Ask Dr. Gramma Karen: How to Explain Grandmother’s Imminent Death

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Dear Dr. Gramma Karen,

My mother has advanced cancer and is in palliative care. Right now she is very sharp and is excited when everyone comes to visit.

When my mom starts to slow down and becomes less lucid and her body is starting to shut down and she can’t recognize anyone, what do we tell our six-year-old daughter, who is very close to her? We can’t take her to see her grandma and have that be her last memory of her.

Tonight my wife, our daughter, and I went to visit with my mom and she was over the moon! Our daughter showed her the dolls we bought from a local store. While we were shopping, my mom was “with us” on FaceTime while we walked through the store. This was our daughter’s idea because that’s where she and her grandmother used to go together. Our daughter thought it would be special, and it was. My mom was just so happy!

I know that these FaceTime visits and actual visits are coming to an end. What do we do? How do we explain it to our daughter?

Dr. Gramma Karen’s Response

The situation you describe — that is, the decline of grandparents’ health and their eventual death — is one that many families have already experienced firsthand, or they understand that they will have to face it in the future.

First and foremost, I think what you say and how you say it is key.

Good Days Versus Uncomfortable Days

For example, at six-years-old, your daughter is able to comprehend that her grandmother is very sick and that she has both “good days” and “ uncomfortable days.” Good days are those when her body and mind are able to enjoy all the things that make her happy and fill her with joy — such as visiting with family and friends or doing FaceTime with them.

Uncomfortable days are those when Grandma does not feel good and she prefers not to visit with people; she just wants to rest. You can help your daughter understand that Grandma is not rejecting her when she is having an uncomfortable day; rather, she needs her rest to help energize her so she can enjoy a good day.

You can explain that Grandma’s health is not as good as everyone would like it to be and she requires a lot of help from the doctors to help her be comfortable and try to have good days. She is taking medicines, and sometimes the medicines help, and other times they don’t, and that is when she prefers alone time so her mind and body can rest.

By using this framework, you can inform your daughter what kind of a day Grandma is having — a good day or an uncomfortable day — and your daughter will understand whether she will be able to visit with Grandma or not, either in person or using technology.

I urge you and your wife to take on (force yourselves, if need be) this attitude: “This is the way things are. We wish grandma wasn’t sick, but she is sick. She will have good days and uncomfortable days.” Over time, Grandma’s uncomfortable days will outnumber her good days, a reality that will be apparent to your daughter.

“Is Grandma Going To Die?”

You did not bring this up specifically, but most likely your daughter will ask if Grandma is going to die. I suggest you acknowledge that yes, sometimes people do die from cancer because either there are no medicines to treat the cancer, or the medicines being used are not effective.

Then you can add whatever information is accurate to describe your mother’s situation. For example: “Of course we’ll keep hoping, but the doctors said they are sorry to have to tell us that the medicines are not working. Now it is important to keep Grandma comfortable so she can have as many good days as possible.”

This explanation may suffice, or it may not. If your daughter persists, “Is Grandma going to die,” then you may have to be more direct and say, “We don’t know that for sure, but the doctors are saying it is looking more and more like that is going to happen.”

Your daughter can handle this approach if you and your wife model it for her. You should talk about how sad you are that Grandma is sick, you can say you wish it were otherwise, but part of life is accepting its realities and making the best of them. You can emphasize that your focus, while Grandma is still with you, is to make her as comfortable as possible and to enjoy whatever time you can with her. Your daughter will take her lead from you and your wife.

I close with one additional comment. You know your daughter best, so you can decide if this suggestion has any merit: Your daughter might benefit from the three of you talking with a professional to help explain the expected progression of Grandma’s situation.

Some kids find it reassuring to have additional input from someone who is specifically trained to have these types of discussion with children. The staff where your mother is being treated, or your daughter’s pediatrician, can help you locate an appropriate professional.

I hope you find my suggestions helpful. Please know I am thinking of you and your family.

Ask Dr. Gramma Karen is published every other Tuesday.
E-mail queries to [email protected].

Karen L. Rancourt’s most recent book is,
Ask Dr. Gramma Karen, Volume II: Savvy Advice to Soothe Parent-Grandparent Conflicts.

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