A Conversation We Avoid
I was having dinner with a dear friend recently when I told her about someone very close to me who is ill and in declining health.
I wondered aloud to my friend about all the things I might do to help this person I love dearly get healthier.
My friend is a geriatric physician. She listened for a while and then asked me a simple question.
“Do you think it’s time to talk about hospice?”
I stopped.
Hospice.
How had I not thought about hospice?
I'm a psychologist in cancer care. I’ve spent over a decade on an integrated palliative care team. I’ve sat at the bedsides of people who were dying. I’ve held their hands and sat with families as they struggled with decisions about treatment and end-of-life care. Conversations about death and dying are not foreign to me.
And yet hospice had never entered my thinking about my loved one.
I was thinking about getting them stronger and healthier.
I wasn’t thinking about dying.
And that has stayed with me.
Why?
The easiest answer is that I love this person and don’t want to lose them. Of course I don’t.
There’s nothing particularly revealing about that. None of us want to lose someone we love.
What surprises me is what I had apparently managed not to think about.
I knew this person was older and their health was deteriorating. I knew we were no longer talking about returning them to the life they had been living before all of this began. I knew all of those things.
But somehow I hadn’t allowed those facts to become the question:
Could my loved one be approaching the end of their life?
Knowing that someone we love will eventually die and allowing ourselves to consider that they may be dying are not the same thing.
I think we human beings have become remarkably good at keeping death outside the room.
We know it exists. We know it will eventually come for the people we love. We know it will eventually come for us.
Just not yet.
And when someone tries to bring it into the conversation, we often push it right back out.
When someone says, “I’m afraid I might die.” We respond with, “Don’t talk like that.”
“I want to make sure you know what I want if things get worse” gets a reply of “You’re going to be fine.”
“I think I need to start getting some things in order“ is halted with “Stop thinking that way. You need to stay positive.”
We may think we’re offering hope.
But sometimes I wonder who we’re actually trying to protect.
From an Acceptance and Commitment Therapy perspective, there is a concept called experiential avoidance. It describes something remarkably human: our attempts to avoid, suppress, escape, or control internal experiences that are painful or frightening.
And death gives us plenty of them.
Fear. Grief. Helplessness. Uncertainty.
The thought of a life continuing without someone we love.
The awareness of our own mortality.
The fear that talking about death means surrendering.
Maybe even the irrational sense that saying the word aloud somehow summons death.
So we don’t say it.
And for a little while, that works.
“Don’t talk like that.” The conversation stops.
“Let’s stay positive.” We get to talk about something else.
“Let’s focus on getting stronger.” Now we have something to do.
And I’m beginning to wonder whether doing can sometimes be another way of avoiding.
I wasn’t sitting somewhere consciously thinking, “I refuse to consider that my loved one might be dying.” I was trying to help. To solve the next problem.
A reasonable thing to do.
An expression of how much I care.
And maybe, without realizing it, something that allowed me to remain focused on helping this person live rather than considering whether it might also be time to talk with them about dying.
Avoidance doesn’t always look like running away.
Sometimes it looks remarkably productive.
I think about the people I sit with every day in cancer care.
There are patients who know their cancer is serious and want to talk about what might happen if treatment stops working. There are people who want to talk about dying. They want to talk about what they’re afraid of. They want to make plans. They want to say things to the people they love while there is still time.
Sometimes the people who love them aren’t ready to listen.
“Don’t talk like that.” “You’re not going anywhere.” “We’re going to beat this.”
Those words are spoken from a place of love.
I wonder what it’s like to be the person who may be dying and discover that the people you most need to talk to cannot bear to hear you talk about it.
Perhaps our silence doesn’t make death less frightening.
Perhaps it makes dying more lonely.
I’ve spent much of my professional life sitting on one side of this conversation.
That night at dinner, I found myself sitting in the other chair.
My friend didn’t suggest my loved one was dying. She didn’t tell me what decision I should make.
She simply asked whether it might be time to let hospice enter the conversation.
Nothing about my loved one’s condition changed when she asked the question. This person was exactly as ill after those words were spoken as they were before.
What changed was what I was willing to consider.
I’m thinking differently now about something I’ve witnessed for years in working with serious illness.
Maybe talking about death doesn’t mean surrendering hope.
Maybe talking about death is simply allowing ourselves to make space for something that has been in the room all along.
And perhaps one of the most loving things we can do is allow death to enter the conversation long enough that we might hear what someone we love needs to say about it.
Reflections on the inner psychological experience of living alongside cancer.
Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.
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