Chapter 18
Anticipatory Grief:
Caring for a Dying Loved One

Tom sat in the oncologist's office and tried to listen to the doctor's words. His wife Marian was in the chair beside him. The doctor spoke carefully, the way doctors do when the news is very bad. There were phrases like comfort measures and goals of care and months, not years. Stage four. Pancreatic. The doctor was kind. He did not rush. When he finished, he asked if they had any questions. Tom could not think of any questions. He could not think at all.

On the drive home, Marian was quiet. Tom gripped the steering wheel. The sun was bright and low, and the traffic was ordinary, and the radio was playing a commercial for a furniture store. He kept thinking how strange that was — that the world was going on like nothing had happened, when inside the car something enormous had just happened. He knew he was supposed to say something. He had no idea what. He reached across the gear shift and held her hand. She did not pull away. She did not speak either. They drove home like that.

In the days that followed, Tom's feelings came in waves he did not understand. He would be making her breakfast and suddenly start crying at the stove. He would wake up at three in the morning and feel her warm beside him and feel relief — she's still here — and then a second wave of dread, because she was still here but she was also already leaving, and he did not know which feeling was worse, the presence or the coming absence. He felt guilty when he looked at the calendar and saw the weeks ahead and for a fraction of a second wished it were over. He felt more guilty when he felt the opposite — when he wanted to hold on forever, to keep her even if the keeping was cruel to her. Some days he could not decide whether he was grieving already, or whether grief came later and this was something else.

It was something else. And it was also grief. Both were true.

The pastor came to see him on a Thursday. Tom did not quite know how to explain what he was feeling. He said, "I'm mourning her, and she's still here. I'm mourning in front of her. I don't know how to do that." The pastor did not try to fix it. He sat with Tom at the kitchen table for a long time. Finally he said, "There is a name for this. It's called anticipatory grief. It's real grief. And what you're doing — loving her while you lose her — is one of the hardest and holiest things a human being ever does."

That was three months ago. Tom is still in it. This chapter is for Tom, and for Marian, and for you — if you are walking a loved one toward the end of the road. The grief has already begun, and it is going to continue until the day your loved one dies, and then it will shift into a different kind of grief, and that grief will stretch on for years. But this season — this anticipatory season — has its own shape. It has its own pain. It has its own gifts. And Scripture, the Christian tradition, and the deathbed research together give caregivers the tools they need to love well in this hard, holy season.¹

The Grief That Starts Before the Death

Tom had a name, finally, for what he was feeling. Anticipatory grief. The name did not fix anything. But it told him something very important: he was not alone, he was not crazy, and his feelings were not premature. Grief that begins with the diagnosis is still grief. It is not a rehearsal for the real grief that will come later. It is a real grief that happens first.

Anticipatory grief wears several faces, and most caregivers will meet them all before the journey is over.² There is the first face, the one that hits in the doctor's office: shock. The body freezes. The mind slows. You hear the words but cannot make them mean anything yet. This shock can last hours or weeks. It is your soul's way of easing you into a reality that is too large to absorb all at once.

There is a second face: anticipatory mourning. You are already missing a person who is still here. You look at her on the couch and your chest aches at her presence — because you already see the couch empty. You find yourself cataloguing her laugh, the way she taps her finger on her coffee cup, the specific pitch of her voice saying your name. You are storing her up. That is not morbid. That is love preparing for absence.

There is a third face: pre-loss depression. Many caregivers describe it as a kind of heavy gray that settles over everything. Sleep disturbances. Appetite loss. A feeling that the future has been taken away. This is not the same thing as clinical depression, but the two can overlap, and when they do, it can be helpful to speak with a physician or counselor.³ Christians sometimes feel ashamed of this face, as though the darkness were a failure of faith. It is not. It is a normal human response to a very hard thing.

There is a fourth face, and of all the faces this is the one caregivers feel most guilty about: ambivalence. You want the suffering to end. You also never want it to end. You want her to be free of pain. You also want to never let go. You catch yourself hoping, some days, that the dying will go quickly — and then you hate yourself for hoping. Hear me: this is not a failure of love. It is actually an expression of love. You are aching for her suffering and aching for her presence at the same time, and the two aches are not canceling each other out. They are both speaking.

And there is a fifth face — the strangest one: the strange simultaneity of still loving her and already missing her. You lie in bed next to your wife, and you love her as much as you ever have, and at the same time you already feel a hole where she used to be. That is not betrayal. That is the soul holding two seasons at once — the season you are in, and the season coming. Both are true. Both are real. Both are painful. Grief, as Jerry Sittser has written, is not a tidy process but "the soul's slow reckoning with a love too large for the small boundaries of death."⁴

What the Dying Season Often Looks Like

For many Christians, the dying of a loved one is the first dying they have ever walked closely with. The territory is unfamiliar. If the diagnosis brings with it an expected trajectory — months of decline rather than a sudden death — there are some gentle patterns that can help you know what to expect. These patterns are not a script. Every dying person is different. But hospice workers see enough of the same arc that they can map it, roughly, so that families are not blindsided at every turn.⁵

The Early Phase (Weeks to Months)

In the first phase, your loved one is still relatively themselves. They can talk. They can laugh. They can pray. They may be weaker. They may tire faster. But they are recognizable. The doctors have said months. You have time. This is the phase in which much of the most important work is done — the conversations about legacy, the sharing of favorite memories, the speaking of love, the writing of letters. It is also the phase in which many families avoid the hardest conversations, telling themselves there is more time. Please do not wait. The middle and final phases are often not suitable for deep conversation. Say what you need to say while your loved one can hear you.

