Eventually, she realized there weren’t any. A week before her father passed away, Mishkin told him: “There’s nothing I’ve ever wanted to say and didn’t.” He was very weak, but he managed to answer: “I could not ask for a better daughter.” Within days, he was no longer able to speak.
The answer, according to people who spend their careers alongside the dying, is that you don’t have to. There are words that can bring comfort, invite honesty, and help both of you find peace. But there’s no perfect script—and your presence likely matters more than anything you manage to say.
Almost always, they say yes—of course they would. "Well, go now,” says Byock, a palliative care physician in Montana and author of The Four Things That Matter Most. You'll say generous things at the memorial about what a remarkable person your friend was. Better to say them while she can hear you. "It's much more fun to say those nice things when somebody is alive," Byock says. If you can only make one trip, make it this one.
The window for a real back-and-forth closes before most families expect it to. Start when the diagnosis arrives, says Dr. Kate Brazzale, chief medical officer of Empath Health, which operates Florida’s largest nonprofit hospice network. "Don't wait, because the person that's dying needs to be able to respond and speak," she says. "You need to get all those things out of the way. Towards the end, the person that's dying may not be able to speak, and it's not very fair to unload on them at that point."
Lead with the obvious—and then let them talk
Once you're in the room, you don't need to read from a prepared statement. But on the drive or flight over, Byock suggests, think about what's most obvious to you, and open with that: “It's really good to see you. I've been thinking about you so much. It's just so good to be with you.”
"Notice I'm just saying the most obvious things," he says. "If the person means enough for you to travel and see them, they are important to you. This is a time to say it out loud."
If their answer surprises you—or you don’t quite understand it—don’t rush to reassure them or claim to know how they feel. Brazzale suggests three words instead: “Help me understand.” Unlike “I know how you feel,” which few people can truthfully say to someone who is dying, the phrase invites them to share more. “It opens the door,” she says.
The conversation can also turn toward the past. Davies uses an approach called life review, inviting people to reflect on the experiences that shaped a person’s life—the highs and lows, regrets and celebrations, important relationships, and the legacy they’ll leave. Looking back can include plenty of laughter: Families might retell favorite stories or swap inside jokes. “I have no idea what they’re referencing,” she says, “but it’s almost like they’re recounting the stories.”
The first two are there because no relationship is perfect. "Within the history of almost all relationships, there are times of misunderstandings, hurt feelings, anger—sometimes real transgressions," Byock says. You can be specific about what you’re asking forgiveness for, or you can keep it general. “Dad, please forgive me, because I know I haven’t been the perfect son,” Byock offers as an example. “And I forgive you for the times that I felt misunderstood and harshly judged by you.”
It’s a good conversation to have even if no one is sick. Byock had it with his own mother in October 2003, prompted by the galleys of his book. They sat together, and he said nearly all of it, including thanking her for being his most steadfast supporter. There were tears, and they talked for an hour. A month later, his mother died suddenly of an undiagnosed heart condition. "I miss her," he says. "But there was nothing critically important left unsaid between my mom and me."
Reassure them about what they're leaving behind
Vlahos sees it most clearly with the matriarch of a family—the woman who called all the kids every Sunday, who hosted every holiday. She describes a patient who seemed to be holding on, and whose sons finally said the thing she needed to hear to pass peacefully: “I promise I'm still going to call Dad every Sunday. I promise we're still going to have Christmas.”
Then there are the reassurances almost no one thinks to offer. Brazzale says patients who are declining may worry about soiling themselves, losing their dignity, or being moved out of their home at the end. What she’d want to hear, she says, is this: “We’re going to keep you clean. We’re going to keep you safe. We’re going to keep you comfortable.” If dying at home is the plan, family can add: “We’re going to keep you home.” “There’s something about cleanliness that resonates with people,” she says. “It sounds simple, but it’s quite powerful.”
Karnes recommends making room for both private goodbyes and a shared gathering. First, have each person go into the room alone, sit down, hold their loved one’s hand, and talk about the relationship. “You can speak from your heart and say everything you want and need to say,” she says, even if the person is nonresponsive. Then come back together: Gather around the bed, put on dad’s favorite music, let the kids in, put the dog on the bed. After the death, before you call the funeral home, let everyone go in alone one last time if they want, Karnes suggests.
Skip the platitudes—and don't try to fix it
"How could we possibly know how they feel? We haven't died," Brazzale says.
And avoid any framing that treats dying as quitting, Brazzale recommends. She has watched families push patients through a 10th round of chemotherapy so no one can say they gave up. "There's going to be a point at which they die, and you should never frame it that they gave up," she says. "What a terrible thing, that 100% of the human race is just going to quit."
That means silence is a legitimate option. Vlahos believes many of these important final encounters don’t happen because people feel pressure to find the right words. “Sometimes the right thing to say is nothing—to just let someone talk,” she says.
You don’t have to hold yourself together, either. Vlahos would far rather someone show up and cry with her than stay away. Brazzale once made the same point, half-jokingly, to her own children. She initially told them she didn’t want anyone crying at her bedside when she died—then reconsidered. “Actually, you’d better shed a few tears,” she told them. “Because that shows I mattered.”
The person who is dying is grieving, too, Brazzale says. Trying to protect each other by hiding that sadness can create distance at a moment when time together is especially precious. “Don’t be tiptoeing around one another for fear of hurting each other’s feelings,” she says, “because the scars left behind will be that much deeper.”
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