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Some tips on what to say, including sometimes saying nothing at all.
Some tips on what to say, including sometimes saying nothing at all.

SocietyAugust 12, 2023

How to talk to people who are dying

Some tips on what to say, including sometimes saying nothing at all.
Some tips on what to say, including sometimes saying nothing at all.

Some tips on being good company to someone who is facing their mortality.

All week long The Spinoff will be opening up about the end. Click here to read more of our Death Week content.

One day everyone you think is cool, fun and lovely will be on their deathbed. The older they are the more likely they’ll be sick, probably with cancer, and know death is coming. If they’ve beaten you to the end, it’s likely that apart from being sad, your guts will be twisted with dread and fear, and at least some of it will manifest as social anxiety. It’s easy to fret that our trivial chit-chat about TV, accidentally stepping in dog poop, the price of cheese and whatever sports world cup is on may not cut it. Then again, straying from light topics is scary, because you might say something wrong or offensive. 

“Sometimes you see friendships disappear, because I guess people get nervous, they don’t know what to say,” says Amanda Evans, a palliative care specialist. Yet she’s also seen beautiful conversations happen at people’s bedsides. “Don’t be afraid to go and see people when they’re going through this.”

Sandra*, who is preparing to eat her share of asparagus rolls and say her farewells at a celebrating life party (or living funeral), says she is looking forward to all the conversations she will have there.

Talking to people who are dying is not something most of us do often, but it doesn’t have to be scary, even when Sandra threatens to haunt you. How can we be good company to people who don’t have much time left?

Remember they are still alive

The image I have in my head of someone on their deathbed is straight off a cheap stock image website. You can barely see a human because they’re almost entirely covered up by sheets and tubes. It isn’t very flattering or accurate, just this week I’ve met a dying person who works and enjoys motorcycle riding, and another organising a party.

Their body may be unwell, but they are the same person inside. Talk with them as you always have,” says Sandra. It seems she continues to be darkly hilarious, she says she’s been joking about alternative ways to dispose of her body once she dies.

“Just because they’re dying doesn’t mean they have a different personality”, agrees Evans. “This is the person that you’re friends with, this is the person that you care about. If they were an asshole they will still be an asshole.” She laughs, which is very much allowed when you’re around death. I’m beginning to wonder if I’m outing myself as being so afraid of death, I’ve forgotten people who are dying are, well, people. “Sometimes you do need courage to walk through the door,” says Evans, “but when you’re there, you realise that it’s actually OK.”

Trivial chit chat

When I ask Sandra if she enjoys chit-chat about ordinary everyday things, her response is quick. “Abso FKN lutley! That is 90% of what we talk about.” 

Talk about death

Catherine D’Souza, who began specialising in palliative care in 2009, says even she is sometimes surprised by how open her patients are about death. “The majority absolutely welcome an open and honest discussion,” she says. In palliative care, you learn that “death is comfortable, calm and peaceful for the majority of people. It doesn’t have to be a time of suffering and despair.” 

Still, one’s own death can be a lot to process. “Some people like to talk over things multiple times. They will talk about dying every day, that’s their choice. Some people don’t want to talk about it so much. They’ve had that conversation, an honest conversation, and then they feel like that’s enough,” says D’Souza.

The topic of death may need to be broached differently with children. Evans is one of only three paediatric palliative care specialists in the country, currently caring for children who are dying, through Rei Kōtuku. Evans asks if they feel like their body is changing, to which they usually say yes. Then, she asks what they think is happening. “They might turn to me and say, ‘I’m dying’.” In her experience, children aren’t as scared of dying as people might assume. 

Adults often avoid the topic because they try to protect children, but “if no one’s talking about it, then it makes them feel more isolated, and more lonely and more anxious and fearful.” Evans has found that what children who are dying are most afraid of is being without their parents, so they need reassurance. “I spend time with the parents and tell them to keep saying to the child that they’re not going to be alone.”

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Gabi Lardies
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Don’t feel sorry for them

Anna Cruse, motorcycle rider, acrobat, martial arts enthusiast and Addams Family lover has a terminal cancer diagnosis. Her cancer is not one which is causing her a lot of pain, so she is enjoying life. “I do not consider myself to be a victim. And I really really do not like it when people treat me like one,” says Cruse. Sometimes she feels people are tempted to think of her as a fragile “patient” when she tells them about her diagnosis, but “most people who know me, they know that I can’t be treated like I’m soft or delicate.” 

Cruse is careful to point out she’s not a “representative of the whole dying community”. She says, “if it’s the worst pain that anyone’s ever experienced in their life, it’s going to be a lot different for them.”

By the same token, Cruse doesn’t appreciate false positivity. Sometimes people say things like “you got this,” and she thinks, “Well, yeah, I’m gonna die. This is not a battle which I am going to win.”

Evans says it’s important to remember death is not something to be “fixed”. “People don’t have to come and make it better, because there’s nothing to make better”.