The Middle Phase (Days to Weeks)

The middle phase is marked by withdrawal. Your loved one sleeps more. They eat less. They may stop wanting to see visitors. Sometimes families take this personally — why doesn't she want to see me anymore? — when in fact the withdrawal is not about you. The dying person is turning inward. This is holy work. The body is tiring. The soul is beginning, in some way we do not fully understand, to prepare.

In this phase, the dying person may say strange things. They may speak of people who are not in the room. They may speak in symbolic language — about packing, about travel, about getting ready. Do not correct this language. We will come back to this in a moment. What your loved one is saying is often not confusion. It is the beginning of a vocabulary that the research literature has named and studied for decades.

The Final Phase (Hours to Days)

In the last phase, your loved one may become hard to rouse. Breathing changes, sometimes becoming fast, sometimes becoming slow, sometimes slipping into a pattern of long pauses called Cheyne-Stokes respiration. The skin may mottle. The extremities cool. Sometimes, shortly before the end, there is a period of restlessness — what hospice workers call terminal restlessness or terminal agitation. This is frightening to watch but usually manageable with medication, and it usually passes. In most cases, what follows the restlessness is a long, quiet, peaceful slipping away.⁶

Here is something I want you to know: hearing is believed to be the last sense to fade. Even when your loved one looks unconscious, even when they no longer respond, there is good reason to believe that a part of them still hears you. So keep talking to them. Read Scripture to them. Tell them you love them. Sing to them. Tell them it is okay to go. What you say in those final hours is very likely getting through.

What the Research Says About the Dying Person's Inner Life

If you are tending a dying Christian, one of the most comforting gifts of modern research is what we now know about the inner experience of the dying themselves. For most of Christian history, families had only their own testimony and the witness of pastors. That testimony was always precious — and it has been confirmed, now, by a great deal of careful clinical study.

Dr. Christopher Kerr is a hospice physician in Buffalo, New York. Early in his career he was struck by the way the nurses spoke about the visions and dreams of dying patients. The nurses were certain these experiences were different from hallucinations, different from side effects of medication, different from confusion. Kerr set out to study them. He and his team at Hospice Buffalo followed hundreds of dying patients over many years. They asked, simply: what are you experiencing in your dreams? In your waking visions? In your inner life?

Let that sink in for a moment. Roughly nine out of ten dying patients in a careful, large hospice study reported meaningful inner experiences in their final weeks and days. Most of those experiences brought comfort. Most involved the presence of someone the patient had loved who had died before them. That is not a fringe phenomenon. That is, apparently, what dying looks like from the inside for most people.

Peter Fenwick, the British neuropsychiatrist, has reported similar findings in his research with hospice nurses and families in the United Kingdom. Fenwick describes a progression in the dying — a series of phases in which the person often moves from fear and struggle to greater and greater peace as death approaches. He notes that in the last days, many dying persons seem to "reach out" to someone unseen, to speak to the deceased, and to experience what he and his wife Elizabeth call "pre-death visions" — experiences of deceased loved ones, of a beautiful place, of light.⁸

Before Kerr and Fenwick, Maggie Callanan and Patricia Kelley, two hospice nurses in the United States, wrote a quietly groundbreaking book called Final Gifts. In it they named something they had seen again and again at the bedsides of the dying: a phenomenon they called nearing-death awareness. In the weeks before death, Callanan and Kelley observed, many dying persons begin speaking in symbolic language about what is coming. The language is often gentle, surprising, and rich with meaning — if the family knows how to hear it.⁹

A grandmother says, over and over, "I need to get on the train." A father says, "Do you have my ticket? I can't find my ticket." A mother says, "Who is going to help me pack?" Another says, "The bus will come soon. I'm just waiting for the bus." A man who was a farmer all his life says, "I need to get the cows in before dark." A woman who was a seamstress says, "I'm almost done with this piece. Just need to finish the hem." These are not confused utterances. They are, in the language of hospice research, the way the dying communicate to us that they know something is coming. They have stepped, slightly, into an awareness we cannot share.

