Silence is a powerful communication tool, particularly in tender end-of-life conversations. Here's how silence helped five experts navigate those conversations, and how it can help caregivers too. Starting a sensitive conversation with someone you care for about the last stage of life can be daunting, particularly if you have an expectation of how the conversation should go. But letting go of the need to say the ‘right’ thing, and allowing silence instead, can help you see things from a different perspective. Dr Kathryn Mannix, palliative care physician and author of Listen: How to Find the Words for Tender Conversations, explains an early experience shaped her attitude to silence in what she prefers to call ‘tender’ conversations. As a recently qualified doctor, she was tasked with speaking to a family friend about concerns over his behaviour following his wife’s death. These included setting a place for her at the table and speaking as if she were still alive. He told Dr Mannix they were both very proud of her and “just left it there.” Right then, she realised her friend wasn’t stuck in unhealthy grief. In fact, continuing traditions shared with his wife was an effective coping mechanism. “I could have so easily told him this is what should be happening, and these are the ways you should be dealing with it,” she says. “But because I respected him so much and was so anxious about saying the wrong thing, I didn't say anything.” “My experience of being lost for words is the same one other people have in these tender conversations. It allows you to move from one understanding to another. That journey requires thinking and processing and that requires silence. These days I use silence deliberately.”Silence transforms your thinking
The magic of silence
Silence slows down the conversation, giving you time to digest and sit with what is. It’s an invitation to connect with the present moment.
Palliative care social worker and Violet Clinical Committee member Jo Wood says ‘magic’ can come from silence. “Often, there's so much complexity in a situation. Giving people an opportunity to sit with something you've been talking about can help them reflect and process. They’ll often come up with a different way of viewing something.
“I've seen some beautiful things come out of silence. I vividly remember sitting and talking with a gentleman in a palliative care unit. His bed faced a vast expanse of windows. For a while, we sat in silence and looked outside at the trees. He eventually broke the silence and marvelled at how delicate and beautiful the leaves were with their unique patterning. It was such a lovely moment and demonstrated the grounding nature of silence.
“On another occasion, after speaking with a married couple, we sat in silence as we reflected on the depth of the conversation. The patient, the woman, suddenly looked at her husband and said, ‘I'm scared’. Her husband started to cry and hugged her tightly. It was an incredibly intimate moment. The woman later told me this was the first time her husband had been truly vulnerable with his emotions. She had long been craving that connection.”
Silence provides space for decision making
Allowing silence into your conversations can give you, and the person you’re talking to, space to consider what happens next. Confusion can become clarity when you don’t rush to fill the space with words.
Professor Rod McLeod, Chair of Violet's Clinical Committee, recalls one of approximately 15,000 conversations he’s had during his palliative medicine career in which silence played an important part. He was talking to the wife and daughter of a man with advanced dementia. “They came into the conversation very angry because they felt they'd been let down by the health system in the care of their father and husband,” he explains. “My silence gave them an opportunity to gather their thoughts and think about which direction to go in.
“Their silence was also important. When somebody’s not saying anything, it's almost as if you can see the cogs turning in their mind. Are they going to continue to be angry? Are they going to continue to be upset? Or have they moved past that and are they now looking for a solution?”
Harnessing the power of silence
There’s immense power in the pause between words. Accepting it allows for a deeper connection and can completely change the dynamics of your conversation.
Violet Guide Rose Dillon agrees silence plays a key role in difficult conversations. “Silence gives both people a chance to just take a breath and think about what's been said and what might be coming. It gives you a break from that incredibly intense feeling of bearing your whole soul.”
Importantly, she points out that just because people aren't talking doesn't mean they're not communicating. “For example, locking eyes signals connection. This could mean ‘I get it – I know how big/scary/complicated/wonderful this moment is’ or ‘you can count on me. I'm staying right here with you’.
“A gentle touch of another's hand can be very reassuring and help the person feel more confident and less frightened. A silent hug might signal protection.”
Terri Soller, Managing Director of leadership consultancy Conversus Leaders, believes silence’s power is frequently underestimated.
“I love silence and I don't shy away from it. Silence creates a kind of heat in the moment that says ‘I can't be flippant about this. I need to actually consider what I think.’ People tend to fill a void, frequently with nonsense. Silence is often more powerful.”
Silence has a purpose in every conversation, but it's particularly potent for open, meaningful end-of-life conversations. Embrace it. Take the time to listen, digest and reflect before you speak. Breathe. Inhale (let), exhale (go). Let go of your need to have an answer and trust that deep connection and understanding happen when there is silence.
