These will be some of the hardest and most meaningful conversations you will have with your loved one, yet sadly too often no one knows how to start the dialogue. As a hospice nurse I have difficult conversations daily. There were times when checking in on a person with a terminal diagnosis I’d simply ask, ‘What is important to you today, and how can I help?’ When confronted directly with an ‘Am I dying?’ makes most people unsure of how to respond. Your first reaction is to try and make the person feel better by saying ‘No, no you’ll be better in no time’, but does this answer make anyone feel better? No. You feel awkward for lying and being put on the spot, while your loved one shuts down, hiding their true thoughts and fears thinking you are in denial or can’t handle talking the truth. They already know or suspect they are dying. Instead of feeling like you have to provide all the answers, try asking ‘ Tell me, how are you feeling? Do you think you are dying today?’ This can better serve to steer the discussion to where the person sees themselves in the process. I loved hearing that Celine Dion, whose husband died of throat cancer, once said when sharing the openness of her and Rene’s relationship “ I’ll say, you’re scared? I understand, talk to me about it.” She acknowledged his fears and walked that path with him. She did not have to have all the answers, but just be there to listen. In the last week before my own father’s death, before I had become involved in hospice, I traveled down to stay with my parents for the weekend. I wanted to help my mother care for my dad who was five and a half months into his terminal diagnosis. I had never in those five and a half months ever talked openly with him about his dying, although I had easily and often discussed his dying with my mother and siblings. My mother had not told my dad that I was coming, and when I arrived that evening my dad seemed out of sorts and upset to see me there. In retrospect I think it scared him that perhaps I knew something he didn’t. He sat on the couch ignoring me and focused on looking at the newspaper, not being able at that point to actually read it, when suddenly he thrust the newspaper into my face and said “ I know why you’re here! This is why you came!” And there in my face was an ad for the local funeral home. Shocked, and taken completely by surprise, I found the courage to answer “ Yes, dad, you are dying and I came down to spend the weekend with you. I love you.” Unfortunately my dad had slipped into an agitated state I now know as terminal restlessness and the opportunity to have that real conversation about his dying had passed. Four days later he died. Lesson learned? Speak openly, honestly and frequently. Say all that you want your loved one to hear and know before that opportunity is lost forever.