Callanan and Kelley distinguish two kinds of nearing-death awareness messages. The first kind describes what dying is like — the going, the packing, the journey. The second kind describes what the dying person needs in order to die peacefully — a relationship mended, a grandchild blessed, a word of permission, a forgiveness received. Both kinds matter. Both kinds deserve careful listening. Sometimes the smallest-seeming sentence is a request for a very big thing. A dying father says for the fifth time, "I'm worried about Nancy," and the family finally realizes he will not rest peacefully until he has been assured that his estranged daughter will be cared for. A dying mother keeps asking about an old friend she has not seen in years. The family tracks the friend down; she drives through the night; the dying mother settles into peace within hours of her arrival.

When your loved one speaks this language, sit close. Ask, gently: "Where are you going? Do you know who will meet you there?" "What do you need before you can rest?" Sometimes the answer will surprise you. Sometimes there will be no answer, and only the sense that something passed between you. Sometimes the answer will be so specific and peaceful that it will anchor your family for decades.

I tell you this because it will matter, perhaps very soon, in your loved one's room. When she says, "I need to catch the train," you will want, every fiber of you, to correct her. You will want to say, "Mom, you're not going anywhere. You're in bed. There is no train." Do not correct her. What she is telling you, in the only language she has for it, is that she senses her departure. The most loving thing you can do is ask: Where is the train going, Mom? Who will you meet there? You may be astonished at the answer.

The Holy Work of Being Present

When our loved ones are dying, we are usually desperate to do something. This is understandable. It is also not usually what is most needed. The most important gift you will give your dying loved one is not something you do. It is your presence — steady, unhurried, unafraid.¹⁰

Presence is theology. Scripture tells us over and over that the God of Israel is a God who is with His people. His name through the prophet is Immanuel — "God with us" (Matthew 1:23). The psalmist, walking the valley of the shadow, is comforted not by a solution but by a companion: "I will fear no evil, for you are with me" (Psalm 23:4). The God who is present in suffering does not always remove it. He accompanies. He abides. He stays.

When you sit at your loved one's bedside without fidgeting, without reaching for your phone, without rushing off to the next errand, you are putting on skin this very biblical reality. You are showing her, with your body, that she is not alone. That is a theological act, whether you know it or not. That is pastoral ministry, whether you have a seminary degree or not. That is love, exactly as Jesus modeled it in Gethsemane when he asked his friends, "Could you not watch with me one hour?" (Matthew 26:40). Watching with — simply being there — is one of the oldest and deepest callings of Christian love.

Listening to the Dying

Listen to your loved one. Listen to what they say when they are still able to say things. Listen to what they say when they are drifting. Listen to what they say in symbolic language. Listen even when it feels like there is nothing to listen to but quiet breathing. The dying have things to teach us, and if we spend the hours scrolling on our phones or watching the monitors, we will miss the teaching.

When your loved one speaks in the symbolic language of nearing-death awareness — the packing, the traveling, the waiting for someone — receive it. Ask gentle questions. "Who is here with you, Dad?" "Where are you going?" "What do you see?" Do not press. If they want to tell you, they will. Many families have found that the most precious conversations of their life happened in this symbolic register, when their loved one was speaking from a place that felt to them like a threshold.

Speaking Love

Say what needs to be said. I cannot emphasize this enough. Every hospice chaplain has sat with family members after a death who said, "I wish I had told him…" — I wish I had told him I loved him, I wish I had thanked him, I wish I had asked his forgiveness, I wish I had forgiven him. The time to do these things is now. Not when the time is right. Not when you find the right words. Now. There may not be a later.

The hospice chaplain Ira Byock has identified four phrases that dying persons and their families almost universally need to say to one another: I love you. Thank you. I forgive you. Please forgive me.¹¹ These are not magic words. They are the grammar of love preparing for separation. If there is something between you and your loved one — a wound, a silence, a misunderstanding — name it and work to heal it. Not every wound can be fully closed in the dying weeks. But most can be gentled. Do not let the death fall on an open wound if there is any way to prevent it.

Giving Permission to Go

This is one of the tender, counterintuitive gifts of the Christian deathbed. Many dying persons seem to wait — to hold on — until they receive explicit permission from those they love most to let go. They hold on for the out-of-town child who has not yet arrived. They hold on until the spouse steps out of the room, then slip away. They hold on until a daughter whispers, "It's okay, Mom. You can go."

Giving permission is not abandonment. It is one of the great last gifts of love. When the family has said goodbye, the death often comes within hours. When the family cannot let go, the dying sometimes linger past what their body should bear. If your loved one is in the final days and seems unable to release, you may need to tell them — quietly, at the bedside: We love you. We are going to be okay. You have done a beautiful job. Jesus is waiting for you. You can go.

Those words have loosed many a tired soul. They will not feel natural the first time you say them. Say them anyway.

Forgiveness and Reconciliation

If there is any work a Christian family can do in the anticipatory season that outlasts the funeral, it is the work of forgiveness. Very few families arrive at a deathbed with no history. Most arrive carrying old sentences, old silences, old wounds. Some of these go back decades. The death does not have to heal all of them. But the dying season does give many families a unique window to soften what can be softened.

