Sydney Mishkin’s father had Stage IV sarcoma for seven years. In the weeks before he died, she kept trying to figure out what she still hadn’t told him. She searched through their old texts and listened to his voicemails. At night, she lay awake reviewing their entire relationship, desperate to identify the words she might one day regret leaving unsaid.
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 exchange was deeply meaningful—but also bittersweet. Mishkin worried she had said too much or made her father feel obligated to summon the energy for a profound response. “How do you sum up a lifetime of loving somebody into a sentence or two?” she says.
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.
Don't wait for the right moment
When people ask Dr. Ira Byock whether they should make the trip to see a seriously ill friend or relative, he answers with a question: “Would you go to the funeral?”
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.
Hadley Vlahos, a hospice nurse and author of The In-Between: Unforgettable Encounters During Life's Final Moments, regularly hears from families who want her to alert them when the end is near. Her answer never changes. "You need to come right now," she says. "Everyone looks for this perfect time, and they always think that there's gonna be more time." In hospice, the opposite is true: Beginning care earlier leaves more time for meaningful conversations. "You don't want to wait until they're in a coma," she says.
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."
Sometimes there's no window at all. Christine Davies, director of spiritual care at Robert Wood Johnson University Hospital, has been a hospital chaplain for more than 25 years. She’s present for expected deaths after long illnesses, as well as sudden ones. "We may not even have the opportunity to say these last words, and so we have to say them all of the time," she says. "Knowing no day is promised makes it all the more sacred."
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.”
From there, say the thing you assume they already know. "I so value our relationship. You've been so important to me," Byock offers as an example. Then get specific, the way you might at a celebration of life—without going overboard. “You've always been there for me.” “You're one of the funniest people I've ever known.” “What a remarkable parent you've been.”
"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."
Then shift the focus to how they’re feeling. Byock's go-to: “How are you doing physically—but also, how are you doing within yourself?” "That phrase is one that we don't hear very often, but people tend to know what I'm asking," he says.
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.
She also asks patients directly whether they're afraid—one of her most effective questions, though she notes it lands differently coming from a physician than from a daughter. What surfaces is rarely just fear of physical pain. It's fear of the unknown, of losing control, and of what their loved ones will have to endure.
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.”
Say the four things that matter most
Decades ago, Byock started teaching patients, students, and families that there are four things worth saying to someone before you're forced to say goodbye. Put them in your own words if you like, but here’s how he phrases it: “Please forgive me. I forgive you. Thank you. I love you.”
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.”
In conversations between parents and children, Byock suggests adding an expression of pride. A parent might say, “I’m so proud to be your dad.” “Who else on the planet can tell your child how proud you are to be their mom or their dad?” he says. “That is a gift that keeps on giving.” A son or daughter can reverse it: “I’m so proud to be your daughter.” When the person dying is young, Byock focuses especially on this kind of affirmation.
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
Much of what frightens people at the end isn't about them. It's about everyone else.
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.”
Vlahos remembers a patient who was told, “I promise to make sure your grandson knows you.” "I think that matters a lot more than people think," she says.
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.”
In the final phase of dying—a period Barbara Karnes, a hospice nurse and educator since the 1970s, calls labor—many people become nonresponsive. “What we watchers can do is talk as if they can hear us,” she says. Hearing is thought to be one of the last senses to fade, so continue as though your loved one may still hear you. Brazzale offers similar advice: If you run out of things to say, choose a beautiful book and read aloud. She also suggests keeping your touch light—holding a hand rather than hugging, which can be jarring.
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
Some phrases are worth retiring entirely. At the top of the list: “I know how you feel.”
"How could we possibly know how they feel? We haven't died," Brazzale says.
Davies advises against what she calls spiritual platitudes, like “everything happens for a reason” and “God needed another angel.” "That can be really harmful to the people that are hearing it," she says. Such phrases try to impose meaning onto someone’s suffering or force an unbearable moment to feel better, she says, rather than leaving room for the person’s actual emotions.
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."
Platitudes often spring from the urge to talk someone out of what they’re feeling. But if a dying person says, “This sucks,” you don’t need to insist otherwise. “You can be like, ‘Yeah, you know what, it does,’” Vlahos says. Making room for that honesty also helps relieve the dying person of another burden: managing everyone else’s emotions. Loved ones rarely mean to put them in that position, Vlahos says, but she sees it happen often.
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.
Davies gives her chaplaincy students a five-word rule: “Show up and shut up.” Her interns sometimes come to her surprised that a grieving family hugged them, because they felt they hadn’t done anything. “No—you bore witness to what they were going through,” she tells them. “‘You were there in the hardest moment, and you didn’t fill it with words. You allowed for the silence to take place.’ We try not to cheer people up, because there’s no cheering up.”
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.”
