Help With A Critical Endeavor: Providing Meaningful Comfort to the Sick and Dying

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I have been fortunate to connect with Abigail Johnston, a dynamic woman who has selected a title for her blog that’s a perfect description of her and her mission: “No Half Measures: Living Out Loud With Metastatic Breast Cancer.”

Faced with a daunting diagnosis that could crush many of us, Abigail has instead seized the time she has to become a patient advocate and educator. While she’s unsparing in her descriptions of her own and others’ ordeals–often worsened by bureaucratic entanglements and seemingly uncaring (possibly burned-out) professionals–her posts are marked by humor, a sense of the absurd, compassion, and practical suggestions. They are life-affirming.

I am pasting her most recent post, “Ring Theory,” below because its approach to communicating with seriously ill people–and their loved ones–provides information that I think we all need. And, when we eventually find ourselves in the center of the ring, I believe we will all hope that those around us are similarly well-informed.

Ring Theory

[From the blog No Half Measures: Living Out Loud With Metastatic Breast Cancer, by Abigail Johnston.]

I ran across this theory early on in my experience with Stage IV Metastatic Breast Cancer and it really resonated with me. The longer I’ve lived with the disease, the more it resonates with me. While I’m horrible at asking for help and often overestimate what I can handle, the kindness of some family and friends has driven home how important this idea really is.

Actually it’s probably more the actions of some family and friends who have not shown kindness that has really driven home how important this concept is to those of us who are dealing with a health crisis.

I’ve included a link below to the full explanation of the theory, but here are the basic tenets, paraphrased from Silk and Goodman:

1. Draw a circle. In this circle, write the name of the person at the center of the Health crisis.
2. Now draw a larger circle around the first one. In this ring, put the name of the person next closest to the crisis.
3. In each larger ring, put the next closest people. As Silk and Goodman state, “Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones. . . When you are done, you have a Kvetching Order.

A pictorial representation may help:


The basic idea is that the person in the middle does not receive the venting/kvetching from outer circles, especially when said venting is about the person in need of help.

For example, if you are a family member of a terminally ill patient who spends the night in the hospital with your dying family member, you don’t then get to complain to that dying family member about how that night away from your family was stressful for you or how others in the family did or didn’t communicate nicely when arranging for someone to spend the night.


This theory takes into consideration that the person who is dying is carrying a much heavier psychological load than anyone else and that close family is affected more than distant relatives or acquaintances.

In essence, this theory is how to demonstrate love in a clear and understandable way. Violating this idea creates more and more angst and damage to the person who is already carrying more than a healthy person ever could understand.

Why would someone who loves a dying person want to cause further damage?

Here’s an article that lays out the ring theory in much more detail for anyone who is interested in learning more.


I hope after you’ve read Abigail’s post, You’ll also read the Psychology Today article about the Ring Theory to which she links, and the original LA Times Op-Ed by the authors, Silk and Goodman. The Psychology Today article includes some practical suggestions that are extremely helpful.

Please don’t let yourselves be put off by the rough-hewn drawing; this material is more than worth the few minutes it will take you to read through it all.





24 thoughts on “Help With A Critical Endeavor: Providing Meaningful Comfort to the Sick and Dying

  1. Annie, and Abigail, thankyou for this. A wonderful concept in dealing with somebody close with a severe, life-threatening illness. We dealt with this with our daughter and her lymphoma–happily, she’s been found to be all clear after her treatment (though she has years of follow-up to go.

    Liked by 2 people

    1. You’re most welcome. I was quite impressed by Abigail’s post ( I’m extremely impressed with Abigail!). I’m glad you found it helpful—and hope your daughter’s “all clear” continues forever.


  2. Great post, it’s so simple but totally makes sense when laid out like that. I guess I’ve seen a lot of great people in action comforting, it never occured to me that someone would complain at a person who was dying???

    Liked by 2 people

    1. I know; seems astonishing. But it’s clearly happening. When I think about it, I know at least one woman whose mother would be likely to do that, from what my friend has told me about her.


  3. What an idea. So simple and so true. Also like the whole ring idea. Will pass it on, and as always, thanks for the insight. Not just a kindness, but a gift.

    Liked by 2 people

    1. You’re welcome—of course thanks go to Abigail. She has a clear voice in articulating what it’s like to be on the health crisis side. Reminds me of dear Caz in that regard (whom I never would have had the pleasure to get to know if you hadn’t led me to her).

      Liked by 1 person

  4. I’m all for not complaining to the sick person specifically about the burden they’re placing on you, but I also know that if I were sick, I wouldn’t want people to hide their real emotions around me.

    Liked by 2 people

    1. I think it might depend on how they express their emotions. If they’re sad and teary, that’s one thing; if they’re resentful of the time and effort they’re expending to see you, and they let you know that, I would hope that I’d be able to tell them how unwelcome their visit is. Or would you still want unvarnished honesty under those circumstances?

      Liked by 1 person

      1. I prefer honesty anyway! If they resent me for having to be there then I don’t want them to be there. If they just came to see me, like, once a month or something, then they’re gonna get a dressing down for complaining, because once a month is NOT a burden…
        If they are like, “I’m so sad you’re going to die!” and start crying, well, that’s fine and normal. Maybe they don’t have to visit every DAY and do that… hahaha.
        I guess it depends. I would appreciate knowing how they feel about things, but I wouldn’t want to have to endure constant self-pitying harangues either. Having to die is distressing enough, so we could at least try and squeeze some laughs into that last bit of time left.

        Liked by 1 person

    1. I don’t know if you saw my response to Darnell, but Abigail inspires me in many of the same ways you do. Grit, humor, honesty, practical approaches and insights…I think you’re both extraordinary women!
      Annie xx

      Liked by 1 person

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