If you are the dying one and there is something you need to confess — to a spouse, to a child, to a sibling, to a friend — do not wait. Ask for the person. Speak plainly. "I need to ask your forgiveness for something I did thirty years ago. I should have asked long ago. I am asking now." Your humility in naming it, even this late, may be the very thing that loosens a chain your family has carried for a generation.

If you are a caregiver and there is something you need to say to the dying one — an apology, or a grievance you have held — pray carefully about whether and how to speak. Some grievances are better carried to Christ and released there, without burdening a dying person with them. Others may need to be spoken. Seek wise counsel — a pastor, a mature believer, a Christian counselor — before the conversation. If you do speak, be gentle. Your goal is not to extract a response. Your goal is to clear the ground between you so that love has a place to stand.

Forgive where you can. Some Christians say, "I cannot forgive what she did to me." That is honest. But Scripture calls us to forgive as we have been forgiven (Ephesians 4:32). In the dying weeks, God often gives astonishing grace for this work. Ask Him. He is not stingy with the grace a dying bedside requires. Many a son has kissed his father's forehead at the end, in the grace of a forgiveness he could not have dreamed of a year before.

And if reconciliation cannot happen — if your loved one is beyond response, or the estrangement is too deep, or a sibling will not come — release what you can to the Lord. Not every story is completed at the deathbed. Some will be completed only at the great reunion. That is not defeat. That is hope.

The Spiritual Care of the Dying

Your loved one may or may not want to talk about faith in this season. Follow their lead. But the Christian tradition has a great treasury of practices designed exactly for this time, and a wise caregiver draws from them gently.

Reading Scripture Aloud

Read slowly. Read passages your loved one knows and loves. Read them more than once. Psalm 23 is often the first, and often the most. "The Lord is my shepherd; I shall not want." Many Christians who have forgotten the names of their grandchildren still know Psalm 23. The cadences of the King James Version, in particular, seem to stay lodged deep in the memory of Christians who memorized it as children.¹²

Other passages to consider reading: Psalm 27, Psalm 46, Psalm 91, Psalm 139. John 14:1–6 for the hope of Jesus' prepared place (we explore this passage in depth in Chapter 7). Romans 8:31–39 for the love that cannot be separated (Chapter 36). Philippians 4:4–9 for the peace of God that passes understanding. Revelation 21:1–5 for the new heaven and new earth.

Do not read everything. Read one passage. Pause. Let the words settle. Read it again if they want. Sometimes a dying person will ask, with their eyes or with a word, for the same passage many times. That is a gift. Give it.

Praying with the Dying

Pray simply. Long prayers can be hard for the dying to follow. Short, concrete, warm prayers often land better: Jesus, hold her. Jesus, be near. Jesus, give her peace. Pray for the Lord's presence, for comfort, for the taking away of fear. Pray for you, too — for the courage to stay, to say what needs to be said, to not run from the room.

The Lord's Prayer has comforted Christians at the bedside for twenty centuries. Many dying persons who can no longer form their own words can still say the Our Father along with you. Some will move their lips when you say the words. Start it. See if they follow. Do not be surprised if they do.

Singing

If the family tradition welcomes singing, sing. You do not need to sound good. You need only to sing what your loved one loved. "Amazing Grace." "It Is Well with My Soul." "Great Is Thy Faithfulness." "How Great Thou Art." "Abide with Me." "In the Garden." "Blessed Assurance." Many hospice workers have seen dying persons, unresponsive for days, mouth the words of a familiar hymn.¹³ Music reaches the soul by a road that language alone cannot travel.

Anointing with Oil

James 5:14–15 describes a specific practice: "Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the one who is sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven." Different Christian traditions receive and practice this differently. Some consider it a sacrament; some consider it a pastoral practice. Either way, it is a lovely and ancient thing to do at the bedside of a dying believer: to touch a little oil to the forehead, and say, Lord Jesus, we anoint your servant [Name] in your name. Give her your peace. Forgive her sins. Receive her into your everlasting arms. Ask your pastor if this would be appropriate in your context and family tradition.

Communion

Where your tradition welcomes it, offering your dying loved one the Lord's Supper one more time — what older Christians called the viaticum, the "food for the journey" — is a profound gift. A small piece of bread. A small sip of wine or juice. The words of Jesus: This is my body. This is my blood. Take and eat. Take and drink. In remembrance of me. Many Christians have found that the last communion at their loved one's bedside was one of the most beautiful moments of their life together.

The Family System Under the Strain

Dying changes families. Not always for the better. Old conflicts resurface. Sibling dynamics that were settled thirty years ago suddenly unsettle again. Money questions surface. The adult child who lives near the parents often bears far more of the daily burden than the ones who live far away — and the ones who live far away sometimes want more say in decisions than feels fair. Disagreements break out over medication, feeding tubes, whether to bring in hospice, whether to go to a facility, whether to keep fighting or to stop.

