"For of all sad words of tongue or pen,
The saddest are these: “It might have been!”
Saying the Four
me. I forgive you. Thank you. I love you.
These four simple statements are powerful tools for improving your
relationships and your life. As a doctor caring for seriously ill
patients for nearly 15 years of emergency medicine practice and more
than 25 years in hospice and palliative care, I have taught hundreds
of patients who were facing life’s end, when suffering can be
profound, to say the Four Things. But the Four Things apply at
any time. Comprising just eleven words, these four short
sentences carry the core wisdom of what people who are dying have
taught me about what matters most in life.
The Wisdom of Stating the Obvious
Ask a man who is being wheeled into transplant surgery or a woman
facing chemotherapy for the third time what’s on his or her mind and
the answer will always involve the people they love. Always.
The specter of
death reveals our relationships to be our most precious possessions.
I’ve lost count of the number of times I’ve met people in my office,
an emergency room, or a hospice program who have expressed deep
regret over things they wish they had said before a grandparent,
parent, sibling, or friend died. They can’t change what was, but
without fail their regrets have fueled a healthy resolve to say
what needs to be said before it’s too late – to clear away hurt
feelings, to connect in profound ways with the people who mean the
most to them.
Everyone knows that all relationships, even the most loving, have
occasional rough spots. We assume that the people we love know that
we love them, even if we’ve had our disagreements and tense moments.
Yet when someone we love dies suddenly, we often have gnawing
We are all sons or daughters, whether we are six years of age or
ninety-six. Even the most loving parent-child relationship can feel
forever incomplete if your mother or father dies without having
explicitly expressed affection for you or without having
acknowledged past tensions. I’ve learned from my patients and
their families about the painful regret that comes from not speaking
these most basic feelings. Again and again, I’ve witnessed the value
of stating the obvious. When you love someone, it is never
too soon to say “I love you,” or premature to say “Thank you,” “I
forgive you,” or “Will you please forgive me?” When there is nothing
of profound importance left unsaid, relationships tend to take on an
aspect of celebration, as they should.
A deep, natural drive to connect with others lies at the heart of
what it means to be human. The Four Things can help you discover
opportunities to enliven all your important
relationships—with your children, parents, relatives, and close
friends. You need not wait until you or someone you love is
seriously ill. By taking the time and by caring enough to express
forgiveness, gratitude, and affection, you can renew and revitalize
your most precious connections.
The Practice of Good-bye
It’s been said that life is a sexually transmitted condition with a
terminal prognosis. Having worked for years in close proximity to
death, I have come to understand viscerally that we live every
moment on the brink. We are, each one of us, at every moment, a
heartbeat away from death. Seen against the backdrop of our certain
mortality, our differences are dwarfed by our commonality – and the
importance we hold for one another.
The stories in The Four Things That Matter Most are drawn
from the experiences of people who have stood at death's door, and
from their loved ones who learned to use the Four Things in their
own daily lives. These stories inspire us to open to the potential
for emotional wholeness at any moment in our lives – even in
our most troubled relationships.
When I work with people who are approaching the end of life, I
emphasize the value of saying the Four Things and I also encourage
them to say good-bye. The Four Things offer essential wisdom for
completing a lifelong relationship before a final parting.
Thankfully, not all good-byes are final – but good-byes can be
meaningful. It’s important to say good-bye in a way that
affirms our relationship and acknowledges our connection to one
The word "good-bye" derives from "God be with you," a blessing that
was traditionally given at parting and, in some churches, still is.
The protection and God’s help of presence and guidance can be
requested whether two people expect to be separated a few hours or
forever. In leaving nothing unsaid, we can recapture this original
meaning, so that, in saying good-bye, we are actually blessing one
another in our daily interactions as well as when we face major life
challenges or crises. It only takes a moment to shift the way you
say good-bye from a reflex to a conscious practice. Your good-bye
and your blessing can become treasured gifts to other people as you
Expanding the Realm of the
Our world is bounded by our imagination. This may sound
philosophical, but I mean it in a most practical, tangible sense.
Helen Keller once wrote, "Worse than being blind would be to be able
to see but not have any vision." When a formerly cherished
relationship is marred by unkindness, bitterness, or betrayal, we
may assume that healing is beyond our grasp, but this assumption can
create a self-fulfilling prophecy. Do you really want to have such a
limitation on your vision for your life?
The extraordinary experiences of the people whose stories I tell in
this book demonstrate that healing and wholeness are always
possible. Even after years of alienation, of harsh criticism,
rejection, or frustration, you can establish – or re-establish –
authentic understanding and appreciation of others with the help of
the Four Things. Even as people confront death (their own or
others’), they can reach out to express love, gratitude, and
forgiveness. When they do, they consistently find that they, and
everyone involved, are transformed—for the rest of their life,
whether those lives last for decades or just days. Stories and
experiences of people who have courageously used the Four Things
enlarge our vision and imagination, expanding the realm of the
possible for us all.
The Four Things are powerful tools for reconciling the rifts that
divide us and restoring the closeness we innately desire. When
bad feelings occur in our close relationships, we tend to put off
the work required to make things right. We always assume we’ll have
another chance…later. That’s understandable, but it’s a mistake.
Feeling resentful toward the people we love, or once loved, feeling
distant from them, erodes our own happiness.
A brush with death often instills in us a newfound appreciation for
the gift of life. Simple pleasures – a cup of tea, sunshine on one’s
face, the voices of our children – feel like miracles. When we’ve
had a close call that shakes us up, the anger we’ve felt toward
people closest to us no longer seems significant. Ill will dissolves
in love, appreciation, and affection, and we recognize the urgency
of mending, tending, and celebrating our relationships.
Because accidents and sudden illness do happen, it is never
too soon to express forgiveness, to say thank you and I love you to
the people who have been an integral or intimate part of our lives,
and say good-bye as a blessing. These simple words hold essential
wisdom for transforming that which matters most in our lives – our
relationships with the people we love.