[Editor’s Note: Every month, MCN’s Director of Witness to Witness, Kaethe Weingarten, PhD, shares stories, resources, and helpful tips to support health care workers during these ongoing unprecedented times. Dr. Weingarten also offers a twice-monthly newsletter, filled with resources, recent articles, and her news and views. Sign up for the newsletter on the Witness to Witness webpage.]

When I was a freshman in college, the father of a friend with whom I had gone to elementary school died. My mother wrote me a letter – parents wrote letters to their children when they lived away from home in those days – and told me about my friend’s loss. She also provided my friend’s address and told me to write a condolence note. I had never written one and I didn’t know what to say. I procrastinated. A week or two later, my mother’s letter to me contained a question: “Did you write a condolence note to Julie?” I didn’t reply. Her next letter contained words I have never forgotten. “Dear, I am concerned that you may not have written Julie a note. You are probably delaying because you are uncertain what to say, and you don’t want to say the wrong thing. The only wrong thing in a situation like this – illness or death – is NOT saying something. Your discomfort about whether or not you will say the right words is insignificant compared to the pain she is feeling. She will only register that you care. When she doesn’t hear from you, it will register that you don’t care, and I know this isn’t true.” I wrote my condolence note in the next hour.

Decades later, I was living with my two children in a house that backed up to our neighbors’ house, and my children cut through their backyard on the way to school. We were close as families. One day I learned that the dad of the family, Jack, had had to leave urgently because his mother had died. I explained this to our two children, who were appropriately sad for him. A few days later, Jack was returning home, and I told them that when they next saw Jack, they would need to say to him they were sorry that his mother had died. Our eight-year-old promptly went to the backroom overlooking our neighbor’s house and stared out the window; she was waiting for Jack so she could rush out and tell him. Our 11-year-old, on the other hand, I noticed, began going to school the long way around. These reactions, mine and my children’s, are all common ways people respond to illness and death.

In the last two years, many of our friends, neighbors, and colleagues have had to grieve, losing loved ones to COVID, or sometimes to a health concern that went untreated because of the pandemic. Many were unable to say goodbye to loved ones because of hospital protocol, disrupting the grieving process. Yet, they still have needed to grieve -- and we need to respond to their experiences of illness and death. Most of us have not been taught the simple lessons of being helpful or comforting when someone is ill or dies. If we are lucky and the adults around us are adept, we may have observed how people offer comfort in culturally appropriate ways in various situations: within families, within friendship groups, with neighbors, and with colleagues. But most of us are not so fortunate. Most of us have to figure out the “rules” for ourselves.

The following few points are ones that I have used for decades and shared with many others. They may not be suitable for you or your community, but they may provide a starting place to consider what IS right. I would also love to hear from anyone reading what your “rules” are. You can reach me at w2w@migrantclinician.org.

When Someone Else Is Suffering…

Say something: Like my mother, I think not saying something is just not OK. The most straightforward sentence: “I’m sorry for your loss” or “I am sorry that you are ill,” is preferable to silence. 

Frame your comfort without asks of the griever: That said, I try to avoid saying something that requires the person I want to comfort to do any emotional labor. What is emotional labor? It is the work involved in managing one’s own and/or another person’s feelings. If I say, “I am so sorry that you are ill. Please tell me what I can do to help?” The second sentence is offered as a kindness, but it does require the ill person to come up with ideas for you. That really should be on your plate, not theirs. Or, if I say, “This is hard for me. I am at a loss for words. I don’t know what to say to comfort you.” That isn’t just comfort; it’s also asking the ill person or the grieving person to care for you. They undoubtedly do not have the bandwidth to do that.

Don’t compare grief: Mentioning a loss of yours at the same time as you are comforting them for a loss of theirs is also not a good idea in my book. “I am sorry to learn that your beloved dog died. I know just how you feel. I still haven’t recovered from the death of my cat two years ago. Do you remember Barty? I was devoted to that cat, and I still can’t believe the car that hit him left the scene. If there is anything I can do, please let me know.” That attempt at consolation combines the disadvantages of #2 and #3. The recipient has to manage a sad story and then come up with ideas for the consoler.