None of this is unusual. I want you to know that, because in the middle of it you may feel as though your family is uniquely broken. It is not. Every family in this valley is straining. The pressure exposes the old cracks. Expect this. Plan for it, if you can. And when possible, bring in help from outside: a hospice social worker, a pastor, a trusted family friend. These people can mediate conversations the family itself cannot hold.¹⁴

Some specific patterns to watch for:

First, not every family member is on the same page about the trajectory. One will have accepted that death is coming; another will still be searching for the clinical trial that might save your loved one's life. Both are expressions of love. Do not demand that everyone accept the prognosis at the same time. Families do anticipatory grief at different speeds.

Second, the primary caregiver — usually one spouse or one adult child — carries a disproportionate weight. They are exhausted. They are sleeping poorly. They may be missing work or postponing their own medical appointments. They are often the last to admit how close they are to breaking. Watch for them. Protect them. If you are the primary caregiver, please accept help. The casserole the neighbor brings is not an intrusion. The offer to sit with your loved one for an afternoon is not a pity gesture. It is the Body of Christ being what the Body of Christ is supposed to be. Let it be that.

Third, siblings often grieve in radically different styles. One weeps. Another plans. Another withdraws. Another becomes angry. None of these is wrong. All of them are ways human beings carry unbearable weight. Make room for your siblings to grieve in their own way, even when their way annoys you. The person they are grieving is the same person. The love is the same love. The shape of the expression is different.

Preparing Children and Grandchildren

One of the deepest mistakes many well-meaning families make in the dying season is protecting the children from it. We tell ourselves we are sparing them. In most cases, we are not sparing them. We are sparing ourselves the difficulty of the conversation. Children know something is wrong. They usually know more than we realize. When we do not tell them the truth, we leave them to imagine things — and what they imagine is almost always worse than the truth.

Tell your children and grandchildren, age-appropriately, what is happening. "Grandma's body is getting very tired. The doctors can't make her better. She is going to die soon. We are very sad. We will miss her very much. But we have this time with her now, and we want to spend it well." Answer their questions honestly. Do not use language like "going to sleep" or "we lost her" — young children can take these literally and develop fears about sleeping, or guilt about having misplaced someone.¹⁵

Include children in the dying process if they want to be included. Let them visit the bedside. Let them read Grandma a story. Let them bring a drawing. Let them help in small ways — fetching water, straightening the blanket, singing. These are not traumas. These are the memories, years from now, that your children will thank you for. We explore children's grief more deeply in Chapter 30.

Preparing the Dying Person

This is the part many families find hardest: the dying person is often more ready to talk about their dying than the family is. Many dying persons long for permission to speak plainly about what is happening — and they wait for someone to give them that permission. Often, no one does. The family, aching, keeps changing the subject. And the dying person dies with things still locked inside them that they wanted to say.

Give them permission. Ask gentle questions. "Dad, what are you thinking about these days?" "Mom, what are you afraid of, if anything? What gives you peace?" "Is there anyone you want to see? Is there anyone you want to write to?" "Is there anything you want me to do after you're gone?" "Are there things you want to say to any of us?"

Many dying persons — when given the opening — will want to do a life review. They will want to tell the stories of their childhood one more time. They will want to talk about the war, about their first job, about the day they met their spouse, about the time they almost failed out of college, about the sermon that changed them, about the thing they most regret. Receive all of it. Write it down if you can. These are holy hours. Your grandchildren, a decade from now, will read what you wrote and meet a grandparent they never got to know. That is a legacy built in the dying weeks.

Many dying persons also want — plainly, without embellishment — to hear that it is okay to go. They may be tired. They may feel they are a burden. They may be afraid of the dying itself but ready, in their spirit, to be gone. They need to know you will be okay, that you will take care of one another, and that you will not be devastated by their departure. Of course you will be devastated. Tell them anyway. Tell them you will miss them and that you will also be all right. That is one of the last great gifts you can give.

Caring for the Caregiver

Now a word to you, primary caregiver. I need you to hear this because almost no one else will say it to you with sufficient directness.

You are dying too. Not physically. But you are pouring out your life for the sake of another life. You are losing sleep you cannot afford to lose. You are neglecting your own body. You are eating whatever is nearest. You are crying in the car on the way to the grocery store. You are snapping at your children. You are not praying. You feel guilty about all of this, and the guilt only makes it worse.

Hear me: this is not sustainable, and it is not holy. Scripture commands rest. Jesus himself withdrew, often, to lonely places — even in the middle of a ministry of urgent need (Luke 5:16). The Sabbath is not an optional extra for the strong. It is a gift for the weary, and there is no one wearier than the primary caregiver of a dying loved one.¹⁶

So eat real food. Sleep when you can. Step outside at least once a day and feel the sun. Accept every offer of help. Arrange respite care so you can have two or three hours a week that are yours. Find a friend or a counselor or a pastor who is caring for you during this time. Pray the Psalms, even when you cannot pray your own prayers. Lean on the Body of Christ. If there is not yet a community around you carrying you, ask your church. If your church is small or absent, ask GriefShare or a local hospice chaplaincy — they are often glad to help.

