Most likely your kids have heard about Elizabeth Edwards' terminal breast cancer and Michael Douglas's advanced (though not necessarily fatal) throat cancer. These parents' frightening stories may come up at the dinner table. If so, use them as a way to launch discussion and action surrounding any of your own loved ones who are very sick or dying. A few ideas:
Discuss how death is a fact of life. Some stats to help you out: In the United States (population: 310 million), one birth happens every seven seconds—and one death every 13 seconds. This year cardiovascular disease (accounting for about a third of all deaths) will kill more than 800,000 Americans and cancer will kill more than 560,000.
Celebrate loved ones' lives. In the September issue of Elle, columnist E. Jean recommends making a scrapbook to help kids learn about the life of their loved one. If grandma can travel, she suggests, put her in the car, drive her to her favorite spots, and record her stories. When her mother-in-law was dying, Chicago mom Natalie Stacker catalogued her documents, including love letters. Grammie's report card was a particularly big hit with Stacker's daughters.
Be honest, up front—and calm. Make sure your grandkids (or any young children who may believe death is temporary) do not think a dying relative will reappear. "For children, 'forever' is a very different thing than for you and me," says clinical psychologist Thomas Merrill. "Say they're not coming back."
Reassure kids. Understandably, children and teens may be even more upset by the death of a relative who is close to their parents' age. After all, they may logically conclude that mom and dad could be next. "You want to make sure they don't generalize it to, 'your time is tomorrow' — waking up and their parents are gone," says Merrill. Encourage kids to share their feelings, which can include anger, grief, sadness, and confusion. For more information, see the American Academy of Pediatrics' "Helping Children Cope with Death."
Consider a child's age. Preschool children may see death as reversible, whereas 5- to 9-year-olds typically understand it's not — though they often don't think it will happen to them or anyone they know. Teens often feel guilty ("I should have told my father that I loved him when I had the chance"), according to the American Academy of Pediatrics. And they may be angry at God or doctors (for allowing a loved one to get so sick and being unable to prevent it). The Adolescent Life Change Event Scale ranks a parent's death as the top cause of adolescent stress.
Think about the loved ones' age, too. "An 85-year-old grandparent who's ill and dying [is] very different from a 45-year-old uncle," says psychologist Marsha Levy-Warren, author of The Adolescent Journey. "One feels more immediately threatening in terms of the age of the parents." An elderly grandma "feels much more removed," she says. "There's an assumption based on intellectual understanding that people who are elderly are likely to pass away sooner than someone who's your parents' age or your sister or brother's age."
Make sure your kids know you're taking steps to stay healthy yourself. If a 45-year-old aunt with the hereditary BRCA-I breast cancer is dying, explain that you're getting genetic testing and frequent mammograms to greatly reduce the odds that you will suffer the same fate. You might even say, "I get examined x number of times a year," says Levy-Warren. "The idea is basically to say, 'I'm taking care of it.'"
Watch for changes in behavior. Teens may express their grief by acting out (or being "perfect"), by turning to substances to numb their pain, or by eating too much or too little, according to the AAP. Some kids may be reluctant to go to school. "They're afraid their parents will die while they're gone," says clinical social worker Bobbie Sandoz-Merrill, co-author of Settle for More.
Listen to songs about dying. The best provoke emotions and discussion. Some famous ones: Bob Dylan's "Knockin' on Heaven's Door" (covered by Guns N Roses and Avril Lavigne, among others), "We'll Meet Again" ("We'll meet again. Don't know where. Don't know when."), "Far Side Banks of Jordan" ("My one regret is leaving you behind"), Johnny Cash's recording of "Corinthinians, 15:55" and "Ain't No Grave (Gonna Hold This Body Down"), Neil Diamond's "Done to Soon," and the spiritual "Swing Lo, Sweet Chariot" ("Comin' for to carry me home"). When singer Warren Zevon was sick with inoperable cancer, he recorded his death-themed final album, The Wind, with "Keep Me in Your Heart" ("Shadows are falling, and I'm running out of breath. Keep me in your heart for a while…"). For more songs about death, click here.
Factor in faith. Religions vary when it comes to what happens after death. Whatever your belief system, stress to kids that loved ones "lived a good life and will be in our hearts forever, even though their bodies are gone," says psychologist Marcella Weiner, co-author of Psychotherapy and Religion. "They were loved. As they're sick and dying, we can be with them, wish them well, know wherever they go, they have lived a good life — even if it's a short life." Depending on your faith, you may explain to kids that a loved one may survive in a new form. Muslims, who strongly believe in life after death, think this life is a trial to prepare for the next one. Jewish people do not always interpret the Torah the same way. Some think no afterlife exists whereas others think virtuous people are reunited with their ancestors. Christians believe in an afterlife. (According to Corinthians, "For we know that if the earthly tent which is our house is torn down, we have a building from God, a house not made with hands, eternal in the heavens.") Stacker explains that when her daughters were younger, this faith made accepting death easier: "Great Grammie went to heaven with Jesus."
Seek help from a professional. Not everyone needs it, but know that good psychologists, psychiatrists and clinical social workers can help. For information, see sites for the American Psychological Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the National Association of Social Workers.
Talk about loved ones' wishes. It may seem awkward, but you want to honor your relative's desires. Where does grandma want to be buried? What kind of service would she like? Who should get which of her special treasures? Would she want to be on life support? A serious illness is a wakeup call for you (not just your loved one) to write (or rewrite) a will — and name a person who would make choices for you if you become incapacitated.
Stress the positive. It's frightening and sad when someone is gravely ill. But resist the urge to become too morbid about grandma's health. Instead, advises Levy-Warren, say, "We're fortunate we've had her as long as we've had her."