Four Things Matters Most 11 Words with a

Four Things Matters Most: “ 11 Words with a profound impact” Mark Philbrick, RN, MSN ANNA Conference May 13, 2015

Dr. Ira Byock

About the Author Ira Byock, MD is a nationally recognized authority in palliative and end-of-life care. He is a longtime advocate on behalf of seriously ill people and their families. Dr. Byock serves as Executive Director and Chief Medical Officer for the Institute of Human Caring for Providence Health. Former Director of Palliative Medicine at Dartmouth. Hitchcock Medical Center in Lebanon, NH from 2003 -2014.

Objectives 1. Discuss how 11 words expressed in four short sentences can have a profound impact on relationships at end-of-life. 2. Describe common obstacles that get in our way from expressing these concepts. 3. To participate in exercises that will allow us to experience the power of these 11 words.

The “Four Things” are not “Things” at all… • They are just 11 Words. • Well-chosen words can be a catalyst for healing & wholeness. • They are tools for Self-Care too. • We mostly need to speak these words to ourselves. • To mend, tend and nurture our relationships to ourselves and others.

The “Four Things” in 11 Words: 1) Please Forgive Me. 2) I Forgive You. 3) Thank You. 4) I Love You.

The Four Things in 3 Parts: 1) Forgiveness 2) Gratitude 3) Love

LESSON #1: Human Beings are Imperfect! • Likely you will die imperfect so “Get Over it!” • We can strive for perfection but we can’t achieve it. • In our culture we are driven to be “human doings” instead of “human beings”. • We blame ourselves for not “living up to our potential. ” • Mortality teaches us a lot about life…. • It teaches us to have mercy for others but also ourselves.

LESSON #2 The “Four Things” are not “Things” • Ask someone being wheeled into surgery or 3 rd round of chemo, “What matters most to you right now? ” • They always mention names of people they love. • Relationships are what matters most!

LESSON #3: Because Human Beings are Imperfect… Relationships tend to be Imperfect! Many of us suffer from the “mundane wounds” inflicted upon us by others that will negatively affect the quality of our lives.

Relationship Wounds…. • Most of our emotional scrapes and bruises eventually heal. • Sometimes the “scabs are thin”. (People we love sometimes pick our scabs. ) • Some wounds are deeper… • Lies, infidelities, painful divorces, lawsuits can be opened up, or re-opened all too easily or never let go of. • Some wounds are very deep and may never close… such as: Physical, emotional or sexual abuse. • The deepest wounds are usually perpetrated by people we trusted. • If it wasn’t for Mortality there wouldn’t be any urgency to deal with any of these.

LESSON #4: Healing is Possible! • “It ain’t over until it’s over. ” (Yogi Berra) • Life is an unfolding story. • It’s stories that matter. • There is always another chapter to be written even if it’s only a few paragraphs long. • If someone has harmed you, you have a right to be angry. • Anger is a totally legitimate emotion. • You have the “right” to be angry, it’s an option but not your only choice.

FORGIVENESS: • Be gentle with Yourself & Others. • Life is there to be Lived Fully. • “Forgiveness is giving up all hope for a better past. ” (Lilly Tomlin) • • Get rid of the “anger baggage” we carry. Not letting the past determine your future. • Forgiveness is not just absolving a harm. • Forgiveness is fundamentally not about the other person, but ourselves. • It’s not easy but it’s volitional.

FORGIVENESS: • Giving & Receiving Forgiveness is an emotional strategy to improve our own well-being. • It’s recognizing that the past cannot be changed but it need not control our future. • • It’s not about forgetting. You are going to remember what has happened and it’s going to change your behavior in the future. • We can only take care of our side of a relationship. • If you expect that your words & expressions will be returned in kind you are at high risk for being disappointed.

FORGIVENESS: • “ 90% of life is showing up. ” • The other 10% is arriving with “good intentions”. • Say the words that are heartfelt & authentic but without an expectation that they must be returned in kind. • Make a good faith effort. • Family life tends to be “messy”. • Even the most loving relationships tend to be imperfect. • This is to be expected and it’s OK.

Putting it into practice

FORGIVENESS: • You cannot “Feel” your way into it. • You have to “Choose” to do it. • Not – “Help me to forgive… or “I want to forgive…. ” • Rather – “I choose to forgive. ”

Gratitude… saying, “Thank You”! • Gratitude & Joy are intimately fused… • “In the act of saying thank you we expand ourselves. • Thanking people in an explicit way is an act of generosity. • We then invest attention in what we have – not what we lack. • In most cases we realize we have what we need – we begin to recognize how much we have been given.

Gratitude… saying, “Thank You”! • People who are dying don’t take things for granted. • When nothing is left unsaid or undone just being in one another’s presence takes on a sense of celebration. • Gratitude and Joy emerges.

“Thank You”…

Putting it into practice Who are the people in your life who have encouraged, invested and believed in you?

What can I say? • Thank you for the deposit you made in my life. • For the investment of your time. • For you words of encouragement. • For believing in me. • For being there. • For being patient with me.

Expressing Love: Remember the Love Languages!

The 5 Love Languages…. 1) 2) 3) 4) 5) Words of Affirmation Physical Touch Receiving Gifts Quality Time Acts of Service

Putting it into practice

The MOST Excellent Way…

The 5 th “Thing”…. Saying, “Good Bye”