And, please: remember you are a creature. You are finite. You are dust that God has breathed into (Genesis 2:7). You are loving a dying person in a fallen world, and you are not infinite. You cannot be everywhere, do everything, or feel the right thing every moment. You are going to fail at some of this. You will lose your temper. You will wish it were over. You will miss a visit. You will say the wrong thing. Forgive yourself. Confess it. Receive grace. And keep going.

One more specific word. Many caregivers develop what the literature calls compassion fatigue — a numb flatness that descends as the months of caregiving stretch on. You may feel less, rather than more, as the dying deepens. You may feel guilty that the tears do not come as easily as they did at the beginning. This is not a sign that you have stopped loving. It is a sign that your nervous system is protecting itself from a load it was never designed to carry alone. The remedy is not to try to feel more. The remedy is to rest more, to share the load more, to let others carry what you cannot. Grief will find you again when there is room for it. For now, your job is to keep walking. Love in the dying weeks often looks less like dramatic tenderness and more like simply staying.

When the Dying Person is Not a Believer

Some readers are walking someone they love toward the end — and their loved one has never professed faith in Christ. This is its own kind of agony. The grief is layered. You are losing them, and you are also afraid for them. You want to say something, to secure their soul somehow, before it is too late. But you do not know how to say it without making the last weeks terrible.

Let me say several things here. First, you are not the Holy Spirit. Your loved one's eternal state is not finally in your hands. That is not defeatism; that is humility. The One who made your loved one, who has loved them every day of their life, is the One who will receive them. He is better at evangelism than you are.

Second, do not weaponize the dying process for evangelistic pressure. The deathbed is not the time to pick a fight. It is not the time to warn of hell. It is not the time to manipulate a confession out of fear. Those tactics — when they "work" — often leave the family and the dying person with a worse aftermath than they had before. Your faithful, unpressured love in the dying season is itself one of the most beautiful proclamations of the gospel your loved one may receive.

Third, if your loved one welcomes prayer, pray with them. If they welcome Scripture, read it to them. If they welcome conversation about Jesus, have it — simply, without pressure, with the gentleness of Christ. Ask what they think about God. Ask what they are afraid of. Listen more than you speak. Many hardened hearts have softened at the edge of eternity, not because a family member pressed harder, but because someone finally stopped pressing and simply loved.

Fourth — and this is one of the pastoral claims this book stands on — trust the God of postmortem opportunity (we explore this fully in Chapter 13). The real Jesus does not abandon your loved one at the moment of their last breath. The character of God does not suddenly turn cold when the heart monitor goes flat. Your loved one will encounter — either in the dying itself, or in the intermediate state, or at the last judgment — a real, personal Jesus who knows them and loves them. What kept them from faith in this life (the angry father who confused them about the Father in heaven, the hypocritical church that wounded them, the doubts that were never answered, the suffering they never understood) will not stand between them and Him at that meeting. They will meet the real Jesus. They will have a real opportunity to respond to the real Jesus. What they will do with that opportunity only God knows. But the picture of a God who has waited for them their whole life and now meets them, fully, with open arms, is the picture Scripture gives us — and it is grounds for hope that is not the same as certainty, but is also not nothing.¹⁷

Your faithful love is evangelism enough. The rest is between them and God. That is a harder rest to rest in than you would like, but it is real rest, and it is biblical rest.

Dreams, Presences, and Unexpected Gifts

Sometimes in the weeks before a loved one dies, something unexpected happens to a family member. A son dreams of his grandfather — the one who has been dead for twenty years — and in the dream his grandfather seems to be preparing to welcome the dying mother. A daughter feels, suddenly, an unmistakable sense of her dead father's presence in the room where her mother is dying. A wife wakes in the night convinced, somehow, that her dying husband has already "been somewhere" and returned.

These experiences are known in the research literature as after-death communications (ADCs) or sensed presences, and they are far more common than most Christians know. We explore them in detail in Chapters 22 and 23. For now, three brief words.

First: if this happens to you in the anticipatory grief season, you are not crazy. These experiences are reported by huge numbers of grieving and anticipating people, and most of them bring comfort rather than distress.¹⁸

Second: receive them gently. Do not try to force meaning onto them. Do not seek more of them. If they come unsought and bring peace, receive them as a possible grace.

Third: evaluate them carefully. We have a full discernment framework in Chapter 25. Briefly: if an experience brings peace, is consistent with Christian faith, does not contradict Scripture, and does not urge you toward occult practices, it is likely either a dream bearing comfort or a genuine grace. If an experience brings fear, urges against faith, or pushes you toward mediums or séances, it should be treated with caution and brought to your pastor.

A Word to the Husband in the Oncologist's Office

Tom, I want to come back to you, sitting there in the car outside the oncologist's office, gripping the steering wheel. The months ahead are going to be the hardest of your life. I will not pretend otherwise. You will have days you feel like you are drowning. You will have conversations that break you open. You will sit with Marian at three in the morning when she cannot sleep and you cannot sleep and the night will feel very long.