HEIDELBERG, GERMANY - MARCH 30: In this photo illustration a Old man has a family photo in his hands on March 30, 2022 in Heidelberg, Germany. (Photo Illustration by Ute Grabowsky/Getty Images)
Photos can be useful prompts (Photo: Getty Images)

Happy memories 

Sandra says the conversations she has most been enjoying recently with her sons have been “laughing together about the funny things that have happened in our lives together.” Her sons have sometimes opened these conversations by asking her, “Tell me about xyz again please Mum.” 

Annie Meredith, an end of life doula, has some similar openers. She asks people what brings them joy in life, what’s important to them, who are their significant people and places, and asks them to think of a time when they felt most alive (not all at once). Then, she always has a couple of questions up her sleeve to help someone keep digging into their memories – Can you tell me a bit more about that? How did that make you feel?

Have some fun and whiskey

“People don’t want to be miserable the whole time. When they’re dying, they want moments of joy, they want to enjoy the remaining life that they have left,” says D’Souza, who has seen some beautiful moments in palliative care wards.

“I remember when an elderly chap was dying, all of his brothers, uncles, sons gathered around the bedside, and they all shared a glass of whiskey together and toasted him as he was dying. That was rather moving because it was his favourite drink,” she says. Others put on favourite music, or sing, to celebrate the dying person’s life.

“I hope I’m laughing until my last breath,” says Cruse, “I love to laugh. I love to have these funny things going on. Having a clown near would be fantastic. Strippers, too. And whiskey – it’s classy.”

Some of Sandra’s friends have been cracking her up by saying things like “get well soon”. Not everyone’s sense of humour is this dark, but you “gotta laugh or cry,” says Sandra. She’d rather laugh.

Ask if they are at peace

“It is quite a weird thing to say out loud sometimes, but actually when you ask it, because it’s quite vague – peace can mean different things for different people – they bring up things that are important to them,” says Evans. 

It’s the type of contemplative question which might get you weird looks if you were to ask it at a friday night barbecue, or a cringe on a first date, but next to death, it’s a gentle probe to look back on life. The question could also bring up feelings of unfinished business, which, if they’re wanting to talk through them, could be juicy.

Say the wrong thing

“People always do and say silly things. It’s okay. You can have a laugh about it. You don’t have to be perfect,” says Evans. Making an egg of yourself is just life, but it is different from pressing someone to talk about things they really don’t want to. If in doubt, ask.

Tell them that you love them

This is what Sandra thinks is most important.

Its you or the op shop

Ask if you can have that dress

In Evans’ experience, this shameless honesty elicited laughter from the person dying. “It was a question that they would expect to come out of that person’s mouth, it was just that type of relationship,” she said. I’m taking this to mean that by the bedside, we don’t have to turn into angels, we can be ourselves.

On the topic of inheriting things, don’t put practical questions off the table. Asking if someone has their affairs in order isn’t necessarily in bad taste. Nor is asking them to write down all their passwords and knowing what they want done with their social media accounts. And have they planned their funeral? You can offer to help! A fun activity to do together! 

Nothing at all

“Be comfortable to sit with silence, sometimes silence gives them more time to think,” says Meredith. She stresses that listening is important, and so shutting up is essential. Quiet can give the dying person a chance to bring up what’s on their mind, or for them to simply feel comforted by your radiant presence. 

Evans too thinks your presence is enough, “Come and just be, you don’t need to say anything. You could just sit there and be on your phone, but being there can make the person feel less alone. There’s a lot of comfort from someone just sitting here.”

For Evans, D’Souza and Meredith, who have dedicated their careers to helping people who are dying, spending time in their company is not sad or scary – it’s a privilege. “I think some of the most beautiful conversations that I can ever have are with someone nearing the end of their life,” says Meredith, “these conversations tend to be more honest, real and authentic.” 

Keep going!
(Image: Getty, additional design: Tina Tiller)
(Image: Getty, additional design: Tina Tiller)

SocietyAugust 11, 2023

On the job: three people on using drugs at work

(Image: Getty, additional design: Tina Tiller)
(Image: Getty, additional design: Tina Tiller)

Using drugs at work is usually well against workplace policy due to their ability to impair judgement and impact safety. Here, three New Zealanders who have used drugs at work for various reasons speak to Sam Te Kani about their experiences.

Over the last few years, Aotearoa has made some significant advances in our attitude, and legislation surrounding drug use. Slight increases in the accessibility of medicinal cannabis and the legalisation of drug checking are among these advances, which are helping to keep people safer despite the still recreationally illegal drug market.

Still, public misconceptions about the spectrum of drug use prevail, arguably peaking where substance use overlaps with the various performance pressures of the workplace. 

From a random sample of candid users, Jerome* says: “Drugs have always been a part of my life and therefore a part of the workplace. I was once giving away water cooler trials as a 17-year-old, cold-calling businesses, and a guy in the office put half a trip and half a pill in my mouth at lunch time, and then later tried to get me to pay him.” He remembers the following high being a “pretty annoying” way to spend a Monday night.

