Welcome back to our corner booth. Hope you’re getting the chill out of your bones with that beautiful afternoon sun streaming onto your shoulders. I’ve got a fresh pot of Earl Grey today to warm up a topic that has frozen me with a sense of impossibility – how to deal with relationships we leave unresolved and how to feel we’ll be fondly remembered.
I’ve asked dozens of people why they find death so frightening. “I’m leaving too many broken relationships, too much undone business,” an 80-year-old friend told me. Yet, when I asked my mother in her final weeks, joyful tears filled her eyes as she reflected on a life that felt to her full and complete. Among her last words, she said, “I’ve had the best possible life.” I knew this to be true of a woman who had developed deep and meaningful relationships and cleared up past grievances.
The Weight of Words Unsaid
How many times have you thought, “I wish I had a better relationship with my brother, my ex-wife, my son/daughter, my friend from high school, my ___(fill in the blank).” What sparked the rift? For my friend Josh it was, “We let a silly inheritance dispute tear us apart.”
A groundbreaking 2022 study in the Journal of Palliative Medicine surveyed 2,000 hospice patients and found that relationship regrets dominated their end-of-life concerns. The research revealed that 83% of terminally ill patients expressed regret about at least one damaged relationship they hadn’t attempted to repair. Even more striking, 67% said they wished they had reached out to estranged family members sooner, and 91% believed their quality of life would have been better if they had maintained closer family connections.
As one hospice nurse told me, “I’ve never heard anyone say they wish they’d stayed angry longer.”
The Science of Estrangement
Recent research from the University of Cambridge’s Centre for Family Research has shed light on family estrangement, finding that it affects at least 1 in 5 families in the United States. The study found that the most common triggers included value conflicts, emotional abuse, traumatic family events, inheritance or money disputes, and divorce and remarriage complications.
Dr. Karl Pillemer’s Cornell Legacy Project, which interviewed over 1,500 people aged 65 and older, found that resolving family conflicts was the most commonly cited “life lesson” participants wished to pass on to younger generations.
The Barriers We Build
When I think about my own unresolved fissures, I’m aware that I feel they can’t be overcome out of a sense of fear of rejection or shame. Dr. Sarah Mitchell, a grief counselor I interviewed, explained that our reluctance often stems from what she calls the “triple threat” of reconciliation:
Fear of vulnerability
Pride and the need to be “right”
The comfort of familiar pain versus the uncertainty of change
Breaking Down the Walls
Dr. Ira Byock, a palliative care physician and author of “The Four Things That Matter Most,” suggests four simple phrases that can heal most relationships: “Please forgive me,” “I forgive you,” “Thank you,” and “I love you.” These words might seem basic, but they carry the weight of mountains. They acknowledge both harm and humanity, both mistakes and meaning.
Let me share Maria’s story. She hadn’t spoken to her father in 15 years after he missed her wedding due to his alcoholism. When she learned he was dying of liver cancer, she visited him in hospice. “I started with ‘thank you,’” she told me. “Thank you for teaching me to ride a bike, for working two jobs to put me through college, for loving me even when you couldn’t show it right. That opened the door to everything else we needed to say.”
Family therapist Dr. Katherine Schafler recommends starting with small gestures - a card, a text, an invitation for coffee. Begin with “I” statements: “I miss our friendship” rather than “You never call.”
Here are some practical steps I’ve gathered from various experts and personal experiences:
Start with yourself. Write a letter you don’t send, exploring your feelings and responsibility in the rift. Understanding your own part in the conflict is crucial for genuine reconciliation.
Set realistic expectations. Not every relationship can or should be fully restored, but even small improvements can bring peace. A study in the Journal of Social Psychology found that even minimal contact, if positive, can significantly reduce end-of-life regrets.
Choose the right medium. Some conversations need to happen face-to-face, while others might be better started through writing. Trust your instincts about what would work best for your situation.
Consider timing. Major holidays or family events might not be the best times for difficult conversations. Choose a neutral time when both parties can focus on the discussion.
Getting Help Along the Way
Sometimes we need professional help to navigate these waters. Consider professional mediation or counseling for complex family disputes. You can find counselors who specialize in almost everything else imaginable. The American Association for Marriage and Family Therapy (www.aamft.org) offers a therapist finder tool to locate qualified professionals in your area.
Research from the American Psychological Association shows that professional mediation has a 70% success rate in helping family members reconcile long-standing conflicts. Even more encouraging, 85% of those who reconciled reported maintaining positive relationships two years later.