But here is what I want you to hear. You are not alone. Jesus walks this valley with you, the way he walked it with the disciples in Gethsemane, the way he walked it with Lazarus's sisters at the tomb. He does not spare his people from dying. He does walk with them through it. He is walking with you and with Marian right now.

The Church is for this. If your church has been quiet or awkward, speak up. Ask for help. Ask a friend to organize meals. Ask your pastor to come sit with you. Ask someone to pray over the house. The Christians around you may not know how to start. Let them know it is okay to start.

And, Tom — listen carefully — some of the most precious conversations of your marriage are still ahead of you. Marian is not yet departed. She is not lost. She is not even, strictly speaking, dying right this minute. She is alive, here, still in reach. The diagnosis has stolen the future, not the present. Take the present while it is yours. Tell her everything you have ever wanted to tell her. Thank her. Ask her forgiveness where you need to. Let her ask yours. Read Scripture together. Pray together. Sing old hymns together. Look at old photos. Tell her what she has meant to you. Tell her what she has taught you. Tell her, again and again, that you love her.

And when the time is right — when her body is tiring, when she is ready — tell her it is okay to go. Tell her Jesus is waiting. Tell her you will be all right. Say it even though you will not be all right, not for a long time. Say it because it is true that you will be all right, in the end, in the only sense that finally matters: you will see her again. She is not lost to you. She is going ahead of you. That is what the Bible means when it calls the dead in Christ those who have "fallen asleep" — not that they are unconscious, but that their dying is, for a believer, only a sleep from which they awake with their Lord (1 Thessalonians 4:14).¹⁹

The oncologist has given you months, not years. What he has not given you is a timetable for love. Love does not end when the oncology appointments end. It does not end at the hospice bedside. It does not end at the casket. It does not end at the graveside. The relationship you have with Marian was forged by God and will be renewed by God. Every day you have with her now is a day the Lord is giving you. Spend it well. The work ahead is hard and holy. You will be up to it, with His help. You will not be up to it alone.

Do not grip the steering wheel all the way home. Reach for her hand. Hold it. That is where you start.

For Your Reflection

Sit with these questions. There are no right answers. Some you may not be ready to answer. That is fine. Come back to them later if you need to.

1. What face of anticipatory grief is most familiar to you right now — shock, anticipatory mourning, pre-loss depression, ambivalence, or the strange simultaneity of loving and missing at the same time? What does it feel like in your body?

2. What is the most important thing you would say to your loved one if you knew you had one more clear conversation? Have you said it yet? What is stopping you, if you haven't?

3. Is there forgiveness — given or received — that needs to happen between you and your loved one while there is still time?

4. Who in your life is caring for you during this season? If no one, who could you ask?

5. When your loved one dies, what do you want your last weeks with them to have looked like? What can you do this week to move toward that?

6. What part of the dying process frightens you most? What would it mean to bring that specific fear to Jesus?

7. If you believe your loved one is in Christ, what would it mean to let the hope of reunion — not someday vaguely, but in the real conscious presence of Christ in the intermediate state — carry you through these months?

For Pastors and Caregivers

This chapter is as much for you as for the bereaved. Most pastoral visits happen after the death. But the anticipatory grief season is where much of the most important pastoral work is done — often quietly, before a single funeral plan is made. Your presence in this season can shape everything that follows.

Key Pastoral Observations

First, recognize that the anticipatory grief period is a pastoral window of enormous significance. Families in this season are spiritually tender, theologically hungry, and hungry for presence. Do not wait for them to call you. Call them. Visit them. Show up. A pastor who sits unhurriedly at a dying parishioner's home for an hour is doing more pastoral work than a pastor who runs three meetings and answers twenty emails.

Second, notice who is carrying the weight. Identify the primary caregiver early. Often it is the spouse. Sometimes it is one of several adult children — usually the one who lives closest. This person will not ask you for help. You need to offer it proactively. Ask: "What do you need this week? Is there someone I can ask to bring dinner Wednesday? Can I come sit with your mom for two hours Saturday morning so you can go walk somewhere by yourself?"

Third, be aware that the dying person is often ahead of the family. They are often ready — or close to ready — to speak plainly about dying, while the family is still trying to avoid the word. Your gentle presence can make those conversations possible. Sometimes you are the only person in the room whom both the dying and the family trust enough to speak the truth in front of.

What to Say

Here are specific sentences that have landed well. Try them. Change them. Make them your own.

• "I'm not going anywhere. I'll be here whenever you need me. And I'll keep coming whether you call or not."

• "What do you need right now? What do you need from me specifically this week?"

• "What are you hoping to be able to say to [your loved one] before she dies? Would it help to practice saying it with me?"

• To the dying: "What are you thinking about today? What's on your heart?"

• To the dying: "Are you afraid of anything in particular? Can we pray about that specifically?"

