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Listening to hidden messages: nearing death awareness

Listen for the hidden message and near death awareness

By Terre Mirsch

I worked with a hospice patient named Annie who, like far too many, was taken from us at a young age—eighteen years ago, when she was only 42. Eighteen years ago…why is it that I remember that moment, standing at her bedside, as if it happened just yesterday?

What she said to me was simple, and so her message was easy to miss: “Thank you,” she said as I was leaving that Friday afternoon. Annie was sitting at the side of her bed, awake and alert, weaker, but she did not ‘appear’ to be significantly different than my prior visits.

“No problem, Annie- I’ll see you on Monday. Do you remember how to call our 24-hour number if you need anything?”

“Yes,” she said, “but I really want to thank you for everything you have done for me and my family.”

“You’re welcome,” I said, and off I went after giving a brief update to her young daughters.

In hindsight, I recall wondering why she made it a point to ensure that I heard her thank you. For a brief moment, I wondered why there seemed to be a sense of urgency behind her words. That was the last time I saw Annie- she died on Saturday evening with her daughters at her bedside. Annie knew what I could not see from the physical signs and symptoms of her illness; she knew that she was dying and she knew that she would not be seeing me on Monday.

This knowledge, termed nearing-death awareness, is common and can provide a sense of peace as one gets closer to the final weeks, days, or hours of life. Communication using symbolism and metaphors is, however, often mistaken for confusion. Messages can easily be misinterpreted or overlooked, as was the case with Annie and me. Paying close attention to the words and their hidden meaning provides us, and them, an opportunity for understanding and closure.

The following tips provide some guidance for hearing and responding to these hidden messages:

  • Allow your loved one to talk and share their experiences without negating or dismissing them.
  • Listen carefully, not only to the words but to the meaning and message behind the words.
  • Don’t mistake symbolic communication for confusion, hallucinations, or dreams.
  • Ask questions to gain better understanding, if possible.
  • You don’t need to have answers to questions, and it is OK to say that you don’t know. Listening and understanding, rather than answers, is what is needed.
  • Understanding hidden messages provides an opportunity to tell your loved one about the difference they made in your life, or to ask or provide forgiveness, or to say goodbye and I love you.

What might I have said to Annie had I recognized that her thank you was our final goodbye? Perhaps I would have taken the time to express my appreciation for all she taught me; perhaps I would have allowed Annie to talk more about how she felt, leaving us at a young age; perhaps I would have asked her if there was anything unspoken or unresolved with family or friends. I don’t know for sure what I would have said to Annie, had I recognized her hidden message. I am grateful, however, for knowing her and for the lessons that she taught me.

For more understanding about nearing death awareness, you may want to read Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan and Patricia Kelley. You can get it at your favorite bookstore, or you can order it on line at or

4 Comments Post a comment
  1. As a 43 year old mother (of 2 daughters) recovering from breast cancer, I found this to be absolutely spot on. Sometimes, patients just need to share thoughts to a good listener. Meanwhile, many family and friends aren’t really sure how to help someone who is at the end of life. Your words provide comfort and guidance to all involved. Thank you.

    January 23, 2012
  2. Mike Green #

    I loss my wife at a young age to cancer. (29 yrs old) It was during the trials of chemotherapy and its side effects that I truly learned the meaning of love. The moments we share as we suffer together filled us both with the spirit of love that no one can ever take from us. This experience has allowed me to persevere through troubling times. We should embrace the opportunity to be there (in mind, body and spirit) when hard times present themselves. It is through this courageous act that we will experience the true meaning of love.

    January 24, 2012
  3. brenda dellavecchia #

    Beautiful reminder, thanks for sharing your story.

    January 25, 2012
  4. Linda Yerkes #

    No one realizes how deep emotions go until you live with someone with cancer. The highs and lows are very emotional. It definitely doesn’t get easier through the years but it makes each and everyday more special.

    January 26, 2012

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