Bottom Line/HEALTH:So let’s talk about children, because that’s really frightening, to talk to your children. What’s your strategy and advice for that?
Hollye Jacobs, R.N.:The irony was that, despite all of my years as a hospice nurse—I did both adult hospice as well as pediatric hospice, so yes, I took care of dying children. I had so many years of experience helping children through very difficult circumstances, whether it was delivering the news of a diagnosis or end-of-life issues. I knew up here what to do, cognitively what to do…but when it came to what was in my heart, I can’t even begin to tell you how emotionally burdensome this experience was for me. I knew how to do it, but the actual doing of it was so difficult and gave me a whole new perspective on the process for talking with children. So I get now how hard it is—and how emotional it is—so acknowledging that is really important. In my book, I outline exactly how to talk to children using developmentally appropriate language, outlining exactly what children know and at what ages. Let me back up for a second. Chapter Two of the book is called, “Children Always Know,” and what I know based on my experience—professionally as a nurse and as a social worker, and now personally as a patient—is that no matter what we think, children always know when things are haywire in a family, whether it’s a diagnosis, a divorce, a job loss—children always know. It’s so important to include them from the beginning of the process throughout the trajectory.
Bottom Line And if you don’t, they’ll be scared anyway.
Jacobs:If you don’t, children are left to their own devices, and what I know for sure is that when children are left alone without accurate information, they have the capacity to create things that are far worse than reality. And, things can always get worse. I know this—even when you’re doing hospice, you think, Well, somebody’s dying. It can’t get any worse than that. Well, it can get worse when a child somehow thinks that he or she was somehow responsible for that, and that’s literally what children will do. Or, in the case of a diagnosis—take a heart attack, for example, or a cardiac disease—children could somehow think that they were responsible. That’s why it’s so important to first acknowledge the fact that children always know…and secondly, engage them in the process. One of the things that can be very helpful is to engage team members to help in the dialogue process.
Bottom Line Who’s a team member?
Jacobs:You could say to your physician, “Listen, I know I need to tell my kids, but I’m terrified and I don’t know how, so is there someone who could help me in this process?” The majority of the time, the doctor’s going to say, “Absolutely, you could talk with the nurse practitioner…you could talk with a social worker…you could talk with a child development specialist. A child psychologist is another person who could help. You could either have a conversation with them to lay everything out. It is comparable to what I do in the book. Or you could even potentially have that person present when you’re having that conversation with your children. There are tools to help and also acknowledge how incredibly difficult this process truly is.
Bottom Line Right, and again, these strategies are not just for breast cancer. It’s any illness. It could be divorce. It could be anything.
Jacobs:It could be a car crash, natural disaster…
Bottom Line Whatever. The neighbor up the street. It is really important, so it’s really valuable to have people who understand and have the skills to talk to kids.

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