Comfort in, dump out: There is a wonderful “theory” described by Dr. Susan Silk, called “ring theory.” It can be summarized as “comfort in, dump out.” It has two simple rules. Rule #1: The person in the center ring – for example, a woman whose husband has died -- can say anything she wants to anyone, anywhere. She can complain, whine, and moan and say, “Life is unfair,” and “Why me?” That’s the payoff for being in the center ring. The person in the smaller circle outside of that center ring – say, a good friend of the wife and husband -- can say anything she wants to people in the circles larger than the ones she is in. She can “dump out.” Rule #2: If you are in a larger circle – perhaps a friend of the couple -- you can only say things that are supportive and comforting to those in the rings smaller than yours. You can only “comfort in.” For example, perhaps you are a friend of the couple, and you are dismayed that the husband died so young of a preventable cause. You can turn to a colleague who does not know the couple – therefore someone in a ring even further out from the center than you – to express your sadness and shock. But these concerns should not be expressed when you are with the wife who is grieving her husband. Because she is at the center of the ring, you should focus on “comfort in” – providing comfort and support to her as she grieves, rather than sharing your own grief with her. 

When We Are Suffering…

Ring theory is clear and straightforward, but it does depend on one element to be effective: the person offering comfort has to have a good idea of what will comfort the person at the center, and so that means the person at the center has to have been able to communicate that clearly. We all know that the person at the center may not know what is comforting to them. I recently gave a webinar and asked the attendees to name one activity that was comforting to them. Half of the group could not name one thing that was a sure bet comfort to them! I ended the webinar, sat down, and wrote out a list of comforting ideas to use as a W2W resource. 

When we let people know we have suffered a loss or we are ill, it is helpful to be explicit about what they can do to help. Here are two examples:

• To a group of friends: “I wanted to let you know that my sister died last Friday, peacefully at home. Her family surrounded her. I will be resting at home for the next few days, but I would love to see you to share stories about my sister with you after that.”
• To work colleagues: “I wanted to let you know that my sister died last Friday, peacefully at home. Her family surrounded her. I will be taking off Tuesday and Wednesday to be with family. After that, I will return to work. I would appreciate your going forward with any urgent work tasks that we share that come due on Tuesday and Wednesday. I will resume my duties on Thursday.”
   

Sometimes, we are so overcome or exhausted or sick that we cannot do that ourselves. In those cases, it may be helpful to let someone else take that over. Here are a few suggestions:

• To a group of friends: “Kaethe has let me know that she will be ‘out of commission’ for the next two weeks recovering from her operation. Some of you have asked if you can bring food. Yes, that would be great. Please bring any food items in containers they do not need to return, and be sure you put your name on your offering so they know whom to thank.”
• To colleagues: “Kaethe has let me know that she will be recovering from her operation and taking medical leave for the next two weeks. I will be re-assigning her tasks today and tomorrow. Short friendly emails to her while she is recuperating will be much appreciated, although please be aware that she may not be able to respond right away.
   

This may not be true for everyone, but it is true for me: being ill or grieving is hard work, and learning that people we care about don’t know how to offer care or consolation when we most need it adds to the emotional work that illness and grief entail. I have said many times, “Illness made me know things about people I wish I didn’t know.” Of course, I have also learned wonderful things about people who “came through” in unexpected, dear, and welcome ways. But it is the silences that have been disappointing and sometimes hurtful.

Like my mother said to me 60 years ago: Silence – absence-- hurts when connection is needed. Don’t get hung up on saying the perfect words; just let the person know you care. In the end, well, at the beginning, middle, and the end, that is what matters.

Read the Witness to Witness resource called Some Comforting Ideas for practical ways to soothe ourselves. View all the Witness to Witness resources on the Witness to Witness webpage. 

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