The Four Things That Matter Most

About the Author

Ira Byock, MD is a nationally recognized

authority in palliative and end-of-life care and he is

a longtime advocate on behalf of seriously ill people

and their families. Dr. Byock serves as Professor of

Internal Medicine at the Geisel School of Medicine

at Dartmouth and has served as Director of

Palliative Medicine at Dartmouth-Hitchcock Medical

Center in Lebanon, NH from 2003-2014.

Objectives

1. To understand how 11 words expressed in four short

sentences can have a profound impact on relationships at

end-of-life.

2. To describe what common obstacles 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:

Please Forgive Me.

I Forgive You.

Thank You.

I Love You.

The Four Things in 3 Parts:

• Forgiveness

• Gratitude

• 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 3rd 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.

• 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.

YOUR TURN

Who is someone in your life who you can

apologize to for wronging in some way? Can

you write this apology out in a letter to them,

even if you never send it or they are

deceased?

Is there someone who you wish would

apologize to you for something? Can you

choose to forgive them even if they never

apologize to you?

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.

YOUR TURN

Who are the people in your life who have

encouraged, invested and believed in you?

What would you say to them?

• 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.

What can I say?

Expressing Love:

Remember the Love Languages!

(The 5 Love Languages by Gary D. Chapman)

1) Words of Affirmation2) Physical Touch3) Receiving Gifts4) Quality Time5) Acts of Service