly "have all the answers."

2. Some conversations may be uncomfortable for you to hear, but be there and listen nonjudgmentally. Your chronically ill loved one will probably still want to talk about things like her children or the news, but she will also bring up more weighty topics that might make you uncomfortable. Even if you'd rather not go near a particular conversation, remember, the patient needs to talk-even if you don't want to hear it. If you stifle her feelings and concerns, you could reinforce feelings of isolation and resentment. Do your best to listen objectively.

3. It's OK 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. You might say, "I'm not the right person to answer that, but I'll help you find out." The right person may be a spiritual counselor, a pastor, a rabbi, and so forth.

4. Sometimes silence really is golden. Just sitting silently, perhaps with an arm around the person, can communicate compassion that is beyond words.

5. 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. A simple touch can tell them, "You are not alone; I am here with you."

6. Pay attention to body language (and it may disclose what is really being said). Maybe your loved one is saying one thing but the body language is screaming the opposite, 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. When you learn to "speak" body language, you will be able to more accurately get to the heart of the matter.

7. Laughter and smiling can sometimes be the best medicine: Smiling is a universal language. When you are 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. Even in the worst of times, the ability to laugh gives the message that life is valuable.

8. Don't take anger personally. Do respond to it constructively. This person is likely in pain, afraid, unable to "see" the future, and it is not unusual for caregivers to be on the receiving end when their loved one blows up. While you can't control the person's anger, you can control your own response to it. Try to identify what really caused the outburst; it can be triggered by various emotions, perceptions, events-or just frustration at being in an uncontrollable situation.

Relating, Listening, and Responding to the Loss of a Loved One

The Vital Smarts (Crucial Conversations) people asked 180,000 readers to share their perspectives of what constitutes meaningful advice at this critical time (Vital Smarts, 2012). They received a rich amount of wise and heartfelt comments and collated what to say...and what not to say. When people are grieving, they want your heart, not your brain (intellect). No one, intentionally, says insensitive comments to someone who is grieving; however, it does occur. The following points may help.

Listen, ask, and respond. Asking a grieving person what he or she needs may be an impossible question. Saying, "If there's anything I can do for you, please let me know," may be a well-meaning, but impossible "assignment" for someone who is grieving. However, asking a specific question may be a blessing. When a coworker lost his wife to cancer, a friend simply asked: "Give me your most dreaded task." He said, "I can't look in the closet." The friend spent the next day putting the closet contents in piles: some to goodwill, those to be packed up so the children could make decisions when they were ready, and those to keep.

Nike had it right when it comes to responding during crises: Just Do It. After a long illness, my friend's husband died in their home with hospice. When she flew out with him to be buried in his home state, she asked if I could get the hospital bed and other equipment picked up. That was done and, along with others, the house was cleaned, the laundry was washed and put away, food was set in the fridge, and flowers were on the table.

If you really want to do something, stop and think about everything you know about their life. What little chores do they have to do to make it through a day? What extra tasks will now fall on them because of the loss? Mow a lawn. Weed a flowerbed. Cook a dinner. Bring in groceries. Find some proactive task you can do to communicate real compassion.

1. Speak simply and sincerely. Don't avoid the grieving person because you don't know what to say. "I'm sorry for your loss," and you being there is enough. And, sometimes saying less means so much more. Offer condolences and say, "I've been thinking about you and/or praying for you." A simple, "I don't know what to say," or a hug is far better than a question that has to be responded to, such as "How are you?"

2. Share memories of the loved one. People appreciate this sharing. The one who is now gone had lived in this world, touched others, and made his or her mark. Funny stories can be so healing. Stories previously unknown to the family may bring joy at a difficult time. Pictures shared may be precious.

3. Allow grief. Allow them to hate breast cancer, to cry, to hurt, to be angry. I was in my late teens when my father died. When I saw him lying there (the first "dead" body I had ever seen), I started to cry. People around me began the "soothing dance" (there, there, don't cry), but Aunt Cele held me and told everyone to let me cry. That was more than 40 years ago and Aunt Cele is now gone, as well, but I still remember this important act of kindness.

4. Realize that it takes time. One friend lost her husband suddenly at the age of 48 years. A year later, a family member essentially told her "get over it." Everyone has their own timeline.

What People Don't Want to Hear

Many of the 180,000 Vital Smart's readers complained of friends who offered judgment or unwanted advice rather than providing a simple connection. Please consider before verbalizing any of the following:

1. "It was God's will." or "He or she is in a better place."

2. "It's time to get on with your life."

3. Saying nothing: don't just avoid saying anything about the loss. This, too, can leave one hurt and bewildered. Some readers found saying absolutely nothing to be the most offensive and painful of all.

4. Giving unwanted advice. "Why don't you just do...." There may be a time-later on-for a mutual conversation, but when the person is in the throes of pain and loss is not the time.

5. Refrain from "one-up" stories. "Gosh, I'm so sorry to hear about your aunt. I had an uncle who died of cancer, but his death was much worse."

6. Don't blame the survivor-there already may be plenty of that going on, but it serves no compassionate purpose.

7. Don't ask for details. If the family wants to talk, you can listen.

8. Don't tell him or her to be grateful. For example, when a cousin in her 50s died suddenly, a friend mentioned to the husband, "At least you don't have any young children at home." This is far from comforting.

Most people simply do not know how to react or what to say in some circumstances. They may try to be supportive, yet have it come out wrong. If you are the recipient, perhaps you can appreciate that he or she has made the effort and has tried in his or her own way to be comforting. At least they have connected with you when it is actually much easier to avoid any communication. Many of us have had inappropriate things said at times of loss, but they have come from caring, loving people with the best of intentions.

Communication successes may be large, as in a wonderful keynote presentation, or they may be as small as giving a meaningful touch. The PCM wishes the readers and their loved ones a blessed holiday season, full of miracles, large and small.

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