When Reconciliation Isn’t Possible
I have a friend who, after a decade of being best buddies, suddenly emailed that she just couldn’t be friends anymore. She explained that this was not because of me but because of where she was in her life. Nonetheless, I felt almost as much pain as having a close relative die. I couldn’t imagine this had nothing to do with me, my personality. It felt so unresolved, even after, in a final phone call, wherein I apologized for whatever I had done to bring on the fissure and said I’d be happy to change, she reiterated that we had to stop talking.
Despite my best efforts, my friend wasn’t willing or able to engage in reconciliation. The advice I’ve found to bring some measure of peace is this:
Forgiving unilaterally, without expecting or requiring a response
Writing a letter expressing your feelings, even if you never send it
Working with a therapist to find closure within yourself
Creating a ritual of release to help you let go
Tom, a retired teacher I interviewed, shared that to find peace in dealing with an estranged son who simply wouldn’t engage, he wrote a card every year on his son’s birthday that told about his life, regrets, and hopes for him. He never sent these so his son wouldn’t feel guilt or shame or obligation. They simply made Tom feel better.
A Gift to the Living
Each relationship we heal creates ripples that extend far beyond us. A fascinating study in the Journal of Positive Psychology found that witnessing family reconciliation had significant positive effects on the mental health of extended family members, particularly children and grandchildren. One blog I read shared, “When my sister and I made peace after 20 years, our kids started talking again too. Now holidays are actually happy.”
Building New Bonds: Beyond Family and Friends
Sometimes we focus so intensely on repairing old relationships that we forget the profound impact of creating new ones. A 2023 study in the Journal of Gerontology found that seniors who developed new social connections in their final years reported significantly higher life satisfaction than those who focused solely on existing relationships.
The famed sex therapist Dr. Ruth was famous for having a sizeable number of “chosen family” – people she cared deeply about and who cared about her. She had a calendar in which people could sign up for regular or just one-off meet ups. She sent cards on dates of important events in their lives and always was there for them when they needed her.
I, too, have created “chosen family”. These are a few “adopted” kids in their 30’s and 40’s who, gratefully, I’ve met them through my daughter. We talk to and text and (the ones close by) see each other regularly. Our conversations are deep and meaningful. I help them financially when they are in a fix – car or house loans and in one instance a monthly stipend for a year to get through a financial crisis.
Other friends have volunteered at schools or libraries or nursing homes. One friend shared, “The kids I read to once a week have become my surrogate grandchildren. Their hugs and drawings mean the world to me.” And I’ll bet her love means a lot to them. Yet others have mentored young professionals in their field.
Consider these ways to build meaningful new connections:
Volunteer at organizations aligned with your values
Join community groups or classes
Mentor others in your professional field
Participate in intergenerational programs
Share your life stories through local history projects
Supporting the Isolated: A Sacred Trust
One of the most heartbreaking realities I’ve encountered in my medical career is the number of people who die alone. A recent study from the National Institute on Aging estimates that 27% of Americans over 75 are socially isolated. Some have outlived their social circle, others struggled with relationships due to mental health issues or difficult personalities, and some simply preferred solitude until it became loneliness.
Maria Gonzalez, a hospice social worker I interviewed, shared a powerful perspective: “When someone dies alone, it diminishes all of us. But when we step in to provide companionship and dignity at the end, we affirm our shared humanity.”
Here are ways to support those who lack close connections:
Volunteer with hospice as a companion visitor
Join “No One Dies Alone” programs at local hospitals
Participate in “Friendly Visitor” programs through senior centers
Help record life stories or memories for those who want to leave a record
Assist with practical needs like organizing photos or writing letters
TAKE HOMES: Improving your outlook towards impending death, whether it be a month away or decades in the future, begins with healing relationships. Start now, with small steps. Remember that perfection isn’t the goal – progress is. And know that every effort you make toward reconciliation, whether successful or not, is an act of courage. A lifetime of connections will enhance your quality of life, whether those relationships are with loved ones or with adopted family or with strangers you reach out to and give your love.
Join the conversation. I look forward to hearing your thoughts in the comments. Have you experienced a meaningful reconciliation? What worked for you? And don’t forget to visit Fully Informed Conversations (https://www.fullyinformedconversations.org/)
Livingly yours,
Roberta Ness, MD, MPH