"One key to living well lies in expressing the essence of 'the five tasks' in our daily interactions with those we love." ~ Ira Byock, MD

This really has been a remarkable couple of weeks...

I've had a number of quite remarkable conversations with some very special people - about life and memories, about death and dying, about the tasks of our lives and the will to live. One of the conversations I had last week was with one of our clinical experts on the dying phase. We were discussing a young patient and her family, talking about her clinical condition and what we could predict would happen when, and what factors make it very difficult to predict.

Many families of hospice patients become quite upset with us if we do predict events in the course of illness and are wrong, and they get just as angry if we don't predict the course of events. It's very frustrating, since often the family and the patient are in two separate places in their coping with their illness. We often run into ethical dilemmas because the family wants to control things, to extend the patients life, but the patient is ready to go and wishes to say their goodbyes to their family members.

It's such a delicate balance - to hold hope, yet to do those tasks that are so necessary at the end of life. It's hard to help people see that one can have hope and be realisitc - to see healing and wholeness in illness and death. We can pray for a miracle, and see a miracle in the process regardless of the outcome.

Ira Byock has a wonderful book "Dying Well" that tells many stories about his patients. He talks about the 5 tasks of dying - tasks that are important whether we have terminal illnesses or not. To live in the light of death is a concept central to the Buddhist tradition, it's one that other faith traditions certainly share and a concept that we're coming more to grips with in this country as well.

Those five tasks include:

Saying "I'm sorry" - we've all made mistakes, and it's important to acknowledge them.

Saying "I forgive you" - this includes self-forgiveness, i think, but it's so important to understand that the people in our lives are just as human and filled with frailty and fear as we are - part of letting go of pain includes forgiveness.

Saying "Thank you" - even if the gift was to prompt us to look within at our own fears or teach us how not to behave, all of the people in our lives have given us gifts. The acknowledgement of that is a wonderful gift in and of itself.

Saying "I love you" - can any of us hear or say that enough? Yet all to often, we get so busy that we forget to appreciate the ones we love. Then when they are gone, our grief is compounded by regret at the things we didn't say, and the time we didn't spend with them. and finally,

Saying "Goodbye" - This can be the most profound of all of the tasks, since throughout our lives we have a series of hello's and goodbye's, yet we cling to relationships as though they are permanent things. We must be able to let go of each other, painful as that is, yet within that goodbye can be an even deeper unity in spirit.

I think that the holidays are a good time for reflection on relationships - what is wrong with them, what is right with them - what are expectations are for them, what we need and want from them - what we can learn from them, what we can give to them. In considering some family relationships, I think I'd like to approach perhaps a letter with my thoughts on those five tasks, whether I send it or not, to help me understand the dynamic of it.