“More recently I will smoke weed at work because I DJ as well, and… if you’re not in a good mood, [DJing] can be a rough one. So an eighth or tenth of a tab of acid has been life changing for that, helping me see the absurdity of performance. I find it really useful for dragging me out of my own insecurities.”

(Image: Getty Images/Tina Tiller/The Spinoff)

It’s maybe easier to conceive of somebody finding themselves using drugs when their work environment pivots on the availability of certain substances – for a DJ, drugs are to some extent the milieu (though of course they don’t have to be). Speaking to other respondents, many of the stories I heard had more mundane roots – often starting with workers seeking a pharmaceutical solution to burnout, especially in a job that demands alertness. 

This is what happened to Janice*, who worked in the health sector for a number of years. Needing to get through extended graveyard shifts, where the vertigo of their performance was frequently a matter of life and death, they eventually found themselves in need of a stimulant somewhat stronger than caffeine.

“I couldn’t say my own experience was the direct result of work stress, but it certainly fuelled it, a thousand percent. I had grown up around addiction in my family, but work was a huge factor – I was a person who worked and worked and took it home with me. It was a crux.”

When work pressures eventually reached a boiling point, Janice found herself using drugs to deal with the day-to-day struggles. 

“I started to take “uppers” [also known as stimulants] to get by, to get through. Now, my work is nowhere near as stressful, and I’m completely sober. Nursing as a whole runs at a thousand miles per minute, every shift is relentlessly busy no matter where you are or what kind of nursing you do.”

Beyond turning to drugs to cushion various work stressors, Jeffrey* discusses the see-saw of self-managing health issues, and the legislative catch-up which still needs to happen to properly instantiate attentive and nuanced support. 

“I’ve worked in 12 different industries now and drug use in the workplace is prevalent in most of them. My preference is cannabis – basically I use to maintain pain levels for a spinal issue– and I’m a registered medicinal patient now which means I can use when required to for health reasons, which takes that pressure of the illegality off.”

Jeffrey also says “in some of the more high stress jobs I’ve had I’ve been inclined to use a bit more. At a certain stage there’s almost an expected culture where you’re offered A-class and bits and pieces to help you to relax, or to give you that energy boost. [In some companies] it can even feel like a sort of initiation.”

Let’s talk about drugs (Image: Tina Tiller)

This speaks to hierarchical discrepancies both in which drugs are used and how they’re perceived. As both Jeffrey and Jerome experienced, certain drugs were attached to different working worlds that they moved through, with quality and quantity changing along lines of income and status. 

Given those sometimes different expectations, some drug-using professionals have found themselves able to skirt suspicion even as their use became problematic. “I was taking prescription pain pills – tramadol – in excess for the better part of three years,” says Janice. “When it finally came to light what I was doing, it was because I overdosed and had a seizure and was in hospital for a few days, which was my rock bottom. I later had a superior who told me I’d be surprised how often this kind of thing happens.”

Supplementing the stresses of nursing is a far cry from executives having a cocaine lunch, but Janice’s drug use didn’t come without severe punishment.

“After stepping down and almost completely losing the career I’d built”, says Janice, “I was advised not to tick those online application boxes pertaining to drug use, as I’d almost definitely not get an interview. It’s the stigma. I mean I’ve lost people in my life who didn’t want to know me”.

Despite certain drugs being legally available, there is still a heavy stigma over their use – especially in the workplace. “I’m a prescribed patient, so they can’t legally stop me from using, but I also can’t be impaired at work,” says Jeffrey. “I can’t go back to the office looking and smelling like I’ve medicated, so it’s a fine line. I have to sit down with management this year and make sure their policies are respecting the legality of somebody’s use of actual medication.”

Medical-weed
(Image: Getty Images/Tina Tiller)

These stories are not intended as a state-of-the-nation-type snapshot, but they do point to a dissonance between policy and the ways in which fairly ordinary people live their lives. Not everyone who uses drugs does so to get “high”. For many, using is a way to get through another day in a stressful environment, find the confidence to face a crowd, or deal with physical pain. 

Despite their difference at an individual level, what’s obvious through Janice, Jeffrey and Jerome’s stories is that drug use is prevalent in many workplaces and for many reasons – and that realistically this isn’t likely to change. The question then becomes one of mitigation: knowing that this is how some proportion of New Zealanders are going to live their lives, how can we best minimise the harmful effects of this use? Is the best approach to continue applying resources to testing and (often punitive) workplace policy, or is it time to take stock of the real, contemporary situation and to start designing strategies to fit?

*Names have been changed to protect identities

Harm reduction tips for using drugs around work: 

  • Don’t operate machinery if you’re impaired, including driving.
  • Consider other mental health techniques to reduce stress – your work may have a counselling initiative set up, like EAP.
  • If you can, talk to a trusted colleague or someone who can help out when work stress is getting to you.
  • If drugs are still affecting you after a night out or big weekend, have a think about whether it’s safe to go to work. And if you do go, don’t drive.
  • Be aware that many drugs can affect how you perceive yourself and the world around you, which can make interacting with other people difficult.

The Level has more info about how different drugs can affect your ability to work and drive, plus tips on staying safer.