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AVAILABLE
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or  at your 
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Published by  FREE PRESS
A division of  Simon & Schuster
March 2004
Dimensions (in inches):
5.75 x 9.00 x .95
216 pages
ISBN: 0743249097

For more information visit
Dr. Byock's website at
www.DyingWell.org

 

The Four Things That Matter Most
A Book About Living
by Ira Byock, M.D.


Excerpt   Readers' Guide
Table of Contents
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Introduction

 "For of all sad words of tongue or pen,
The saddest are these: “It might have been!”
John Greenleaf Whittier

Saying the Four Things

Please forgive 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 doubts.

            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 another.

            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 part.
 

Expanding the Realm of the Possible

            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.
 

Restoring Closeness

            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.

Table of Contents

"For anyone who believes that years of therapy are required for transforming relationships with others, this book will come as a pleasant surprise. Great wisdom has always been simple - that is why it is elusive - and great wisdom is what this book contains."

-- Larry Dossey, MD author of  "Healing Beyond The Body," "Reinventing Medicine," and "Healing Word."

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