• "Your grief has already begun. You are not grieving too early. What you're feeling is real and it is holy."

• "We don't have to have this conversation right now if you don't want to. But we can, whenever you're ready."

What NOT to Say

• "Have faith and God may heal her." He may. But in the middle of a terminal diagnosis, statements like this tend to shame caregivers who find themselves unable to believe for healing — and to lay additional weight on families who are already carrying too much. Pray for healing. Do not suggest that the dying is a failure of faith.

• "Everything happens for a reason." Not now. Not ever at a deathbed. Even if it is true in some deep sense, it is not the word the grieving caregiver needs. The word they need is "I'm so sorry. This is so hard. I'm with you."

• "You just have to trust God." They are trusting God. That is exactly why they called you. Telling them to do the thing they are already trying to do lands as rebuke, not comfort.

• "She's in a better place" — said while she is still dying. This minimizes the weight of the present. It also assumes a spiritual state that you may not know. Better: "She is loved. God is with her. We are walking with her." Wait until she has actually died, and the theological state is established, before speaking of better places.

• "God doesn't give us more than we can handle." Paul says nothing of the sort (1 Corinthians 10:13 speaks of temptation, not suffering). Caregivers often are given more than they can handle. That is why we have a body of Christ — to help carry what is too heavy for one.

Questions to Ask

• To the caregiver: "What is the hardest part of today?"

• "What are you most afraid of?"

• "When did you last eat a real meal? When did you last sleep more than four hours?"

• "What is your loved one saying these days? What have you been hearing?"

• "Is there anything happening in your family right now that you'd like me to help with?"

• To the dying: "What would a good day look like for you this week? Can we arrange that?"

• To the dying: "Is there anything you would like me to pray for specifically?"

Watch-Outs

First, the dying person is often ready before the family is. You may be the bridge. Listen for cues from the dying that they are ready to speak of their dying; listen for cues from the family that they are avoiding it. When the gap is wide, gently and privately invite the family to talk about it.

Second, the caregiver is often exhausted before they admit it. Watch for flat affect, irritability, weight loss, rumpled clothing, and avoidance of eye contact. Do not ask them whether they are okay. Tell them you are worried about them. Then do something concrete — send a meal, organize respite care, call a church member to sit at the bedside.

Third, family conflicts tend to flare. If you sense a dispute brewing — about care, money, where to die, whether to resuscitate — offer to moderate a family conversation. A third party in the room can sometimes do what the family cannot do on its own.

Fourth, watch for caregivers who themselves are becoming clinically depressed or showing signs of complicated grief onset. Early referral to counseling is often better than late. A good Christian counselor or mental health professional is a gift, not a failure of pastoral care.

Fifth, honor the nearing-death awareness language when the dying are speaking it. Model this for the family. When Mom says "the bus is coming," do not react with alarm. Lean in. Say: "Where is the bus going, Mom? Who will be on it?" This is one of the most powerful ministries a pastor can perform — giving the family permission to receive, rather than correct, their loved one's symbolic speech.

Next Steps

Help the family arrange practical support. A meal train is more important than a theological lecture. Respite care — even a few hours a week — can be what keeps the primary caregiver standing. Contact hospice chaplaincy services proactively; they are usually excellent partners. If your church does not yet have a bereavement ministry or a meal ministry, this may be your moment to start one.

Plan for the death. The family will need you in the hours and days after it. Have your next steps worked out in advance. Who will you call? How quickly will you be there? What will you do in the first hour after the death? What passages will you read? How will you begin the funeral planning conversation?

Finally, care for yourself. Pastors who attend many dyings must practice specific restoration disciplines. After a bedside visit, drive home slowly. Pray. Weep if you need to. Eat. Sleep. Debrief with a trusted colleague. You are not a tool that can be used without rest.

For Further Reading

Rob Moll, The Art of Dying: Living Fully into the Life to Come (IVP, 2010). Gentle, theologically serious, pastorally wise. The best short Christian primer on dying well — read it before you need it.

Kathryn Butler, Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care (Crossway, 2019). A Christian trauma surgeon gives families the practical medical framework they need to make wise end-of-life decisions. Indispensable when the hard choices come.

Christopher Kerr with Carine Mardorossian, Death Is But a Dream (Avery, 2020). The hospice physician's summary of his years of research on end-of-life dreams and visions. Not written from a Christian perspective, but the data is fully compatible with Christian hope.

Maggie Callanan and Patricia Kelley, Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying (Bantam, 1997). The classic work on nearing-death awareness. If you read only one book on caring for the dying, this is the one.

Nancy Guthrie, O Love That Will Not Let Me Go: Facing Death with Courageous Confidence in God (Crossway, 2011). Short, devotional, deeply comforting. A collection of reflections on dying from some of the most faithful Christian voices of the last several centuries.

J. Steve Miller, Deathbed Experiences as Evidence for the Afterlife, Volume 1 (Wisdom Creek, 2023). The fullest Christian treatment of the deathbed research. Technical in places but repays the careful reader.