Silence is not golden: conversations with the dying

Conversations about dying involve interaction on multiple intellectual and emotional levels. The paradigm of clinicians as existential messengers is characterized by process and content and validated by the clinicians' ongoing presence. The necessary attributes that allow clinicians to function as existential messengers and communicate effectively with the dying include recognition of and confidence in one's own strengths, limits, and capabilities; clarity in one's personal understanding of living and dying; the ability to listen carefully and learn from the experience; the willingness to remain present in the face of profound anguish; and a strong belief in the worth of the work. In the process, personal biographies are amended permanently and clinicians are wiser for the experience.