Richard Smith: How to talk to the dying—a lesson from a novel

In one chapter of Elizabeth Strout’s novel Olive, Again Olive Kitteridge, a large, blunt-speaking, retired schoolmistress, encounters in a supermarket Cindy Coombs, who is being treated for cancer and has a fifty-fifty chance of dying. The chapter teaches something about talking to the dying, something that many people avoid.

Cindy, who is on the point of collapsing when Olive meets her, has been sent out to shop by her husband to show—to him not her—that she is strong. Cindy was taught by Olive and “had not especially liked her.” Olive looks Cindy “straight in the eye” and says “You’re having a hell of a time.” The novel is set in a small town in Maine where everybody knows everything about everybody. Olive recognises Cindy’s weakness and says “Well, let’s figure out what you need, and get you out of here.” This is compassion—caring and practical. (Sympathy is: “I’m sorry to hear that you have cancer.” Empathy is: “I’m sorry to hear that you have cancer. I couldn’t sleep when I heard and haven’t slept properly since.”)

A few days later Olive turns up at Cindy’s house. “Oh Christ,” says Cindy’s husband Tom, “It’s that old bag, Olive Kitteridge. What the hell is she doing here?” Cindy tells him to let Olive in. 

“I thought if I called you might say I shouldn’t come over,” says Olive.

Cindy’s husband Tom can’t accept that she might die. “He keeps talking like I’ll get better. I can’t believe it. I just can’t believe it, it makes me so lonely, oh, dear God, I am so lonely.”

Olive replies: “God, Cindy, that sucks. As the kids used to say. That really sucks.”

“There’s a nurse who comes in twice a week, and she told me Tom was acting like every man she’s ever known in these situations. That men just can’t deal with it.” [The italics are all Strout’s.]

Most of Cindy’s friends don’t come to see her.

“I’m awfully glad that you came over,” Cindy said to Olive. “You wouldn’t believe the people who don’t come over to see me.”

“Yes, I would. Believe it.”

“But why don’t they come to see me? I mean, Olive. Old friends don’t even come to see me.”

“They’re scared.”

“Well, too bad!”

“Oh, I agree with you about that.”

“But you’re not scared.”


“Even though you’re scared of dying.”

“That’s right,” Olive said.

In the mail during this time Cindy received a card from the librarians she had worked with. “It had a flower on it, and inside it said Get Well Soon! And everyone had signed their names. Cindy threw it into the wastebasket.

Olive talks about her regret that she wasn’t better to her dead husband. She ends: “I’ve been trying not to talk about myself so much these days.”

Cindy replies: “Talk about anything you want. I don’t care.”

“Take a turn,” Olive said, “I’m sure I’ll get back to myself.”

Cindy talks about crying in from of her sons on Christmas Day and feeling awful and then about being scared to die.

“Oh, I know, I know, of course you are. Everyone is scared to die.”

Olive comes again. In the meantime, Cindy has heard from her husband that Olive has remarried.

“Well, congratulations, I guess. Is it weird?

“Oh it’s weird. It’s weird, yessiree…But we’re old enough to know things now, and that’s good.

“What things?

“When to shut up mainly.”

This leads to a conversation about Cindy’s worries of what will happen to Tom if she dies.

Olive comes again and observes in February that they still have a Christmas wreath on the front door. Cindy says she’s asked Tom to take it down several times but he never has: “Oh, I hate that.”

“He’s upset, Cindy. He can’t concentrate on anything these days.”

And it was strange, but Cindy saw then that Cindy was right. Such a simple statement, but it was completely true.

These are the simple lessons that I draw from this chapter about talking to the dying.

  1. Turn up, even if you are not sure you’ll be welcome
  2. Accept that the person may be (or is) dying and acknowledge that and be willing to talk about it
  3. Don’t keep saying “I’m sure that you’ll get better”
  4. Talk as honestly as you can manage, including about your own fears
  5. Don’t be worried to talk about yourself and your own problems
  6. But be sure that you can shut up and let the dying person speak
  7. You never know but you might say something very useful
  8. I’m not sure that I can draw this lesson from this chapter, but I don’t think that you should worry about saying “the wrong thing”

Richard Smith was the editor of The BMJ until 2004.