“Right now, there is quite likely to be a conversation you are trying to avoid,” writes Kathryn Mannix in her new book Listen: How to Find the Words for Tender Conversations, a follow-up to With the End in Mind, her moving and bestselling exploration of how to die well. “We all have moments when words fail us,” she explains. “This book is an invitation to notice and expand the skills we all possess.”
Using her wide experience as a consultant specialising in palliative care, an area where good communication is paramount, Mannix examines why we may shy away from broaching certain topics with our loved ones, what tools we can use to make those conversations easier to have, and the stumbling blocks we all may encounter along the way. While the author’s background means that the end of life features strongly in this book, it is by no means exclusively about palliative medicine, and it takes the reader through a broad range of situations from adoption to sexuality, from the death of a child in early pregnancy to growing old. Mannix uses real scenarios, from her personal and professional life, to illustrate her theory, and as a result, wisdom, grace and humility shine from every page.
Avoiding the words “difficult” and “challenging”, Mannix prefers to describe the conversations we may try to avoid as “tender”. Tender is a much better adjective, she explains, because it describes a situation where distress may be nearby, but where we do our utmost to minimise the risk of experiencing pain. As medical students, we are taught repeatedly how to palpate a tender abdomen, gently and with great care, always watching the patient’s expression as our cue to continue. Negotiating a tender conversation, however, is usually taught less thoroughly, she goes on to tell the reader. Breaking bad news becomes a series of bullet points: set the scene, check how much the patient knows, fire a warning shot (“I’m sorry, Mrs Jones, but I have some bad news”). While these rules may provide the foundation for a tender conversation, they allow neither for the nuances of the situation nor the needs of either the giver or the receiver, and sticking to them could have dramatic consequences, as we discover at the very beginning of this book in a story that starts with a punch in the face.
Rather than bullet points, a conversation should be more like a dance, Mannix explains – an analogy she returns to many times during the course of the book. “The conversation, like a dance, requires participants to join in and take turns.” One person may lead, she says, but never forces, while the other follows but is never pressured. Conversations, like dances, need practice, and she recommends that after every second question we stop to make sure we have got the steps right. Question, question, check. Question, question, check. Like the 3/4 timing of a waltz.
There are many (many) self-help books out there, but to put Mannix’s words into that category would be doing them a disservice. Listen goes further than a self-help book. It is more of a self-awareness book. A book that enables and empowers, a book that helps us to discover the tools we already possess and allows us to put them to good use. Rather than being told the best way to live our lives, reading through these pages feels more like having a long and rewarding conversation with a really good friend.
Perhaps the most important component in all of the chapters, however, is the telling of stories – not least because it is storytelling that helps us to understand ourselves, and others, so much better. As with Mannix’s first book, there are many moving tales within these pages. Jim, a man in end-of-life care, who needed to rediscover the dignity in washing and shaving himself before he felt ready to die. Mannix’s own widowed uncle, who still set a place at the dinner table for his wife, long after she had passed away, not through denial but because it made perfect sense to him. The most moving story of all, though, comes from Mannix herself when, as a very junior doctor, she found herself in the room of a terminally ill woman. “Am I going to die?” the woman asked her. I have been that doctor, too. Overwhelmed. Unsure of the words. Desperate to fix and smooth, and make good. ‘“Of course not!” Mannix replied, breezily. “Of course not!” A response she regrets to this day. If I could go back to that room, Mannix reflects, what would I tell myself? “We limp to wisdom over the hot coals of our mistakes,” she writes. “Bind your feet, now, and keep walking.”
This wise, gentle and profound book will not only help us to keep walking. It will teach us how to dance.
• Listen: How to Find the Words for Tender Conversations by Kathryn Mannix is published by HarperCollins (£16.99). To support the Guardian and the Observer buy a copy at guardianbookshop.com. Delivery charges may apply.